Predictors of outcome in patients with de novo diagnosis of heart failure with reduced ejection fraction: Role of combined myocardial and lung Iodine-123 Meta-Iodobenzylguanidine imaging

Silverio, Angelo; Polito, Maria Vincenza; Pace, Leonardo; D'Auria, F; Vitulano, Gennaro; Scarano, Massimo; Citro, Rodolfo; Galasso, Gennaro; Piscione, Federico

doi:10.1007/s12350-019-01637-8

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…HFrEF population is characterized by distinct clinical features 7 and a higher risk of SCD and HF rehospitalization than other HF cohorts 8,9 . Thus, HFrEF patients need to be carefully evaluated in order to stratify prognosis and identify higher-risk subjects requiring a close clinical follow-up and frequent drug and dose adjustment 10 . Current HF guidelines recommend a stepwise medical approach based on clinical symptoms, which includes the use of S/V in place of ACE-I or ARBs in ambulatory HFrEF patients who remain symptomatic despite optimal medical treatment 5 .…”

Section: Discussionmentioning

confidence: 99%

“…Normally distributed variables were expressed as mean ± standard deviation (SD) and compared using the Student t test, whereas non-normally distributed ones as median and interquartile range (IQR) and compared with the Mann-Whitney U test. Categorical variables were reported as numbers and percentages and compared using the χ2 or Fisher exact tests, as appropriate 31 . Paired samples t-test was performed to assess changes in continuous echocardiographic data between baseline and 6 months follow-up.…”

Section: Statistical Analysis Distribution Of Continuous Data Was Tementioning

confidence: 99%

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Clinical and echocardiographic benefit of Sacubitril/Valsartan in a real-world population with HF with reduced ejection fraction

Polito

Silverio

Rispoli

et al. 2020

Sci Rep

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The aim of this study was to evaluate the effects of Sacubitril/Valsartan (S/V) on clinical, laboratory and echocardiographic parameters and outcomes in a real-world population with heart failure with reduced ejection fraction (HFrEF). This was a prospective observational study enrolling patients with HFrEF undergoing treatment with S/V. The primary outcome was the composite of cardiac death and HF rehospitalization at 12 months follow-up; secondary outcomes were all-cause death, cardiac death and the occurrence of rehospitalization for worsening HF. The clinical outcome was compared with a retrospective cohort of 90 HFrEF patients treated with standard medical therapy. The study included 90 patients (66.1 ± 11.7 years) treated with S/V. The adjusted regression analysis showed a significantly lower risk for the primary outcome (HR:0.31; 95%CI, 0.11-0.83; p = 0.019) and for HF rehospitalization (HR:0.27; 95%CI, 0.08-0.94; p = 0.039) in S/V patients as compared to the control group. A significant improvement in NYHA class, left ventricular ejection fraction, left ventricular end systolic volume and systolic pulmonary arterial pressure was observed up to 6 months. S/V did not affect negatively renal function and was associated with a significantly lower dose of furosemide dose prescribed at 6-and 12-month follow-up. In this study, S/V reduced the risk of HF rehospitalization and cardiac death at 1 year in patients with HFrEF. S/V improved NYHA class, echocardiographic parameters and need of furosemide, and preserved renal function.Despite the improvements in clinical management and medical therapy of heart failure (HF), the outcome of patients with HF and reduced ejection fraction (HFrEF) remains poor 1 . If compared to the other HF entities, this category shows distinct demographic characteristics, comorbidities, response to therapy, and a substantially higher risk of mortality secondary to sudden cardiac death (SCD) and rehospitalization for worsening HF 2 . Many HFrEF patients are still undertreated and several drugs, such as beta-blockers and ACE inhibitors (ACEi), are under-dosed. This issue is also related to the incorrect risk evaluation by clinicians, who are likely to consider the absence or paucity of symptoms as an indicator of HF stability 3 . In fact, HFrEF is a progressive disorder that, despite the improvement of patient's clinical status achieved with conventional medications, may be associated with a high risk of adverse events at short and long-term follow-up 4 .Current European guidelines 5 recommend the use Sacubitril/Valsartan (S/V), an angiotensin receptorneprilysin inhibitor (ARNI), in replacement of the renin-angiotensin-aldosterone system (RAAS) inhibition in ambulatory HFrEF patients still symptomatic despite optimal medical therapy (OMT). This recommendation comes from a single randomized study named PARADIGM-HF trial 6 , which showed the superiority of S/V compared to Enalapril in reducing the incidence of cardiovascular death or hospitalizations for HF. Few studies have so far investigat...

