Asymptomatic Heart Failure Patients Research Articles

Serial assessment of cardiothoracic ratio as a predictor of progression from stage B to stage C heart failure in asymptomatic patients with cardiac diseases.

Serial assessment of cardiothoracic ratio as a predictor of progression from stage B to stage C heart failure in asymptomatic patients with cardiac diseases.

Have we been underestimating the burden of heart failure?

Have we been underestimating the burden of heart failure?

Predicting Hospitalization By Tapse/Spap and the Role of Spironolactone in Asymptomatic Heart Failure Patients

Aim: To appraise the prediction of tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (SPAP)with regard to hospitalization and the effect of spironolactone use. Materials & methods: Atotal of 245 patients were evaluated for the study. Patients were followed for 1 year and cardiovascular outcomes were determined. Results: It was determined that TAPSE/SPAP was an independent predictor of hospitalization. A 0.1-mmHg decrease in TAPSE/SPAP was associated with a 9% increase in relative risk. No event was observed above the 0.47 level. Negative correlation with TAPSE (uncoupling) began in the spironolactone group when SPAP was ≥43 and innonusers when SPAP was 38 (Pearson's correlation coefficient: -,731 vs -,383; p<0.001 vs p=0.037). Conclusion: TAPSE/SPAP measurement may be useful in predicting 1-year hospitalization in asymptomatic heart failure patients. This ratio was also found to be higher in patients who used spironolactone.

Renalase – a new instrument in multicomponent heart failure assessment

Heart failure (HF) remains a serious problem in Russian and world health care due to the growing morbidity and mortality from complications of heart failure, despite the development and implementation of programs for the early detection and treatment of heart failure in asymptomatic patients. Currently, a large number of new biological markers have been studied that could serve as a laboratory tool for diagnosing and predicting the course of heart failure, but only brain natriuretic peptides have found application in real clinical practice. Renalase is a recently discovered cytokine that is synthesized by the kidneys and released into the blood. To date, seven subtypes of renalase have been found, each of which plays a different physiological role in the human body. Renalase is usually positioned as a signaling molecule that activates cytoprotective intracellular signals, leading to a decrease in blood pressure and protection of the heart muscle. The concentration of renalase freely circulating in the bloodstream of an adult is approximately 3–5 ng / ml. Currently, the level of renalase is determined by the enzyme immunoassay with a detection range of 3.12 to 200 ng / ml, while the minimum detectable concentration of the marker is less than 1.38 ng / ml. The presence of missense polymorphism of renalase is associated with myocardial dysfunction. Data from animal and human studies have shown that renalase plays a key role in the metabolism of catecholamines and in cardioprotective processes. Studies have shown the contribution of renalase to the occurrence of cardiovascular diseases: ischemic heart disease, arterial hypertension, diabetes mellitus, and aortic stenosis. Moreover, detailed protocols of multicenter prospective studies have demonstrated that functional polymorphism of the renalase gene was associated with myocardial hypertrophy in patients with aortic stenosis, hypertension, metabolic syndrome, unstable angina pectoris and stable forms of coronary artery disease, as well as in patients receiving renal replacement therapy. Based on these data and further studies, renalase has been proposed as a predictive biomarker of ischemia in patients with coronary microvascular dysfunction, as well as a predictor of clinically significant progression of chronic kidney disease in patients with cardiovascular diseases.Our review presents data on the role of renalase in heart failure. Further study of the structure and function of renalase, as well as future clinical studies, will allow determining the diagnostic, prognostic and, possibly, therapeutic significance of this biological marker in HF and other cardiovascular diseases.

Abstract 14315: Invasive versus Conservative Strategy for Stable Coronary Artery Disease in Patients With Asymptomatic Heart Failure With Reduced Ejection Fraction

