Asymptomatic Left Ventricular Dysfunction Research Articles

Diagnostic utility of MR-proANP and NT-proBNP in elderly outpatients with a high risk of heart failure: the Copenhagen heart failure risk study

Background: Amino-terminal-pro-B-type-natriuretic-peptide (NT-proBNP) is a diagnostic biomarker for heart failure (HF), but plasma concentrations are influenced by numerous factors. Mid-regional-pro-atrial-natriuretic-peptide (MR-proANP) have comparable diagnostic value in acute HF. However, data are lacking in the non-acute setting. This study sought to assess the diagnostic utility of MR-proANP in outpatients with a high risk of HF.Methods: This prospective study included 399 outpatients. Inclusion criteria were: age ≥ 60 years, ≥1 risk factor for HF (diabetes, chronic kidney disease, vascular disease, atrial fibrillation, hypertension), without known or suspected HF. Unrecognized HF was diagnosed based on clinical signs, patient-reported symptoms and echocardiography. Plasma concentrations of MR-proANP and NT-proBNP were analysed.Results: In total, 65 patients were diagnosed with HF or asymptomatic left ventricular systolic dysfunction (N = 12 LVEF ≤ 40%, N = 7 LVEF > 40% to ≤50%, N = 46 LVEF > 50%). Both MR-proANP (odds-ratio: 1.77; 95% CI:1.16–2.72; p = 0.009) and NT-proBNP (odds-ratio: 1.49; 95% CI:1.22–1.82; p < 0.001) were associated with HF. Area under receiver-operator characteristics curve (AUC) for the diagnosis of HF or asymptomatic left ventricular systolic dysfunction was higher for MR-proANP (AUC = 0.886; p < 0.001) and NT-proBNP (AUC = 0.910; p < 0.001) compared to patient-reported symptoms of HF (AUC = 0.830), but NT-proBNP added more diagnostic information compared to MR-proANP (p = 0.022).Conclusions: Both NT-proBNP and MR-proANP are useful biomarkers in the diagnosis of HF or asymptomatic left ventricular systolic dysfunction in a non-acute setting. However, NT-proBNP added more diagnostic information compared to MR-proANP.

Personalized Approach to Cancer Treatment-Related Cardiomyopathy.

Cancer treatment-related cardiotoxicity (CTRC) represents a significant cause of morbidity and mortality worldwide. The purpose of our review is to summarize the epidemiology, natural history, and pathophysiology of cardiotoxicity-related to cancer treatment. We also summarize appropriate screening, surveillance, and management of CTRC. While cardiotoxicity is characteristically associated with anthracyclines, HER2-B antagonists, and radiation therapy (XRT), there is growing recognition of toxicity with immune checkpoint inhibitors (ICI), tyrosine kinase inhibitors, and proteasome inhibitors. Patients at risk for cardiotoxicity should be screened based on available guidelines, generally with serial echocardiograms. The role of medical heart failure (HF) therapies is controversial in patients with asymptomatic left ventricular dysfunction but may be considered in some instances. Once symptomatic HF has developed, treatment should be in accordance with ACC/AHA guidelines. The goal in caring for patients receiving cancer treatment is to optimize cardiac function and prevent interruptions in potentially lifesaving cancer treatment.

Sleep apnea Syndrome and cardiac dysfunction: correlations and therapeutic aspects

Almost half of patients with sleep apnea syndrome (SAS) have asymptomatic left ventricular (LV) dysfunction, this incidence may vary depending on the criteria used. Along with metabolic syndrome, dyslipidemia, smoking status and lack of exercise, obstructive sleep apnea increases cardiovascular risk. SAS has a high incidence in patients with high cardiovascular risk profile and asymptomatic left ventricular dysfunction. The first phase of evaluating the cardiac dysfunction in an SAS patient is to identify patients with multiple cardiovascular risk factors who will be asked to answer the Berlin and Epworth Questionnaires. Those patients with high scores and clinical suspicion of SAS should be referred to a clinic for further evaluation. This will include polysomnography and screening echocardiography for all the patients. Patients diagnosed by polysomnography with SAS will perform an ENT examination that assesses the presence of obstructive disorders that may contribute to the onset or worsening of SAS. This examination will also indicate whether the surgery to remove the obstacle will be performed. Where considered appropriate there should be initiated specific therapy with ventilator assistance devices during sleep. Therapy consists in SAS treatment and cardiac treatment as well.

