Early Diagnosis Of Heart Failure Research Articles

Significance of the echocardiographic evaluation of left atrial myocardial strain for early diagnosis of heart failure with preserved ejection fraction

This systematic review is based on 19 studies from Elsevier, PubMed, Embase, and Scopus databases, which were found by the following keywords: LA strain (left atrial strain), STE (speckle tracking echocardiography), HF (heart failure), and HFpEF (heart failure with preserved ejection fraction). The review focuses on results and conclusions of studies on using the 2D echocardiographic evaluation of left atrial (LA) myocardial strain for early diagnosis of HFpEF in routine clinical practice. Analysis of the studies included into this review showed a significant decline of all LA functions in patients with HFpEF. Also, multiple studies have reported associations between decreased indexes of LA strain and old age, atrial fibrillation, left ventricular hypertrophy, left and right ventricular systolic dysfunction, and LV diastolic dysfunction. Thus, the review indicates significant possibilities of using indexes of LA strain in evaluation of early stages of both systolic and diastolic myocardial dysfunction. Notably, LA functional systolic and diastolic indexes are not sufficiently studied despite their growing significance for diagnosis and prognosis of patients with HFpEF. For this reason, in addition to existing models for risk stratification in this disease, including clinical characteristics and/or echocardiographic data, future studies should focus on these parameters.

Effect of Loading Changes on the Intraventricular Pressure Measured by Color M-Mode Echocardiography in Rats.

Evaluation of diastolic function is a pivotal challenge due to limitations of the conventional echocardiography, especially when the heart rate is rapid as in rats. Currently, by using color M-mode echocardiography (CMME), intraventricular pressure difference (IVPD) and intraventricular pressure gradient (IVPG) in early diastole can be generated and are available as echocardiographic indices. These indices are expected to be useful for the early diagnosis of heart failure (HF), especially diastolic dysfunction. There have not been any studies demonstrating changes in IVPD and IVPG in response to changes in loading conditions in rats. Therefore, the present study aims to evaluate CMME-derived IVPD and IVPG changes in rats under various loading conditions. Twenty rats were included, divided into two groups for two different experiments, and underwent jugular vein catheterization under inhalational anesthetics. Conventional echocardiography, CMME, and 2D speckle tracking echocardiography were measured at the baseline (BL), after intravenous infusion of milrinone (MIL, n = 10), and after the infusion of hydroxyethyl starch (HES, n = 10). Left ventricular IVPD and IVPG were calculated from color M-mode images and categorized into total, basal, mid-to-apical, mid, and apical parts, and the percentage of the corresponding part was calculated. In comparison to the BL, the ejection fraction, mid-to-apical IVPG, mid IVPG, and apical IVPD were significantly increased after MIL administration (p < 0.05); meanwhile, the end-diastolic volume, E-wave velocity, total IVPD, and basal IVPD were significantly increased with the administration of HES (p < 0.05). The increase in mid-to-apical IVPD, mid IVPD, and apical IVPD indicated increased relaxation. A significant increase in basal IVPD reflected volume overloading by HES. CMME-derived IVPD and IVPG are useful tools for the evaluation of various loading conditions in rats. The approach used in this study provides a model for continuous data acquisition in chronic cardiac disease models without drug testing.

Low limit of detection of the AlGaN/GaN-based sensor by the Kelvin connection detection technique

The AlGaN/GaN-based sensor is a promising POCT (point-of-care-testing) device featuring miniaturization, low cost, and high sensitivity. BNP is an effective protein biomarker for the early diagnosis of HF (heart failure). In this work, a novel AlGaN/GaN device with the Kelvin connection structure and the corresponding detection technique was proposed. This technique can effectively suppress the background noise and improve the SNR (signal-to-noise ratio). A BNP detection experiment was carried out to verify the effectiveness of this technique. It is shown that compared with that of the traditional detection method, the LOD (limit of detection) was improved from 0.47 ng/mL to 1.29 pg/mL. The BNP detection experiment was also carried out with a traditional electrochemical Au-electrode sensor with the same surface functionalization steps. The AlGaN/GaN sensor showed a better LOD than the Au-electrode sensor. Moreover, the influence of AlGaN/GaN sensor package on background noise was investigated with the mechanism of the noise source revealed. Finally, based on the optimized package, the optimal SNR quiescent operating point of the AlGaN/GaN sensor was determined. By biasing the sensor at the optimal quiescent operating point and immobilizing the magnetic beads with anti-BNP on the gate of the AlGaN/GaN sensor, the LOD for BNP detection was further improved to 0.097 pg/mL.