Introduction: In asymptomatic heart failure patients with reduced ejection fraction (HFrEF), an ischemia evaluation is part of the routine diagnostic work up. Nonetheless, in asymptomatic HFrEF patients with stable ischemic heart disease (SIHD) and intermediate to high-risk findings on nuclear perfusion study, the decision to pursue conservative medical therapy versus an early invasive strategy remains debatable. To address this conundrum, we performed a retrospective analysis. Method: A total of 451 patients with SIHD and HFrEF were followed for at least 16 months. All patients were classified as intermediate to high-risk based on their nuclear stress test results. Patients were subsequently dichotomized into two groups depending on whether they underwent an initial invasive approach versus continuing conservative medical therapy. A multivariable Cox regression analysis was performed to compare the primary outcome of all-cause mortality between the two groups. Results: Patients undergoing an initial invasive strategy were younger (68.3 ± 11.5 vs 71.3 ± 11.8 years, P = 0.001) and more likely to have a prior percutaneous coronary intervention (PCI, 50% ± 25.9% vs. 35% ± 13.6%, P = 0.001) compared to the medical therapy group. On multivariable analysis, after adjusting for demographics and confounding factors, there was no difference in all-cause mortality between the two groups (p= 0.120, Figure ). An older age with a prior history of a PCI or a cerebrovascular accident (CVA) were independent predictors of mortality while a history of never smoking was associated with a mortality benefit. Conclusions: In asymptomatic HFrEF patients with SIHD with intermediate to high-risk findings on nuclear stress testing, an initial invasive strategy has no significant mortality benefit when compared to medical therapy. An older age, history of prior PCI or CVA predicted mortality while never smoking provided a mortality benefit.

Global longitudinal strain predicts clinical disease progression in stable asymptomatic heart failure patients better than left ventricular ejection fraction

Abstract Background Previous studies have shown that left ventricular (LV) global longitudinal strain (GLS) is a feasible and reliable predictor for outcomes in heart failure (HF) patients with greater accuracy than LV ejection fraction (LVEF). However, these studies rarely included stable or asymptomatic patients. Purpose To assess the predictive value of GLS, as compared to LVEF, in asymptomatic stable HF patients. Methods This is a retrospective study, including patients with HF with reduced and mid-range ejection fraction (HFrEF: LVEF&amp;lt;40%; HFmrEF: LVEF 40–49%) in NYHA I with no history of decompensation within the previous 6 months. All patients underwent comprehensive baseline echocardiographic assessment. The primary endpoint was the composite of cardiovascular death, hospitalization and need for intensification of HF treatment within a 12 month follow-up period. Results Out of 837 patients with LVEF &amp;lt;50% that underwent follow-up in our HF unit between January 2016 and December 2017, 153 patients were included in the study. The mean age was 74 (±10.2) years and 82% were male. The cumulative incidence of HF progression was 17.8%, with a median time to event of 193 days. Death and hospitalization due to HF accounted for three-quarters of the events. The mean LVEF was 40.9% (± 6.96),without significant differences between patients with and without clinical progression (39.5% vs 43%, p=0.093). We did not find significant differences between the two groups, concerning LV and atrial dimensions, as well as mitral inflow, PSAP and tricuspid annular systolic plane excursion (TAPSE). LV GLS was significantly lower (i.e. less negative) in patients that presented clinical progression, that in patients without disease progression (−7.7 vs −12.2, p&amp;lt;0.001). Receiver operating characteristic curve and univariate Cox regression analysis identified GLS as the most accurate predictor for clinical progression among all continuous variables (AUC: 0.809, cut-off: −8.5%, sensitivity: 74.1%, specificity: 89%, HR: 14.78 (95% CI: 6.2–35.1), p&amp;lt;0.001). LVEF predicted HF progression less precisely (AUC: 0.654, cut-off: 42%, sensitivity: 70.4%, specificity: 54%, HR: 2.38 (95% CI: 1.1–5.2), p=0.03). Conclusion In asymptomatic stable HF patients (in NYHA I), LV GLS showed to be a more accurate predictor of clinical disease progression than LVEF. Funding Acknowledgement Type of funding sources: None. Global longitudinal strain (GLS)Receiver operating characteristic (ROC)

Lifestyle Modification or Medication to Improve Condition of Patients With Asymptomatic Heart Failure - Monitoring and Management of OptiVol Alert to Reduce Heart Failure Hospitalization II (MOMOTARO II) Study.