P1265 A home for two: a case of a twin pregnancy complicated by twin-to-twin transfusion in a woman with a repaired total anomalous pulmonary venous connection

Abstract BACKGROUND Total anomalous pulmonary venous connection (TAPVC) is a rare correctable congenital heart lesion. According to the modified World Health Organization classification (mWHO) of maternal cardiovascular risk, pregnant patients with successfully repaired TAPVC are at low cardiovascular risk (mWHO class I), but the risk rises to mWHO class III if left ventricular (LV) impairment and ventricular arrhythmias are present. CASE SUMMARY A 34 years old woman with corrected supracardiac TAPVC, pregnant with a spontaneous monochorionic diamniotic twin pregnancy (TP) complicated by twin-to-twin transfusion syndrome (TTTS) was referred to the cardiologist in preparation for fetoscopic laser coagulation (FLC). She was born with a TAPVC to the innominate vein associated with an atrial septal defect (ASD), repaired at the age of 3 months by anastomosing the PVC to the posterolateral wall of the left atrium and closure of the ASD with a pericardial patch. At follow up a few years later she developed asymptomatic mild LV dysfunction and alternating brady and tachyarrhythmias including non-sustained ventricular tachycardias (NSVT). At 17th weeks of gestation she presented mild dyspnoea (NYHA functional class II) and an alternance of sinus bradycardia, atrial fibrillation and NSVT. 2D echocardiography showed moderate LV dilatation and dysfunction (LVEF 47%). She was treated with loop-diuretics, but refused antiarrhythmic and anticoagulant therapy. At 19th weeks, TTTS was diagnosed and successful FLC of placental anastomoses was carried out. Symptomatic worsening of LV function and functional class developed in the ensuing weeks (NYHA III, LVEF 40%). Induction of foetal lung maturity with maternal administration of steroids was carried out at 28 weeks but stopped because of spontaneous preterm labour. After delivery, the arrhythmic burden increased to the point of requiring admission to the intensive care unit (ICU) where pacemaker implant was indicated, but refused by the patient. Diuretics and ACE-inhibitors were titrated, but no beta-blockers nor other antiarrhythmics could be started due to intermittent av block. At discharge, the patient was asymptomatic at rest and there were no clinical signs of heart failure. At 17 months of follow-up, she was still asymptomatic, though LV function remained poor. The 2 newborns were discharged after a stormy 4 months in the neonatal ICU and are still being treated for bronchopulmonary dysplasia and the sequels of intraventricular haemorrages. DISCUSSION We are not aware of other described twin pregnancies in repaired TAPVC with residual LV dysfunction and arrhythmia. As the haemodynamic load of twin pregnancy is more severe and the twin pregnancy itself at high risk both for prematurity and maternal cardiac deterioration, evaluation by a Specialist Multidisciplinary referral Unit should occur before conception especially in mNYHA class III and higher, as per current guidelines. Abstract P1265 Figure. Image 1

GRACE Risk Skoru ST Yükselmesiz Miyokard İnfarktüsü Sonrası Semptomatik Kalp Yetersizliği Gelişimini Öngörebilir mi?