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Section: Discussionmentioning

confidence: 99%

Section: Statistical Analysis Distribution Of Continuous Data Was Tementioning

confidence: 99%

Clinical and echocardiographic benefit of Sacubitril/Valsartan in a real-world population with HF with reduced ejection fraction

Polito

Silverio

Rispoli

et al. 2020

Sci Rep

Self Cite

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“…HFrEF carries a substantial risk of morbidity and mortality compared to other heart failure population [14][15]. Therefore, management of these patients demands a systematic step-wise medical approach parallel with diligent risk stratification and therapeutic adjustments, where needed [16].…”

Section: Discussionmentioning

confidence: 99%

Effect of Sacubitril/Valsartan on Echocardiographic Parameters and Functional Class in Patients of Heart Failure with Reduced Ejection Fraction

Shah

Shah²,

Khan³

et al. 2022

JPRI

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Background: This study sought to determine, in retrospect, the effect of Sacubitril/Valsartan on the echocardiographic and functional class of ambulatory HFrEF patients taking conventional heart failure therapy. Methods: We conducted a retrospective observational single-center cohort of ninety HFrEF patients with NYHA Class II-III attending as an outpatient at a tertiary cardiac care facility between November 2018 and January 2020. Standardized two-dimensional transthoracic echocardiography and functional class evaluation were conducted at baseline and after 03-month of SV treatment. Results: At 03-month follow-up evaluation, SV treatment was found to contribute substantially in reversing the cardiac remodeling of HFrEF patients as evidenced by improvement in LVEF (28.51±5.06 to 36.01±10.63; p < 0.001), LVEDD (57.29±7.99 to 53.14±8.22; p <0.001), and LVESD (46.07±9.49 to 43.20±9.22; p <0.001). Additionally, an improvement in sPAP (34.13±9.49 to 32.46±8.14; p <0.001) was observed along with a significant NYHA functional class recovery (2.76 to 1.89, p < 0.001). Upon gender-based stratification, the data suggested no gender-based differences in reverse remodeling effects of SV; though statistically insignificant, LA (38.51±8.23 to 37.3±5.92 mm) and RV (27.10±5.74 to 26.42±2.81 mm) diameters were observed to reduce only in men. Conclusion: Our study maintained that earlier commencement of SV in parallel with conventional heart failure therapy results in a significant amount of improvement in LVEF, LVEDD, LVESD, and sPAP in HFrEF patients irrespective of their gender. Simultaneously, SV alleviates the heart failure-related morbidity through rapid functional status (NYHA Class) recovery.

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“…An elevation in cardiac norepinephrine spillover occurs in HF [ 126 , 127 , 128 , 129 , 130 , 131 ], which primarily results from the increase in cardiac norepinephrine synthesis and release, and the decrease in norepinephrine reuptake [ 84 , 132 ]. By 123 I-MIBG with SPECT and PET images, some clinical studies measured the heart-to-mediastinum (H/M) ratio and 123 I-MIBG washout (WO) rate to demonstrate an increased level of sympathetic neurotransmitter in HF [ 133 , 134 , 135 , 136 , 137 ]. Although the above studies indirectly tested norepinephrine release and demonstrated that these measured scientific parameters are strong predictors of cardiac sympathetic overactivation, heart failure progression, life-threatening arrhythmias, and cardiac sudden death in HF, there is limited information available on the direct measurement of norepinephrine release from cardiac sympathetic nerve terminals during HF progression.…”

Section: Remodeling Of Cardiac Postganglionic Sympathetic Neurons And...mentioning

confidence: 99%

Stellate Ganglia and Cardiac Sympathetic Overactivation in Heart Failure

2022

IJMS

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Heart failure (HF) is a major public health problem worldwide, especially coronary heart disease (myocardial infarction)-induced HF with reduced ejection fraction (HFrEF), which accounts for over 50% of all HF cases. An estimated 6 million American adults have HF. As a major feature of HF, cardiac sympathetic overactivation triggers arrhythmias and sudden cardiac death, which accounts for nearly 50–60% of mortality in HF patients. Regulation of cardiac sympathetic activation is highly integrated by the regulatory circuitry at multiple levels, including afferent, central, and efferent components of the sympathetic nervous system. Much evidence, from other investigators and us, has confirmed the afferent and central neural mechanisms causing sympathoexcitation in HF. The stellate ganglion is a peripheral sympathetic ganglion formed by the fusion of the 7th cervical and 1st thoracic sympathetic ganglion. As the efferent component of the sympathetic nervous system, cardiac postganglionic sympathetic neurons located in stellate ganglia provide local neural coordination independent of higher brain centers. Structural and functional impairments of cardiac postganglionic sympathetic neurons can be involved in cardiac sympathetic overactivation in HF because normally, many effects of the cardiac sympathetic nervous system on cardiac function are mediated via neurotransmitters (e.g., norepinephrine) released from cardiac postganglionic sympathetic neurons innervating the heart. This review provides an overview of cardiac sympathetic remodeling in stellate ganglia and potential mechanisms and the role of cardiac sympathetic remodeling in cardiac sympathetic overactivation and arrhythmias in HF. Targeting cardiac sympathetic remodeling in stellate ganglia could be a therapeutic strategy against malignant cardiac arrhythmias in HF.

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Predictors of outcome in patients with de novo diagnosis of heart failure with reduced ejection fraction: Role of combined myocardial and lung Iodine-123 Meta-Iodobenzylguanidine imaging

Cited by 4 publications

References 28 publications

Clinical and echocardiographic benefit of Sacubitril/Valsartan in a real-world population with HF with reduced ejection fraction

Clinical and echocardiographic benefit of Sacubitril/Valsartan in a real-world population with HF with reduced ejection fraction

Effect of Sacubitril/Valsartan on Echocardiographic Parameters and Functional Class in Patients of Heart Failure with Reduced Ejection Fraction

Stellate Ganglia and Cardiac Sympathetic Overactivation in Heart Failure

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