In heart failure (HF) patients implanted with high-energy devices, worsening of HF can be diagnosed from intrathoracic impedance (ITI) before symptoms appear. Early therapeutic intervention can prevent HF worsening, but the optimal intervention remains unknown. This study aimed to examine which lifestyle modifications or medications can improve HF indicators in asymptomatic HF patients diagnosed from ITI.Methods and Results:This multicenter, prospective, randomized study included patients with high-energy devices, left ventricular ejection fraction <40%, or with a history of HF hospitalization. After the OptiVol alert was evoked by decreased ITI, patients underwent examinations. If they were diagnosed with HF, they were randomly assigned to 3 groups: lifestyle modification, diuretic, or nitrate. After 1 week, they underwent the same examinations. The primary endpoint was change in ITI and serum B-type natriuretic peptide (BNP). Totally, 57 patients were randomized. In all 3 groups, ITI was significantly increased post-intervention compared with pre-intervention. In the diuretic and nitrate groups, logBNP post-intervention was significantly lower than pre-intervention, but not in the lifestyle modification group. Compared with lifestyle modifications, diuretic and nitrate therapy for 1 week may be more effective management of HF detected by decreased ITI. However, lifestyle modification may have the additional benefits of reducing the workload or cost.

Heart failure and its complications in patients with diabetes: Mounting evidence for a growing burden.

Heart failure (HF) is one of the major challenges in the management of diabetes patients. Among subjects with diabetes, up to 20% could have HF. Conversely, diabetes prevalence in HF patients varies greatly from more than 10% up to 50%. When it is present, the risk of mortality and rehospitalization increases substantially. In addition, current evidence points to an increased risk of atrial fibrillation and sudden cardiac death in patients with diabetes. The inter-relation between diabetes cardiomyopathy, left ventricular hypertrophy, coronary artery disease and renal dysfunction indicates complex and intricate pathways. Despite the great value of clinical assessment and echocardiography, there is insufficient data to suggest systematic screening for HF in asymptomatic patients with diabetes. There is little evidence to indicate that improved glycaemic control improves HF outcome in this population. In the case of established HF, the general guidelines apply in diabetes patients. However, recent advances concerning glucose-lowering treatment in patients with cardiovascular disease suggest that the choice of glucose-lowering agent is of crucial interest and should be based on the patient's phenotype. New drug classes, such as SGLT2 inhibitors, seem to be of particular benefit in these patients. In the future, new personalized strategies should aim at not only good control of the glycaemic level but also the reduction and possibly the prevention of HF onset.

The Benefit of Prophylactic Implantable Cardioverter Defibrillator Implantation in Asymptomatic Heart Failure Patients With a Reduced Ejection Fraction

Recommendations for prophylactic implantable cardioverter defibrillator (ICD) implantation in asymptomatic heart failure patients with a reduced left ventricular ejection fraction (LVEF) differ between guidelines. Evidence on the risk of appropriate device therapy (ADT) and death in New York Heart Association (NYHA) class I patients is scarce. Aim of this study is to evaluate ADT and mortality in NYHA-I primary prevention ICD patients with a LVEF ≤35%. A retrospective cohort was studied, including 572 patients with LVEF ≤35% who received a prophylactic ICD with or without resynchronization therapy (CRT-D). To evaluate the incidence of ADT and mortality, NYHA-I was compared with NYHA-II-III using Cox regression analysis. During a follow-up of 4.1 ± 2.4 years, 33% of the NYHA-I patients received ADT compared with 20% of the NYHA-II-III patients (hazard ratio 1.5, 95% confidence interval 1.04 to 2.31, p = 0.03). No differences in mortality were observed (hazard ratio 0.70, 95% confidence interval 0.49 to 1.07, p = 0.10). Additional analyses showed no difference in time to ADT excluding CRT patients (ICD-NYHA-I patients vs ICD-NYHA-II-III patients, p = 0.17) and comparing ischemic and nonischemic cardiomyopathy NYHA-I patients (p = 0.13). Multivariable Cox regression analyses showed that NYHA class was the strongest independent predictor of ADT. In conclusion, primary prevention NYHA-I ICD patients showed a higher incidence of ADT compared with NYHA-II-III ICD patients. These results strongly suggest that primary prevention NYHA-I patients with a LVEF ≤35% are likely to benefit from ICD therapy and should not be excluded from a potentially life-saving therapy.

