Prevalence of left ventricular systolic dysfunction in pre‐dialysis and dialysis patients with preserved left ventricular ejection fraction

Hensen, Liselotte C.R.; Goossens, Kathleen; Delgado, Victoria; Abou, Rachid; Rotmans, Joris I.; Jukema, J. Wouter; Bax, Jeroen J.

doi:10.1002/ejhf.1077

Cited by 42 publications

(48 citation statements)

References 23 publications

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“…In the present research, GLS was lower in the CKD patient group than in the control group, although no significant difference was determined between the groups in terms of GCS. The majority of previous studies have involved stage 3-5 CKD, and significant decreases in both GLS and GCS have been shown, particularly toward the final stage [3,21,22]. The median GFR in the present study was approx-imately 43 mL/min/1.73 m 2 , and our patients had predominantly stage 3 CKD.…”

Section: Discussionsupporting

confidence: 49%

“…Longitudinal and circumferential fiber deformation can be assessed using STE [20]. Hensen et al [21] investigated EF in normal patients with stage 3-5 end-stage renal failure and revealed decreased GLS in this patient group, which they associated with a higher risk of heart failure-related hospitalization and mortality. Numerous similar studies have shown preserved EF in CKD and decreased GLS associated with hospitalization and cardiovascular mortality [3].…”

Section: Discussionmentioning

confidence: 99%

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Relationship between Microfibrillar-Associated Protein 4 Levels and Subclinical Myocardial Damage in Chronic Kidney Disease

et al. 2020

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Introduction: Chronic kidney disease (CKD) is a widespread health problem, in which mortality is most frequently due to cardiovascular diseases. Microfibrillar-associated protein 4 (MFAP4) is an extracellular matrix protein. MFAP4 is involved in several biological processes, particularly the maintenance of vascular integrity and extracellular matrix remodeling. Our review of the literature revealed no data concerning MFAP4 levels in CKD and its relationship with myocardial functions. Objective: The purpose of this study was therefore to investigate MFAP4 levels in CKD, parameters affecting these, and the relationship with myocardial functions. Materials and Methods: Seventy-nine CKD patients and 30 healthy controls were included in the study. Routine biochemical tests and echocardiography were performed once demographic data had been recorded. Blood specimens were collected for MFAP4 analysis, and the results were subjected to statistical analysis. Results: MFAP4 levels were significantly higher in the patient group than in the control group (p < 0.001). Doppler parameters revealed more frequent LV diastolic impairment in the patient group. Tissue Doppler systolic velocity and global longitudinal strain were significantly impaired, revealing the subclinical LV systolic dysfunction in CKD patients. MFAP4 elevation in the patient group was positively correlated with aortic root (AR), global circumferential strain (GCS), and GCS rate. Conclusion: Our results showed MFAP4 elevation in CKD for the first time in the literature, and that this elevation may be related to GCS and AR dilation. We think that, once supported by further studies, MFAP4 may constitute a marker in the evaluation of myocardial functions in CKD. Statistical AnalysisNormal distribution of data was assessed using the Kolmogorov-Smirnov test. Comparisons in groups with parametric conditions were performed using Student's t test, and with the Mann Whitney U test in groups without parametric conditions. The χ 2 test was used to analyze demographic data. Pearson's correlation was used for correlation analyses. Age, creatinine, and iPTH levels differing significantly between the patient and control groups at univariate analysis performed to assess parameters affecting MFAP4 levels were then included in the logistic regression model. Data were expressed as means ± SD. Values of p < 0.05 were regarded as statistically significant. All statistical analyses were performed on SPSS 20 software (IBM, Armonk, NY, USA).

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Relationship between Microfibrillar-Associated Protein 4 Levels and Subclinical Myocardial Damage in Chronic Kidney Disease

et al. 2020

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“…The GLS is measured on the basis of the LV longitudinal shortening in systole, and it is an index of systolic function . It may become abnormal at an earlier stage before a decrease in LVEF . GLS has an independent prognostic value in the mid‐range and preserved LVEF group, because of the loss of prognostic value of LVEF in this HF population .…”

Section: Left Ventricular Ejection Fraction Based Classification: Oppmentioning

confidence: 99%

Heart failure with mid‐range ejection fraction: pro and cons of the new classification of Heart Failure by European Society of Cardiology guidelines

et al. 2020

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Currently, the assessment of left ventricular ejection fraction (LVEF) is the cornerstone of the classification of patients with heart failure (HF). The mid-range LVEF (HFmrEF) category was identified in an attempt to uncover specific characteristics of these patients. So far, the analysis of trials, registries, and observational studies have demonstrated that patients with midrange LVEF belong to a patient cohort with generally intermediate clinical profile as compared with other groups but with a remarkable variety of intrinsic phenotypes. This is due to the limitations of LVEF as the sole criterion to categorize patients with HF and characterize their prognosis, above all when it is >40%. To better define the HFmrEF phenotype, it is reasonable to consider other parameters, such as LVEF changes over time, HF aetiology, co-morbidities, and other imaging parameters. A multiparametric evaluation may contextualize a patient with HFmrEF in a more defined phenotype with a specific prognosis.

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“…They include an impairment of the cardiac output and of the skeletal muscle diffusion of oxygen during exercise with a different contribution in each patient with HFpEF. [132][133][134] They may influence exercise capacity and limit the value of cardiopulmonary exercise testing or the 6-min walk test distance for the assessment of the patients with HFpEF. 130 Pulmonary mechanisms leading to an increase in the lung dead space have also been shown.…”

Section: Diagnosis and Prognosis: Role Of Exercise Testing And Cardiamentioning

confidence: 99%

“…131 Cardiac and extracardiac comorbidities have a major role in patients with HFpEF. [132][133][134] They may influence exercise capacity and limit the value of cardiopulmonary exercise testing or the 6-min walk test distance for the assessment of the patients with HFpEF. [135][136][137][138] A flattening oxygen consumption trajectory during exercise has been recently introduced as a new measurement of disease severity and a prognostic determinant and its value was independent from LVEF in a first study.…”

Section: Hf With Preserved Ef Diagnosis and Prognosis: Role Of Exercimentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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Prevalence of left ventricular systolic dysfunction in pre‐dialysis and dialysis patients with preserved left ventricular ejection fraction

Abstract: The prevalence of impaired LV GLS despite preserved LVEF in pre-dialysis and dialysis patients is relatively high. Patients with preserved LVEF but impaired LV GLS have an increased risk of HF hospitalization and all-cause mortality.

Cited by 42 publications

References 23 publications

Relationship between Microfibrillar-Associated Protein 4 Levels and Subclinical Myocardial Damage in Chronic Kidney Disease

Relationship between Microfibrillar-Associated Protein 4 Levels and Subclinical Myocardial Damage in Chronic Kidney Disease

Heart failure with mid‐range ejection fraction: pro and cons of the new classification of Heart Failure by European Society of Cardiology guidelines

Highlights in heart failure

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