Objective: The Global Registry of Acute Coronary Events (GRACE) risk score has a prognostic significance in patients with myocardial infarction without ST segment elevation (NSTEMI). In this study, we aimed to evaluate the significance of GRACE score at day 1 in predicting the development of in-hospital symptomatic heart failure (IH-HF) in patients presenting with NSTEMI. Material and Methods: Consecutive patients, admitted with NSTEMI between April 2016-May 2017 were evaluated in this prospective cohort study. A total of 179 patients (112 male, the mean age: 65.4±11.2) with left ventricular ejection fraction (LV-EF) <50% and N-terminal pro Btype natriuretic peptide (NT-proBNP) level >125pg/mL along with Killip Class <II symptoms at admission were included in the study. GRACE score at day 1 was calculated according to original scoring system. During hospitalization period, patients who developed Killip Class (KC) ≥2 symptoms after day 1 to discharge were classified as IH-HF (n=55) and others were classified as NIH-HF (n=124). Results: The morbidity and mortality rates were higher in the IH-HF group. Not only GRACE score at day 1 but also atrial fibrillation (AF), three vessel disease, diabetes mellitus (DM) were found to be independent predictors of IH-HF. According to the ROC analysis, the patients with GRACE score at day 1 > 177.5 were found to be at higher risk for IH-HF development. Conclusion: The development of IH-HF in patients presenting with NSTEMI with asymptomatic left ventricular dysfunction significantly increases the morbidity and mortality rates. High GRACE score at day 1 in NSTEMI patients can be used to predict IH-HF.

Myocardial tissue and metabolism characterization in men with alcohol consumption by cardiovascular magnetic resonance and 11C-acetate PET/CT

BackgroundChronic alcohol consumption initially leads to asymptomatic left ventricular dysfunction, but can result in myocardial impairment and heart failure if ongoing. This study sought to characterize myocardial tissues and oxidative metabolism in asymptomatic subjects with chronic alcohol consumption by quantitative cardiovascular magnetic resonance (CMR) and 11C-acetate positron emission tomography (PET)/computed tomography (CT).MethodsThirty-four male subjects (48.8 ± 9.1 years) with alcohol consumption > 28 g/day for > 10 years and 35 age-matched healthy male subjects (49.5 ± 9.7 years) underwent CMR and 11C-acetate PET/CT. Native and post T1 values and extracellular volume (ECV) from CMR and Kmono and K1 from PET imaging were measured. Quantitative measurements by CMR and PET imaging were compared between subjects with moderate to heavy alcohol consumption and healthy controls, and their correlations were also analyzed.ResultsCompared to healthy controls, subjects with alcohol consumption showed significantly shorter native T1 (1133 ± 65 ms vs. 1186 ± 31 ms, p < 0.001) and post T1 (477 ± 42 ms vs. 501 ± 38 ms, p = 0.008) values, greater ECV (28.2 ± 2.2% vs. 26.9 ± 1.3%, p = 0.003), marginally lower Kmono (57.6 ± 12.1 min− 1 × 10− 3 vs. 63.0 ± 11.7 min− 1 × 10− 3, p = 0.055), and similar K1 (0.82 ± 0.13 min− 1 vs. 0.83 ± 0.15 min− 1, p = 0.548) after adjusting for confounding factors. There were no significant differences in CMR measurements and K1 between subjects with heavy and moderate alcohol consumption (all p > 0.05). In contrast, subjects with heavy alcohol consumption showed significantly lower Kmono values compared to those with moderate alcohol consumption (52.9 ± 12.1 min− 1 × 10− 3 vs. 63.7 ± 9.2 min− 1 × 10− 3, p = 0.012). Strong and moderate correlations were found between K1 and ECV in healthy controls (r = 0.689, p = 0.013) and subjects with moderate alcohol consumption (r = 0.518, p = 0.048), respectively.ConclusionAsymptomatic men with heavy alcohol consumption have detectable structural and metabolic changes in myocardium on CMR and 11C-acetate PET/CT. Compared with quantitative CMR, 11C-acetate PET/CT imaging may be more sensitive for detecting differences in myocardial damage among subjects with moderate to heavy alcohol consumption.

Risk stratifying asymptomatic left ventricular systolic dysfunction in the community: beyond left ventricular ejection fraction.