Speckle-tracking echocardiography in the early diagnosis of heart failure after ST-segment elevation myocardial infarction

Aim . To study the potential of global strain analysis using two-dimensional speckletracking echocardiography to predict the heart failure (HF) in patients with ST-segment elevation myocardial infarction (STEMI) based on the 6-month follow-up after revascularization. Material and methods . The study included 114 STEMI patients aged 52 (44; 59) years. Two-dimensional echocardiography was performed with analysis of standard parameters and speckle tracking with analysis of strain and rotational characteristics of the myocardium. Concentration of brain natriuretic peptide was determined. The endpoint was the presence of heart failure (HF) after 6-month follow-up. observation. The analysis of HF risk was carried out using ROC-curves based on 3 criteria. Strain parameters with the maximum sum of sensitivity and specificity were chosen as a cutoff point. Results . Six months after STEMI, depending on the ejection fraction (EF) value, the patients were divided into 3 groups: group 1 — patients with reduced EF (&lt;40%) (HFrEF); group 2 — with mid-range EF (40-49%) (HfmrEF); group 3 — with preserved EF ≥50% (HFpEF). Strain and rotational characteristics differed between groups (p&lt;0,001 for all). It was found that in the acute period of myocardial infarction, global longitudinal strain (GLS) &lt;9,5% (AUR =0,804, 95% (confidence interval (CI) (0,673; 0,936), p=0,001) and global circumferential strain (GCS) &lt;8,7% (AUR =0,722 (95% CI (0,568; 0,875), p=0,012) predicts the development of HFrEF. These values less than 12,5% (AUR =0,830 (95% CI (0,749; 0,911), p=0,001) and 13% (AUR =0,759 (95% CI (0,664; 0,855), p=0,001) is associated with HFmrEF The Twist had the highest predictive value in relation to HFrEF — 4,2° (AUR =0,998 (95% CI (0,993; 0,100), p=0,001). Conclusion . GLS, GCS and Twist have high sensitivity and specificity and can be used in wide clinical practice as simple and cost-effective indicators of HF risk.

Value of Galectin-3 assay in children with heart failure secondary to congenital heart diseases: a prospective study

BackgroundGalectin-3 is a new biomarker, which plays an important role in tissue inflammation, cardiac remodeling, and fibrosis. It can be readily measured in the circulation to detect early heart failure (HF). This study aimed to assess the value of galectin-3 assay in early diagnosis of children with heart failure secondary to congenital heart disease (CHD) and correlate it with the patients’ outcome.MethodsThis prospective cohort study included 75 children diagnosed to have CHD; {Group A: 45 CHD children with HF symptoms and reduced ejection fraction (REF) and Group B: 30 CHD children with no HF symptoms and normal ejection fraction (NEF)}. They were compared to 40 age- and sex-matched controls (Group C). Children with CHD undergone history taking, Ross HF classification, Echocardiographic assessment and laboratory investigations including serum galactin-3 level.ResultsGalectin-3 serum level increased in CHD children, and it showed significant increase in (Gp A) compared to Gp B or Gp C (p = ≤ 0.001). In addition, serum level of Galactin-3 was correlated positively with Ross classification (r = 0.68, p = 0.018) and negatively correlated to EF% (r= -0.61, p ≤ 0.001). Galactin-3 showed better diagnostic value than Ross HF classification in early diagnosis of HF in CHD children with a cut point (≥ 10.4), significantly had 96.7% sensitivity, 90% specificity, 91% positive predictive value, 93.2% negative predictive value, with area under the curve (AUC = 0.96) and 93% accuracy. While there was a significant correlation between Ross HF classification and HF outcome in (Gp A) children (p = 0.05), we did not find any significant correlation between serum galectin-3 level and HF mortality in same group (p = 0.08).ConclusionsGalectin-3 assay is a promising marker for early diagnosis of HF in children with CHD; but it has no role in detecting HF mortality.

Circulating microRNA in Heart Failure-Practical Guidebook to Clinical Application.

Heart failure (HF) remains a major cause of death and disability worldwide. Currently, B-type natriuretic peptide and N-terminal probrain natriuretic peptide are diagnostic biomarkers used in HF. Although very sensitive, they are not specific enough and do not allow the prediction or early diagnosis of HF. Many ongoing studies focus on determining the underlying cause and understanding the mechanisms of HF on the cellular level. MicroRNAs (miRNAs) are noncoding RNAs, which control the majority of cellular processes and therefore are considered to have a potential clinical application in HF. In this review, we aim to provide synthesized information about miRNAs associated with ejection fraction, HF etiology, diagnosis, and prognosis, as well as outline therapeutic application of miRNAs in HF. Further, we discuss methodological challenges associated with the analysis of miRNAs and provide recommendations for defining a study population, collecting blood samples, and selecting detection methods to study miRNAs in a reliable and reproducible way. This review is intended to be an accessible tool for clinicians interested in the field of miRNAs and HF.

Detection of B-type natriuretic peptide by establishing a low-cost and replicable fluorescence resonance energy transfer platform.