Association of Reduced Apical Untwisting With Incident HF in Asymptomatic Patients With HF Risk Factors

ObjectivesThis study investigated the prognostic utility of left ventricular (LV) untwisting (UT) in the elderly patients at risk of heart failure (HF). BackgroundLV UT mechanics represent a unique combination of LV filling linking ventricular relaxation and suction. The value of this parameter in the prediction of outcomes in patients at risk of HF is unclear. MethodsA group of 465 asymptomatic subjects ≥65 years of age with ≥1 HF risk factor (hypertension, diabetes, obesity), recruited from the community, underwent clinical evaluation and echocardiography including measurement of LV apical and basal peak UT velocities. Cox regression analysis was used to identify predictors of new-onset HF and cardiovascular death after a mean follow-up of 18.2 ± 7.5 months. ResultsA composite of both of the study endpoints occurred in 54 patients (11.6%). Adverse outcome was significantly associated with apical (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96 to 0.99; p = 0.006) UT but not with basal (p = 0.18) UT. The prognostic value of apical UT was independent of and incremental to clinical data, as expressed by the ARIC (Atherosclerosis Risk In Communities) study risk score, left atrial volume index (LAVI), and LV global longitudinal strain (GLS). The addition of apical UT to the model including ARIC risk score, LAVI, and GLS was associated with a 41% improvement in reclassification (p = 0.006). ConclusionsEchocardiographic assessment of apical UT provides incremental value in predicting adverse outcome in asymptomatic patients with HF risk factors. The inclusion of apical UT to the diagnostic algorithm may improve the prognostication process in this population.

Depressive symptoms in asymptomatic stage B heart failure with Type II diabetic mellitus.

BackgroundThe presence of concomitant Type II diabetic mellitus (T2DM) and depressive symptoms adversely affects individuals with symptomatic heart failure (HF).HypothesisIn presymptomatic stage B HF, this study hypothesized the presence of greater inflammation and depressive symptoms in T2DM as compared to non‐T2DM Stage B patients.MethodsThis cross‐sectional study examined clinical parameters, inflammatory biomarkers, and depressive symptoms in 349 T2DM and non‐T2DM men with asymptomatic stage B HF (mean age 66.4 years ±10.1; range 30‐91).ResultsFewer diabetic HF patients had left ventricular (LV) systolic dysfunction (P < .05) although more had LV diastolic dysfunction (P < .001). A higher percentage of T2DM HF patients were taking ACE‐inhibitors, beta‐blockers, calcium channel blockers, statins, and diuretics (P values < .05). T2DM HF patients had higher circulating levels of interleukin‐6 (IL‐6) (P < .01), tumor necrosis factor‐alpha (P < .01), and soluble ST2 (sST2) (P < .01) and reported more somatic/affective depressive symptoms (Beck Depression Inventory II) (P < .05) but not cognitive/affective depressive symptoms (P = .20). Among all patients, in a multiple regression analysis predicting presence of somatic/affective depressive symptoms, sST2 (P = .026), IL‐6 (P = .010), B‐type natriuretic peptide (P = .016), and sleep (Pittsburgh Sleep Quality Index [P < .001]) were significant predictors (overall model F = 15.39, P < .001, adjusted R 2 = .207).ConclusionsSomatic/affective but not cognitive/affective depressive symptoms are elevated in asymptomatic HF patients with T2DM patients. Linkages with elevated inflammatory and cardiac relevant biomarkers suggest shared pathophysiological mechanisms among T2DM HF patients with somatic depression, and these conditions are responsive to routine interventions, including behavioral. Copyright © 2019 John Wiley & Sons, Ltd.

How Many Asymptomatic Heart Failure Patients Can Stop Treatment

Not infrequently, individuals with heart failure and reduced ejection fraction (HFrEF) experience a recovery of cardiac function and resolution of

Are patients in heart failure trials representative of primary care populations? A systematic review.

BackgroundGuidelines recommend drug treatment for patients with heart failure with a reduced ejection fraction (HFrEF), however the evidence for benefit in patients with mild disease, such as most in primary care, is uncertain. Importantly, drugs commonly used in heart failure account for one in seven of emergency admissions for adverse drug reactions.AimTo determine to what extent patients included in studies of heart failure treatment with beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and aldosterone antagonists were representative of a typical primary care population with HFrEF in England.Design & settingSystematic review of randomised controlled trials (RCTs) of drug treatment in patients with HFrEF.MethodMEDLINE, MEDLINE In-Process, EMBASE, and CENTRAL were searched from inception to March 2015. The characteristics of the patient’s New York Heart Association (NYHA) classification were compared with a primary care reference population with HFrEF.ResultsOf the 30 studies included, two had incomplete data. None had a close match (defined as ≤10% deviation from reference study) for NYHA class I disease; 5/28 were a close match for NYHA class II; 5/28 for NYHA class III; and 18/28 for NYHA class IV. In general, pre-existing cardiovascular conditions, risk factors, and comorbidities were representative of the reference population.ConclusionPatients recruited to studies typically had more severe heart failure than the reference primary care population. When evidence from sicker patients is generalised to less sick people, there is increased uncertainty about benefit and also a risk of harm from overtreatment. More evidence is needed on the effectiveness of treatment of heart failure in asymptomatic patients with NYHA class I.