Midwall fractional shortening (MWFS) is a measure of left ventricular (LV) systolic function that is more reliable in case of concentric LV geometry compared to LV ejection fraction (LVEF). We hypothesized that MWFS might predict heart failure (HF) and death in a high-risk asymptomatic population, beyond other echocardiographic parameters. Among 4047 subjects aged ≥55/≤80 years followed by 10 general practitioners in northern Italy, the DAVID-Berg study prospectively enrolled 623 asymptomatic outpatients at increased risk for HF. Baseline evaluation included clinical visit, electrocardiogram, N-terminal pro-brain natriuretic peptide (NT-proBNP), and echocardiogram. Mean age of the population was 69 ± 7 years, 56% were men, 88% had hypertension, mean LVEF was 61 ± 9%, and mean MWFS 16.2 ± 3.3. During a median follow-up of 5.7 years, 95 subjects experienced HF/death events. At Cox analysis, lower MWFS was the only echocardiographic parameter, among structural/functional ones, associated with higher risk of HF/death [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.84-0.95, Padjusted < 0.001]. The risk of HF/death related to clinical data and NT-proBNP (baseline model) was reclassified by echocardiography only when MWFS was included into the model (baseline C-statistics 0.761; adding conventional structural/functional echocardiographic data 0.776, P = 0.09; adding MWFS 0.791, P = 0.007). Compared to subjects with normal LVEF and MWFS, only subjects with combined systolic dysfunction (11% of the population) were at higher risk (P = 0.001 for both abnormal; P > 0.24 for either LVEF or MWFS abnormal). DAVID-Berg data suggest to include MWFS assessment in clinical practice, a simple and reliable echocardiographic parameter able to improve risk stratification in subjects at high risk for HF.

Diagnostic Accuracy of NT-proBNP and ST2 in Detection of Moderate to Severe Asymptomatic Left Ventricular Diastolic Dysfunction: Evaluation of The Role of Biomarkers in Screening of Diabetic Patients at Primary Healthcare Settings

Background: Left ventricular (LV) dysfunction, including asymptomatic LV dysfunction, has been shown to be more prevalent in patients with Type 2 diabetes mellitus (DM), and once progress to overt heart failure, carry worse clinical outcomes, compared to those without DM. The use of NT-proBNP and ST2 is well established in heart failure diagnosis and prognosis, but their inclusion in screening in asymptomatic DM patients has limited data.

Péptidos natriuréticos en la detección de disfunción ventricular izquierda en población de alto riesgo. Metaanálisis de pruebas diagnósticas

IntroductionThe concentration of natriuretic peptides in plasma has been proposed as a screening method for early ventricular dysfunction. ObjectiveTo compare the operative characteristics of B-type natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) fraction in a population with risk factors. MethodA meta-analysis of diagnostic tests. ResultsA search strategy was applied that found 86 references, of which 12 were selected according to the inclusion criteria. The role of BNP was evaluated in 8 of these studies, that of NT-proBNP in 3, and both tests in one of them. The cut-off points for BNP varied between 8 and 169.5 pg/mL, with a grouped sensitivity of 82.1% (95% CI; 76.7-86.4%), a grouped specificity of 69% (95%CI; 61.5-75.6%), a positive likelihood ratio (LR+) of 2.65 (95% CI; 2.17-3.23) and a negative likelihood ratio (LR−) of 0.26 (95% CI; 0.21-0.32). When the data were only analysed for cut-off points below 50 pg/mL, the grouped sensitivity improved to 89.2% (95% CI; 82.6-94%), and the LR− was 0.23 (95% CI; 0.14-0.40). Only 3 studies on NT-proBNP were analysed, with cut-off points between 125 and 902 pg/mL, a grouped specificity of 97.2% (95% CI; 90.2-99.7%), a grouped sensitivity of 76.9% (95% CI; 74.5-79.1%), LR+ 3.39 (95% CI; 1.67-6.85), and LR− 0.07 (95% CI; 0.02-0.23). ConclusionBNP and NT-proBNP can be useful in ruling out asymptomatic left ventricular dysfunction in patients at risk.

