The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics

Aschauer, Stefan; Kammerlander, Andreas A.; Zotter-Tufaro, Caroline; Ristl, Robin; Pfaffenberger, Stefan; Bachmann, Alina; Duca, Franz; Marzluf, Beatrice A.; Bonderman, Diana; Mascherbauer, Julia

doi:10.1002/ejhf.418

Cited by 121 publications

(131 citation statements)

References 35 publications

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“…In line with recent publications, [29][30][31][32] several parameters were associated with adverse outcome, such as pulmonary arterial pressures, serum NT-proBNP levels, severity of symptoms, and parameters of right ventricular dysfunction. We observed significant correlations of MOLLI-ECV with these clinically important parameters.…”

Section: Correlation Of Extracellular Matrix Accumulation With Variabsupporting

confidence: 85%

Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction

Duca

Kammerlander

Zotter-Tufaro

et al. 2016

Circ: Cardiovascular Imaging

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115

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N early half of all heart failure patients present with normal or near normal systolic left ventricular (LV) function. 1 This condition has been labeled heart failure with preserved ejection fraction (HFpEF).2 The pathophysiology underlying HFpEF is complex and still incompletely understood. Expansion of the extracellular volume (ECV) due to accumulation of extracellular matrix in the interstitial myocardial space is thought to be one of the main pathophysiologic mechanisms underlying LV stiffening in HFpEF.3,4 Despite the central role of ECV in this condition, data on its prognostic relevance are limited. 5 The gold standard for ECV quantification relies on the histological analysis of endomyocardial biopsies retrieved from the LV. This method, however, is invasive and carries significant risks. Our group previously showed that myocardial postcontrast T1 time by cardiac magnetic resonance (CMR) imaging is significantly associated with prognosis and correlates with ECV by histology.5 However, more recently, CMR T1 mapping, using the modified Look-Locker inversion recovery (MOLLI) sequence, has been proposed as the more robust technique, independent of potential confounders such as renal function, heart rate, or time of acquisition.6-10 However, the diagnostic and prognostic power of ECV as measured by the MOLLI technique in HFpEF is unknown.

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Section: Correlation Of Extracellular Matrix Accumulation With Variabsupporting

confidence: 85%

Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction

Duca

Kammerlander

Zotter-Tufaro

et al. 2016

Circ: Cardiovascular Imaging

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115

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“…In non-CKD patients, this disease has been shown to associate with morbidity and mortality equal to HFrEF [7]. It frequently leads to atrial fibrillation, pulmonary hypertension and - ultimately - right heart failure and death [8-13]. Recently, new therapeutic avenues have become available with promising results regarding hemodynamics and renal function [14-16].…”

Section: Introductionmentioning

confidence: 99%

Heart Failure with Preserved and Reduced Ejection Fraction in Hemodialysis Patients: Prevalence, Disease Prediction and Prognosis

Antlanger¹,

Aschauer

Kopecky³

et al. 2017

Kidney Blood Press Res

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1,910

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Background/Aims: Heart failure (HF) is a main cause of mortality of hemodialysis (HD) patients. While HF with reduced ejection fraction (HFrEF) is known to only affect a minority of patients, little is known about the prevalence, associations with clinical characteristics and prognosis of HF with preserved ejection fraction (HFpEF). Methods: We included 105 maintenance HD patients from the Medical University of Vienna into this prospective single-center cohort study and determined the prevalence of HFpEF (per the 2013 criteria of the European Society of Cardiology) and HFrEF (EF <45%), using standardized post-HD transthoracic echocardiography. We also assessed clinical, laboratory and volume status parameters (by bioimpedance spectroscopy). These parameters served to calculate prediction models for both disease entities, while clinical outcomes (frequency of cardiovascular hospitalizations and/or cardiac death) were assessed prospectively over 27±4 months of follow-up. Results: All but 4 patients (96%) had evidence of diastolic dysfunction. 70% of the entire cohort fulfilled HF criteria (81% HFpEF, 19% HFrEF). Age, female sex, body mass index, blood pressure and dialysis vintage were predictive of HFpEF (sensitivity 86%, specificity 63%; AUC 0.87), while age, female sex, NT pro-BNP, history of coronary artery disease and atrial fibrillation were predictive of HFrEF (sensitivity 85%, specificity 90%; AUC 0.95). Compared to patients without HF, those with HFpEF and HFrEF had a higher risk of hospitalization for cardiovascular reason and/or cardiac death (adjusted HR 4.31, 95% CI 0.46-40.03; adjusted HR 3.24, 95% CI 1.08-9.75, respectively). Conclusion: Diastolic dysfunction and HFpEF are highly prevalent in HD patients while HFrEF only affects a minority. Distinct patient-specific characteristics predict diagnosis of either entity with good accuracy.

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“…This has been found in heart failure with preserved function[17] and ST-segment elevation myocardial infarction. [181920] One of the main findings of this study was that there was significant statistical difference between the studied groups regarding the RV systolic function as indicated by S wave velocity measured by pulsed-wave tissue Doppler while TAPSE showed no difference between the four studied group.…”

Section: Discussionmentioning

confidence: 84%

Hypertension and diabetes mellitus: How do they affect the right ventricular functions individually and together?

Eweda

2017

J Cardiovasc Echography

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Context:The right ventricle (RV) is neglected in clinical practice although the RV function is the primary determinant of prognosis and effort tolerance in many groups of patients.Aim:The effects of type two diabetes mellitus and hypertension solitary and together were studied on right ventricular systolic and diastolic function by echo-Doppler and tissue Doppler echocardiography.Settings and Design:A cohort of 300 consecutive patients with echocardiographic right ventricular (RV) diastolic dysfunction as determined by Doppler echocardiography were included in this study.Methods and Material:Patients were divided in four groups, patients who were neither diabetic nor hypertensive, hypertensive patients, diabetic patients and those patients suffering from both hypertension and diabetes mellitus. Parameters of right ventricular systolic and diastolic function were compared.Statistical Analysis Used:Analyses were performed with SPSS version 12.0 statistical package (SPSS Inc., Chicago, IL, USA).Results:There was significant statistical difference between the four groups as regards E wave, E/A ratio and deceleration time measured by Doppler echocardiography. By pulsed wave tissue Doppler, S, E’ and E/E’ showed significant statistical difference between the four groups. All of these parameters were significantly different between the group suffering from both diseases and the group who had neither of them.Conclusions:The combined effect of both, diabetes mellitus and hypertension on right ventricular function is stronger than the effect of one of them alone.

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The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics

Cited by 121 publications

References 35 publications

Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction

Interstitial Fibrosis, Functional Status, and Outcomes in Heart Failure With Preserved Ejection Fraction

Heart Failure with Preserved and Reduced Ejection Fraction in Hemodialysis Patients: Prevalence, Disease Prediction and Prognosis

Hypertension and diabetes mellitus: How do they affect the right ventricular functions individually and together?

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