O11-3 - Early Administration of Mineralocorticoid Receptor Antagonist Is Useful for Cardiac Reverse Remodeling in Asymptomatic Patients with Dilated Cardiomyopathy

Background: Cardiac reverse remodeling (CRR) is considered to be one of surrogate markers of favorable prognosis in dilated cardiomyopathy (DCM). The administration of mineralocorticoid receptor antagonist (MRA) with ACE inhibitor and beta blocker is recommended to reduce future cardiac events in all symptomatic heart failure patients with reduced ejection fraction. However, little is known about the efficacy of MRA for asymptomatic heart failure patients. We aimed to investigate the association between early administration of MRA and CRR in asymptomatic DCM patients. Methods: We enrolled 74 DCM patients classified as NYHA I in this retrospective cohort study. All patients were divided into two groups; MRA(+) group (n = 33) and MRA(-) group (n = 41). CRR was defined as an absolute increase in left ventricular ejection fraction ≧10% accompanied by a decrease in left ventricular end-diastolic diameter >10% as assessed by echocardiography at 12 months. Results: As for baseline characteristics, the mean of left ventricular ejection fraction and end-diastolic diameter was 36% and 61 mm, respectively. The administration rate of ACE inhibitors/ARBs and was 82% and 81%. Thirty-three (45%) patients were treated with MRA. The rate of CRR was significantly higher in MRA(+) group than in MRA(-) group (58% vs 27%, P = .007). Conclusions: Early administration of MRA is useful for CRR in asymptomatic NYHA I patients with DCM, which may potentially result in a good prognosis.

Association of worsening arterial stiffness with incident heart failure in asymptomatic patients with cardiovascular risk factors.

We investigated the independent and incremental role of worsening arterial stiffness in new-onset heart failure (HF) in patients with preclinical HF. We retrospectively studied 456 consecutive asymptomatic patients with HF risk factors (hypertension, obesity, type 2 diabetes mellitus, atrial fibrillation and ischemic heart disease) who underwent paired applanation tonometry examinations (median interval of 2.4 years) during 2006-2011. Brachial ankle pulse wave velocity (baPWV) was measured as a surrogate marker of arterial stiffness. Patients were followed up for admission for new-onset HF over a median duration of 4.9 years after the second examination. HF was observed in 30 patients (7%). The change in baPWV (∆baPWV) was significantly associated with hospitalization for new-onset HF, independent of and incremental to comorbidities, renal dysfunction, left ventricular (LV) dysfunction and baPWV at baseline. Even in patients with an LV ejection fraction of ⩾40%, ∆baPWV was significantly associated with hospitalization for new-onset HF after similar adjustments. When the patients were divided into groups based on this cutoff value of ⩾15% ∆baPWV and the generally accepted external cutoff value of ⩾1750 cm s-1 for baseline baPWV, the Kaplan-Meier estimates of the time of hospitalization for new-onset HF showed that a higher rate of HF was associated with higher baPWV at baseline and higher ∆baPWV (P=0.00005). In asymptomatic patients with cardiovascular risk factors, the deterioration in arterial stiffness was associated with hospitalization for new-onset HF, independent of and incremental with the clinical LV function and increased stiffness parameters at baseline.