Circulating Neprilysin in Patients With Heart Failure and Preserved Ejection Fraction

BackgroundIn heart failure with reduced ejection fraction (HFrEF), elevated soluble neprilysin (sNEP) levels are associated with an increased risk of cardiovascular death, and its inhibition with sacubitril/valsartan has improved survival. ObjectivesThis study sought to determine the relevance of sNEP as a biomarker in heart failure with preserved ejection fraction (HFpEF) and to compare circulating sNEP levels in patients with HFpEF with normal controls. MethodsA case-control study was performed in 242 symptomatic patients with HFpEF previously enrolled in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction (RELAX) and Nitrates’s Effect on Activity Tolerance in Heart Failure With Preserved Ejection (NEAT-HFpEF) clinical trials and 891 asymptomatic subjects without HF or diastolic dysfunction (confirmed by NT-proBNP levels <200 pg/ml and echocardiography) who were enrolled in the Prevalence of Asymptomatic Left Ventricular Dysfunction study. sNEP was measured using a sandwich enzyme-linked immunosorbent assay (ELISA) in all subjects. ResultsOverall, sNEP levels were lower in HFpEF compared with controls (3.5 ng/ml; confidence interval [CI]: 2.5 to 4.8 vs. 8.5 ng/ml; CI: 7.2 to 10.0; p < 0.001). After adjusting for age, gender, body mass index (BMI), and smoking history, mean sNEP levels were also lower in HFpEF compared with controls (4.0 ng/ml [CI: 2.7 to 5.4] vs. 8.2 ng/ml [CI: 6.8 to 9.7]; p = 0.002). The cohorts were propensity matched based on age, BMI, diabetes, hypertension, smoking history, and renal function, and sNEP levels remained lower in HFpEF compared with controls (median 2.4 ng/ml [interquartile range: 0.6 to 27.7] vs. 4.9 ng/ml [interquartile range: 1.2 to 42.2]; p = 0.02). ConclusionsPatients with HFpEF on average have significantly lower circulating sNEP levels compared with controls. These findings challenge our current understanding of the complex biology of circulating sNEP in HFpEF.

Prognostic value of average real variability of systolic blood pressure in elderly treated hypertensive patients.

The independent prognostic significance of ambulatory blood pressure variability in the elderly is incompletely clear. We investigated the prognostic value of average real variability of 24-hour blood pressure in elderly treated hypertensive patients. The occurrence of a combined end-point including stroke, coronary events, heart failure requiring hospitalization and peripheral revascularization was evaluated in 757 elderly treated hypertensive patients. According to tertiles of average real variability of 24-hour systolic blood pressure patients were classified as having low (≤8.66 mmHg; n = 252), medium (8.67-10.05 mmHg; n = 252) or high (>10.05 mmHg; n = 253) average real variability. During the follow-up (6.9 ± 3.4 years, range 0.4-12.9 years), 195 events occurred. The event rate of the population was 3.74 per 100 patient-years. After adjustment for age, sex, previous events, diabetes, estimated glomerular filtration rate, left ventricular hypertrophy, left atrial enlargement, asymptomatic left ventricular systolic dysfunction at baseline, 24-hour systolic blood pressure, non-dipping and dipping with high morning surge of blood pressure, patients with high average real variability were at higher cardiovascular risk than those with low average real variability (hazard ratio 1.64, 95% confidence interval 1.12-2.40). In elderly treated hypertensive patients, high average real variability of 24-hour systolic blood pressure is associated with higher cardiovascular risk independently of other risk markers, average 24-hour systolic blood pressure and circadian blood pressure changes.

Asymptomatic left ventricular diastolic dysfunction in diffuse systemic sclerosis patients: conventional echocardiography and left atrial speckle tracking