Aiming at the establishment of a sensitive and specific diagnostic method for early heart failure (HF), we developed a cost-effective fluorescence resonance energy transfer (FRET) platform for the detection of B-type natriuretic peptide (BNP), a characteristic biomarker of HF. Graphene oxide (GO) was selected as the FRET receptor in view of its advantages including commercial availability, low-cost and chemical stability, and dye-modified aptamer was used as the energy donor of FRET as well as in charge of the specific recognition of BNP. Based on the ON (strong emission) and OFF (quenching) states of FRET in the presence and absence of BNP, respectively, specific detection of BNP was achieved in the range 0.074-0.56pg/mL with a limit of detection as low as 45fg/mL (3σ). This FRET platform was applied to detect BNP in 45 blood samples to demonstrate its practicability in clinical diagnosis. Compared tothe commonly used Siemens method (chemiluminescence immunoassay, CLIA) in hospital, our approach is more accurate and specific for HF diagnosis with areas under the receiver operating characteristic curves of 0.869 (95% CI 0.733-1.00, P < 0.05) vs 0.850 (95% CI 0.703-0.997, P < 0.05) and specificity of 68.8% vs 65.6%. This platform is promising in early diagnosis of HF through ultrasensitive and specific detection of BNP. Graphical abstract To solve the clinical diagnostic problem for early heart failure (HF) which lacks sensitivity and specificity, we established a cost-effective and rapid fluorescence analysis method based on fluorescence resonance energy transfer (FRET) platform for the detection of B-type natriuretic peptide (BNP), a characteristic biomarker of HF.

Complement- and endothelial activation after out-of-hospital cardiac arrest is associated with poor cerebral outcome

Acetate has a pivotal role in the intermediary metabolism of living cells. Glucose, fatty acids and other carbon sources for oxidation are converted to acetate before entering the mitochondrial tricarboxylic acid cycle. 11C-acetate PET is an established technique in cardiac imaging since decades and allows accurate estimates of both regional myocardial blood flow (MBF) and oxygen consumption (MVO2) to be obtained simultaneously from a single scan of less than 30 min duration. Image acquisition is based on dynamic imaging and analysis requires kinetic modeling approaches for optimal results. These requirements, as well as the need for an on-site cyclotron for carbon-11 production, so far limited the clinical use to advanced PET facilities. In recent years, myocardial 11C-acetate PET has seen a renewed interest in heart failure research into myocardial external efficiency (MEE). MEE is defined as the ratio of the energy associated with external pressure-volume work (cardiac output x systemic blood pressure, converted to Joule) and chemical energy consumed (MVO2 x left ventricular mass (LVM), converted to Joule). Cardiac output and LVM can be measured by echocardiography, magnetic resonance imaging or directly from the 11C-acetate PET scan, and hence provides a fully non-invasive approach to detailing important aspects of the inner workings of the heart. MEE is increasingly used to evaluate new therapies in heart failure and has been validated for that purpose. MEE has a high reproducibility and might potentially also be of use for early diagnosis of heart failure before symptoms develop.This chapter describes scanning parameters with image analysis and summarizes the clinical utility of MBF, MVO2 and MEE measurements obtained from 11C-acetate PET.

Parametric Imaging for the Assessment of Cardiac Motion: A Review.

The assessment of wall motion abnormalities such as hypokinesia or dyskinesia and the identification of their extent as well as their degree of severity allow an accurate evaluation of several ischemic heart diseases and an early diagnosis of heart failure. These dysfunctions are usually revealed by a drop of contraction indicating a regional hypokinesia or a total absence of the wall motion in case of akinesia. The discrimination between these contraction abnormalities plays also a significant role in the therapeutic decision through the differentiation between the infarcted zones, which have lost their contractile function, and the stunned areas that still retain viable myocardial tissues. The lack of a reliable method for the evaluation of wall motion abnormalities in cardiac imaging presents a major limitation for a regional assessment of the left ventricular function. In the past years, several techniques were proposed as additional tools for the local detection of wall motion deformation. Among these approaches, the parametric imaging is likely to represent a promising technique for the analysis of a local contractile function. The aim of this paper is to review the most recent techniques of parametric imaging computation developed in cardiac imaging and their potential contributions in clinical practice.

A clinical importance of natriuretic peptides in pediatric practice

Natriuretic peptides (NUP) are peptide hormones secreted by cardiomyocytes in response to a volume overload of the heart. Emphasis in the article is placed on the history of NUP discovery, their chemical structure and pathophysiological mechanisms of action. The data on determination of NUP reference values in children with cardiac pathologies are analyzed. A NUP clinical significance in early diagnosis of heart failure in children, including those with congenital heart defects is shown. Also considered is NUP dynamics after surgical correction of congenital heart defects. A conclusion is drawn that NUP play an important prognostic role in evaluating early and late postoperative periods and disease outcomes on a whole.Received 11 October 2016. Accepted 22 December 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsAll authors contributed equally at all stages of the research.