86 Abnormal Left Ventricular Geometry is Prevalent in Asymptomatic Patients with Established Rheumatoid Arthritis Compared with those with Early Disease and Healthy Controls

Background Rheumatoid arthritis (RA) is associated with increased incidence of cardiovascular disease (CVD) and heart failure (HF) compared to the general population. CMR studies in the general population demonstrate that increases in left ventricular (LV) mass and early LV structural changes are predictors of HF in asymptomatic patients. Previous studies have reported conflicting data on LV geometry in heterogeneously sampled RA populations. Objectives To investigate the influence of disease duration on LV geometry using CMR by assessing and comparing two distinct RA populations; a well-defined population of newly diagnosed, treatment-naive RA and an established disease group. Method Seventy-five patients underwent CMR at 3.0T (Philips Achieva TX). None had known CVD or diabetes. 30 were RA patients fulfilling 2010 ACR/EULAR classification criteria, with symptoms for less than 1 year, no therapy with disease modifying anti-rheumatic drugs, disease activity score (DAS28) ≥3.2 and at least one poor RA prognostic factor. They were age-matched with 30 RA patients with disease duration >5 yrs. 15 healthy controls were age-matched. Standard balanced steady state free precession cine images were acquired and LV dimensions calculated offline. Tissue-tagging for strain analysis was acquired using a spatial modulation of magnetization pulse sequence. Results Participant characteristics can be seen in Table 1. Age, sex, blood pressure and body size were not different between the 3 groups. The established RA group had excellent disease control with median (IQR) CRP 0.0 mg/L (5.3) and DAS28 2.0 (1.7). CMR measurements are in Table 2. LV systolic performance, using LVEF and Ecc, was normal and similar in all groups. LV geometry was similar between early RA patients and healthy controls (p-values for LVEDV, LV Mass and LV Mass/LVEDV being 0.19, 0.51 and 0.11 respectively). Indexed LV mass and LV mass/LVEDV were lower in the established RA group compared to the early RA group (Mean±SD, 33 g ± 8/m 2 vs. 43 ± 9 g/m 2 , p Conclusion We compare two distinct RA populations and demonstrate that ventricular systolic performance (LVEF and Ecc) in the RA population is similar to controls of similar age. Abnormal LV geometry (LV mass and LVmass/EDV) is prevalent in asymptomatic patients with established RA. LV remodelling appears to occur despite excellent disease control, with the caveat that this is cross-sectional disease activity. These insights suggest that ventricular remodelling occurs later in RA and that CMR is a sensitive tool to detect such changes. Additional longitudinal evaluation can inform on the impact of inflammation/disease activity over time.

The Role of Gratitude in Spiritual Well-being in Asymptomatic Heart Failure Patients.

Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, p<0.01), less depressed mood (r=-.41, p<0.01), less fatigue (r=-.46, p<0.01), and better self-efficacy to maintain cardiac function (r=.42, p<0.01). Patients expressing more gratitude also had lower levels of inflammatory biomarkers (r=-.17, p<0.05). We further explored relationships among these variables by examining a putative pathway to determine whether spirituality exerts its beneficial effects through gratitude. We found that gratitude fully mediated the relationship between spiritual wellbeing and sleep quality (z=-2.35, SE=.03, p=.02) and also the relationship between spiritual wellbeing and depressed mood (z=-4.00, SE=.075, p<.001). Gratitude also partially mediated the relationships between spiritual wellbeing and fatigue (z=-3.85, SE=.18, p<.001), and between spiritual wellbeing and self-efficacy (z=2.91, SE=.04, p=.003). In sum, we report that gratitude and spiritual wellbeing are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual wellbeing on these endpoints. Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients' lives and be of potential clinical value.

Abnormal left ventricular geometry is prevalent in asymptomatic patients with established rheumatoid arthritis compared with those with early disease and healthy controls