ObjectiveOur objective was to assess asymptomatic left ventricular diastolic dysfunction (LVDD) in diffuse systemic sclerosis (SSc) patients using both conventional and two-dimensional speckle tracking echocardiography in correlation to disease variables.Patients and methodsTwenty-two patients with diffuse SSc without symptoms of LVDD and 22 controls were included in a comparative cross-sectional study. Skin fibrosis was assessed by modified Rodnan skin thickness score and disease severity by Medsger’s score. Parameters related to diastolic functions of the left ventricle were obtained by conventional echocardiography. Assessment of left atrium (LA) functions was by two-dimensional speckle tracking echocardiography as a predictor of LVDD.ResultsThere were significant differences between patients and controls regarding E-wave deceleration time (194.8±27.3 vs. 157.1±20.3; P<0.001), E/E’ (8.85±1.98 vs. 6.99 ±0.69; P=0.008), positive peak LAɛ (11.4±2.9 vs. 18.8±2.28; P<0.001), and sec. positive peak LAɛ (17.5±3.9 vs. 25.5±2.7; P<0.001). All LA strain parameters were significantly correlated with disease duration, disease severity, N-terminal pro b-type natriuretic peptide, E/E’, and E-wave deceleration time, while positive peak LAɛ was correlated with the modified Rodnan skin thickness score. Receiver operating characteristic curve analysis identified a positive peak value of less than or equal to 10.8 and sec. positive peak of less than or equal to 17.5 as predictors for the detection of E/E’ more than or equal to 8.ConclusionLA reservoir and conduit functions were significantly affected in SSc patients than controls and were associated with longer disease duration and more severe disease, while only reservoir function was associated with more fibrotic skin changes. All LA strain parameters correlated significantly with E/E’ ratio, while positive peak LA and sec. positive peak LA were demonstrated as LVDD predictors in patients with diffuse SSc.

Regional practice norms for the care of childhood cancer survivors at risk for cardiomyopathy: A Delphi study.

Treatment-associated cardiomyopathy is a leading cause of morbidity and mortality for childhood cancer survivors (CCS). As evidence is not available to guide the management of CCS at risk for cardiomyopathy, we aim to describe the collective opinion of regional experts for the care of these patients using a consensus-based Delphi methodology. Nineteen physicians from the New England region who care for CCS treated with cardiotoxic therapy (anthracyclines, thoracic radiation) participated in a Delphi panel querying their management approach, using three rounds of anonymous questionnaires formatted as five clinical scenarios. Consensus ≥ 89% agreement. The response rate was 100% for the first round and 95% for subsequent rounds. Panelists reached consensus on screening asymptomatic CCS with serial echocardiograms (94%) and electrocardiograms (89%), with some disagreement on frequency during pregnancy (83%). All panelists agreed with exercise promotion, with no restrictions on weight training. Consensus was reached on indications for referrals; cardiology for asymptomatic left ventricular dysfunction (ALVD) (100%) and maternal-fetal medicine for pregnancy (94%). In the scenario of ALVD, there was disagreement on the benefit of additional cardiac testing (50% cardiologists recommended cardiac MRI), and although all panelists endorsed treating with angiotension-converting enzyme (ACE) inhibitors, most adult cardiologists (75%) also recommended therapy with beta blockers, compared with none of the pediatric cardiologists or primary-care physicians. Despite a lack of evidence to guide the management of CCS at risk for cardiomyopathy, a panel of regional physicians reached consensus on managing most clinical scenarios. A controversial area requiring further study is the medical management of ALVD.

Treatment of chemotherapy-associated cardiomyopathy.

The number of cancer survivors is increasing, and cardiovascular events are a significant cause of morbidity and mortality in these patients. Preexisting cardiovascular conditions as well as the development of cancer therapeutics-related cardiac dysfunction (CTRCD), in particular left ventricular dysfunction and heart failure, limit the options for cancer therapies for these patients and contribute to reduced cancer survival. Recent guidelines and position statements from various cardiology and oncology societies provide an outline for the practicing physician for the management of CTRCD. However, this is largely based on data extrapolated from the general heart failure population (including patients without cancers) and is not based on strong evidence. There is now emerging evidence for the prevention and treatment of heart failure related to certain established chemotherapeutic drugs, whereas there is lack of trials for specific cardioprotective strategies to reduce cardiotoxicity of newer targeted cancer therapies. In this article, we discuss the most recent literature for the management of asymptomatic left ventricular dysfunction and heart failure related to chemotherapy, from prevention to the use of goal-directed medical therapies as well as discuss the role for advanced heart failure treatment in this population.

Echocardiography and cancer therapeutics-related cardiac dysfunction.

Cancer therapeutics-related cardiac dysfunction (CTRCD) has become a leading cause of morbidity and mortality for cancer survivors, with the mortality rate for patients with CTRCD reportedly being as high as 60% by 2years after treatment. Although early detection of subclinical left ventricular (LV) dysfunction is essential for delaying progression to heart failure (HF) in patients with a history of using cardiotoxins, assessment of such dysfunction can be challenging. CTRCD may present initially as asymptomatic LV dysfunction and ultimately as symptomatic HF, which can occur even decades after discontinuation of the treatment. Once CTRCD has developed, the mortality rate is very high, because CTRCD is believed to be refractory to conventional pharmacological therapy and to be associated with a poor prognosis. Thus, there has been a growing interest in early detection of CTRCD by means of global longitudinal strain (GLS) assessed by two-dimensional speckle-tracking echocardiography, because it is a more sensitive and robust parameter for detecting subclinical LV dysfunction than other conventional LV functional parameters such as LV ejection fraction. This article reviews the utility of GLS for early detection of cardiotoxicity in patients during and after cancer chemotherapy, and future perspectives for the management of such patients.

Urinary Peptidomic Biomarker for Personalized Prevention and Treatment of Diastolic Left Ventricular Dysfunction.

Diastolic heart failure (DHF) is characterized by slow left ventricular (LV) relaxation, increased LV stiffness, interstitial deposition of collagen, and a modified extracellular matrix proteins. Among Europeans, the frequency of asymptomatic diastolic LV dysfunction (DD) is 25%. This constitutes a large pool of people at high risk of DHF. The goal of this review was to describe the discovery and the initial validation of new multidimensional urinary peptidomic biomarkers (UPB) indicative of DD, mainly consisting of collagen fragments, and to describe a roadmap for their introduction into clinical practice. The availability of new drugs creates a window of opportunity for mounting a randomized clinical trial consolidating the clinical applicability of UPB to screen for DD. If successfully completed, such trial will benefit ≈25% of all people older than 50 years and open a large market for a UPB diagnostic tool and the drug tested. Moreover, sequenced peptides making up UPB will generate novel insights in the pathophysiology of DD and facilitate personalized treatment of patients with DHF for whom prevention came too late. If proven cost‐effective, the clinical application of UPB will contribute to the sustainability of health care in aging population in epidemiologic transition.

Screening for cardiac contractile dysfunction using an artificial intelligence-enabled electrocardiogram.

Asymptomatic left ventricular dysfunction (ALVD) is present in 3-6% of the general population, is associated with reduced quality of life and longevity, and is treatable when found1-4. An inexpensive, noninvasive screening tool for ALVD in the doctor's office is not available. We tested the hypothesis that application of artificial intelligence (AI) to the electrocardiogram (ECG), a routine method of measuring the heart's electrical activity, could identify ALVD. Using paired 12-lead ECG and echocardiogram data, including the left ventricular ejection fraction (a measure of contractile function), from 44,959 patients at the Mayo Clinic, we trained a convolutional neural network to identify patients with ventricular dysfunction, defined as ejection fraction ≤35%, using the ECG data alone. When tested on an independent set of 52,870 patients, the network model yielded values for the area under the curve, sensitivity, specificity, and accuracy of 0.93, 86.3%, 85.7%, and 85.7%, respectively. In patients without ventricular dysfunction, those with a positive AI screen were at 4 times the risk (hazard ratio, 4.1; 95% confidence interval, 3.3 to 5.0) of developing future ventricular dysfunction compared with those with a negative screen. Application of AI to the ECG-a ubiquitous, low-cost test-permits the ECG to serve as a powerful screening tool in asymptomatic individuals to identify ALVD.

Clinical Study of Patients with Heart Failure under treatment with Ozone Therapy.