Background Rheumatoid arthritis (RA) is associated with increased incidence of cardiovascular disease (CVD) and heart failure (HF) compared to the general population. CMR studies in the general population demonstrate that increases in left ventricular (LV) mass and early LV structural changes are predictors of HF in asymptomatic patients. Previous studies have reported conflicting data on LV geometry in heterogeneously sampled RA populations. Objectives To investigate the influence of disease duration on LV geometry using CMR by assessing and comparing two distinct RA populations; a well-defined population of newly diagnosed, treatment-naive RA and an established disease group. Method Seventy-five patients underwent CMR at 3.0T (Philips Achieva TX). None had known CVD or diabetes. 30 were RA patients fulfilling 2010 ACR/EULAR classification criteria, with symptoms for less than 1 year, no therapy with disease modifying anti-rheumatic drugs, disease activity score (DAS28) ≥3.2 and at least one poor RA prognostic factor. They were age-matched with 30 RA patients with disease duration >5 yrs. 15 healthy controls were age-matched. Standard balanced steady state free precession cine images were acquired and LV dimensions calculated offline. Tissue-tagging for strain analysis was acquired using a spatial modulation of magnetization pulse sequence. Results Participant characteristics can be seen in Table 1. Age, sex, blood pressure and body size were not different between the 3 groups. The established RA group had excellent disease control with median (IQR) CRP 0.0 mg/L (5.3) and DAS28 2.0 (1.7). CMR measurements are in Table 2. LV systolic performance, using LVEF and Ecc, was normal and similar in all groups. LV geometry was similar between early RA patients and healthy controls (p-values for LVEDV, LV Mass and LV Mass/LVEDV being 0.19, 0.51 and 0.11 respectively). Indexed LV mass and LV mass/LVEDV were lower in the established RA group compared to the early RA group (Mean±SD, 33 g ± 8/m 2 vs. 43 ± 9 g/m 2 , p Conclusion We compare two distinct RA populations and demonstrate that ventricular systolic performance (LVEF and Ecc) in the RA population is similar to controls of similar age. Abnormal LV geometry (LV mass and LVmass/EDV) is prevalent in asymptomatic patients with established RA. LV remodelling appears to occur despite excellent disease control, with the caveat that this is cross-sectional disease activity. These insights suggest that ventricular remodelling occurs later in RA and that CMR is a sensitive tool to detect such changes. Additional longitudinal evaluation can inform on the impact of inflammation/disease activity over time.

Cognitive Function and Self-Care in Patients with Chronic Heart Failure.

Background and ObjectivesThis study examined the association of cognitive function with self-care and major adverse cardiac events (MACE) among heart failure (HF) patients.Subjects and MethodsIn this prospective study, 86 outpatients with HF completed face-to-face interviews including neuropsychological testing to evaluate cognitive function and the use of the Self-Care of Heart Failure Index to measure self-care. Functional status was assessed with the New York Heart Association (NYHA) classification. Follow-up data on MACE were obtained at 24 months after enrollment.ResultsCompared with the Korean norm values, more than half of the HF patients had cognitive deficits in global function (33.0%), immediate recall (65.1%), delayed recall memory (65.1%), and executive function (60.5%). Patients with symptomatic HF (≥NYHA class II) had the higher risk for substantially poor cognitive function in all areas of cognitive function than asymptomatic HF patients (NYHA class I, p<0.05). Most patients demonstrated poor self-care adequacy in maintenance (84.9%), management of symptoms (100%), and confidence (86.0%). After adjustment for age and gender, memory function was significantly associated with self-care confidence (odds ratio 1.41, 95% confidence interval 1.03-1.92, p=0.033). No relationship was found between cognition and self-care maintenance. There were 19 MACE's during the 24-month follow-up. Patients without MACE had a significantly higher global cognitive function (p=0.024), while no cognitive domains were significant predictors of MACE when adjusted for age and gender.ConclusionHF patients with memory loss have poorer self-care confidence. Studies are warranted to examine the functional implication of cognitive deficits and adverse outcomes in a larger sample.

Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients

Depression adversely predicts prognosis in individuals with symptomatic heart failure. In some clinical populations, spiritual wellness is considered to be a protective factor against depressive symptoms. This study examined associations among depressive symptoms, spiritual wellbeing, sleep, fatigue, functional capacity, and inflammatory biomarkers in 132 men and women with asymptomatic stage B heart failure (age 66.5 years ± 10.5). Approximately 32 % of the patients scored ≥10 on the Beck Depression Inventory, indicating potentially clinically relevant depressive symptoms. Multiple regression analysis predicting fewer depressive symptoms included the following significant variables: a lower inflammatory score comprised of disease-relevant biomarkers (p < 0.02), less fatigue (p < 0.001), better sleep (p < 0.04), and more spiritual wellbeing (p < 0.01) (overall model F = 26.6, p < 0.001, adjusted R square = 0.629). Further analyses indicated that the meaning (p < 0.01) and peace (p < 0.01) subscales, but not the faith (p = 0.332) subscale, of spiritual wellbeing were independently associated with fewer depressive symptoms. Interventions aimed at increasing spiritual wellbeing in patients lives, and specifically meaning and peace, may be a potential treatment target for depressive symptoms asymptomatic heart failure.