Heart failure (HF) is framed in one of the types of cardiovascular diseases; it consists of an acute and chronic form. The disease can evolve slowly from asymptomatic left ventricular dysfunction, to a state of severe disability, presenting a wide prevalence in the population around 10% in people over 70 years old. More than three-quarters of the deaths from this pathology normally occur in low or middle-income countries. Angola is not exempt from this health problem be observed in a relatively young people, bringing disability and death at an early stage of life. Scientific advances and innovative treatments for the control and prevention of the disease continue to be insufficient.&#x0D; The ozone for it’s antioxidant, hemorheologic properties, oxygenation enhancers and blood circulation is an alternative treatment for these patients.&#x0D; We have performed a study where 45 patients who were diagnosed with a chronic stage of II-III HF due to the functional classification of the New York Heart Association (NYHA) and American Cardiology College / American Heart Association (ACC / AHA), previous echocardiogram with a Fracture of Left Ventricular Ejection (LVEF) less than 45%. We administered a Major Autohemotherapy with a protocol of 15 sessions, maintenance every 15 days and cycles every 6 months at 50?g of concentration, an initial dose of 4,000 ?g / ml up to 12,000?g / ml during the 3 years of treatment.&#x0D; Patients after the first treatment cycle improve their functional physical capacity and LVEF increased to normal levels (55%). It was proved that Autohemotherapy is an adjuvant, viable and beneficial treatment in chronic HF.&#x0D; &#x0D; Key words: Heart failure (HF), Major Autohemotherapy, Ozone therapy, Fracture of Left Ventricular Ejection

Cardioprotective Approaches to the Management of Patients with Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: Do We Need Increased Surveillance in Elderly Women on Trastuzumab?

Cardiotoxic effects in patients with breast cancer may present as asymptomatic left ventricular (LV) dysfunction or symptomatic LV decline, which can progress to overt heart failure (HF). Trastuzumab is a monoclonal antibody against human epidermal growth factor receptor (HER)2 and is a recommended targeted treatment for patients with overexpression of this receptor. However, the use of trastuzumab is associated with cardiotoxicity, manifested as LV dysfunction or HF. This review addresses the key issues related to individualised cardioprotection and surveillance, especially in elderly patients with HER2-positive breast cancer, based on the current cardio-oncology literature. Cardiac imaging techniques (e.g., echocardiography or multiple-gated acquisition scan) and biomarkers (e.g., cardiac troponins) that play a crucial role in the detection and monitoring of cardiotoxicity related to systemic therapies for breast cancer are briefly described. This review presents cardioprotective approaches, including interruption or termination of trastuzumab therapy, and treatment with an angiotensin-converting enzyme inhibitor, angiotensin-receptor blocker, or beta-blocker, which have been recommended for the reduction of cardiac adverse effects. Since the data relevant to cardiotoxicity of trastuzumab among real-world older women with breast cancer and cardiovascular diseases are still limited, this article focusses on improvements to the cardiac safety of trastuzumab-based regimens. In particular, this review emphasises the importance of intense surveillance in the elderly female population.

A3102 Asymptomatic Left Ventricular Diastolic Dysfunction in Arterial Hypertension

Objectives: Objectives of the present study were to detect an asymptomatic left ventricular diastolic dysfunction (ALVDD) in subjects with high cardiovascular risk and to compare the incidence of ALVDD in group with and without arterial hypertension. <P>Methods:</P> A total of 400 subjects with high cardiovascular risk aged from 35 to 64 years and who had no symptoms of heart failure were assessed by NT-pro BNP assay and echocardiography. Patients with LVEF < 50% were excluded. The cut-off point for NT-pro BNP was 125pg/ml. Asymptomatic left ventricular diastolic dysfunction was defined as left ventricular hypertrophy or E/e1 ratio > 13 by echocardiography and as increased N-terminal pro-B-type natriuretic peptide level. Results: The study sample consisted of 188 men (47.0%) and 212 women (53.3%). The mean age of participants was 49.5 ± 11.8 years. Hypertension was diagnosed in 198 participants and 202 were normotensive. The mean N-terminal pro-B-type natriuretic peptide value among patients with hypertension was 346.8 ± 169.4 pg. /ml. Asymptomatic left ventricular diastolic dysfunction was detected in 11% (n = 44) of subjects with high risk for heart failure. The incidences of ALVDD among hypertensive and non-hypertensive patients were 16.2% (n = 32) and 5.9% (n = 12). By multivariable logistic regression analysis variables independently associated to ALVDD were ages, left ventricular mass and NT-pro BNP value. Conclusion: Based on our study finding we recommend screening for asymptomatic left ventricular diastolic dysfunction in patients with hypertension by using NT-pro BNP testing and echocardiography.