Diabetes and heart failure : Update 2017

Patients with diabetes mellitus exhibit an increased risk for the development of heart failure. The occurrence of heart failure in patients with diabetes is associated with apoor prognosis. Therapeutic strategies to reduce cardiovascular morbidity and mortality in diabetes have so far mainly focused on the prevention of coronary events but recent data suggest that an early diagnosis of heart failure in diabetes as well as specific therapies could have amajor impact on the prognosis for these patients. This article aims to provide acomprehensive overview on the epidemiology, pathophysiology and prognosis of heart failure in diabetes patients and addresses current aspects of heart failure therapy in diabetes as well as diabetes therapy in heart failure patients.

A qualitative study of the current state of heart failure community care in Canada: what can we learn for the future?

BackgroundIn North America and other industrialized countries, heart failure (HF) has become a national public health priority. Studies indicate there is significant heterogeneity in approaches to treat and manage HF and suggest targeted changes in health care delivery are needed to reduce unnecessary health care utilization and to optimize patient outcomes. Most recent published studies have reported on the care of HF patients in tertiary care hospitals and the perspective of non-specialist stakeholders on HF management, such as general practitioners and clinics or hospital administrators is rarely considered. This study explores the current state of community-based HF care in Canada as experienced by various healthcare stakeholders providing or coordinating care to HF patients.MethodsThis study employed a qualitative exploratory research design consisting of semi-structured telephone interviews conducted with health care providers and health care administrators working outside of tertiary care in the four most populous Canadian provinces. A modified thematic analysis process was used and the different data sources were triangulated. Findings were collectively interpreted by the authors.ResultsTwenty-eight participants were recruited in the study: eight cardiologists, five general practitioners/family physicians, eight nurse practitioners/registered nurses, four hospital pharmacists and three health care administrators/directors. Participants reported a lack of stakeholder engagement throughout the continuum of care, which hinders the implementation of a coordinated approach to quality HF care. Four substantive themes emerged that indicated challenges and gaps in the optimal treatment and management of HF in community settings: 1) challenges in the risk assessment and early diagnosis of HF, 2) challenges in ensuring efficient and consistent transition from acute care setting to the community, 3) challenges of primary care providers to optimally treat and manage HF patients, and 4) challenges in promoting a holistic approach in HF management.ConclusionsAs health systems evolve from tertiary-based care to community-based outpatient services for the management of chronic diseases, this study’s findings pinpoint challenges that have been observed in the Canadian context and can stimulate and orient dialogue toward solutions for a more coordinated approach to improve the care of HF patients and reduce pressure on the healthcare system.

Peripartum cardiomyopathy: definition, incidence, etiopathogenesis, diagnosis, and management.

Peripartum cardiomyopathy (PPCM) is a serious pregnancy-associated disorder of unknown etiology. The precise cellular and molecular mechanisms underlying PPCM are unclear. A heightened awareness among health care providers can result in early diagnosis of heart failure in late pregnancy and the early postpartum period. Though the symptoms of dyspnea and fatigue can result from normal physiologic changes during pregnancy, an electrocardiogram and brain natriuretic peptide level should be obtained in these patients, in addition to baseline laboratory tests such as a complete blood count, and basic metabolic and hepatic function panels. If the electrocardiogram and brain natriuretic peptide level are abnormal, an echocardiogram should be obtained. The role of endomyocardial biopsy for the diagnosis of PPCM is controversial. Patients should be started on diuretics if volume overloaded, and beta-blockers (preferably metoprolol) if no contraindications exist; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be avoided during pregnancy or lactation. There are no standard, universally accepted guidelines for the management of PPCM. Although experimental therapies like bromocriptine, pentoxifylline and immunoglobulins have shown promising results, large double-blind randomized trials are essential to confirm the results of smaller studies. In patients with persistent severe left ventricular (LV) dysfunction, advanced therapies like mechanical circulatory support and heart transplantation should be considered. Owing to recent data demonstrating deterioration of LV systolic function after initial recovery, it is essential to maintain long-term follow up of these patients regardless of initial recovery of LV function. We present a comprehensive review of the literature etiopathogenesis, diagnosis, and management of PPCM.

Potential costs of B-type natriuretic peptide for the identification of people with heart failure in primary care in Scotland – a pilot study

The utility of B-type natriuretic peptide as a screening test for heart failure has been proven in a number of clinical trials. The aims of this study were to assess the utility of the measurement of B-type natriuretic peptide in a 'real life' setting and to estimate the potential costs of implementing its use in primary care in Scotland. Eight general practitioner practices with a combined population of approximately 62,000 were invited to participate. During the 9-month study period, 82 samples for B-type natriuretic peptide measurement were requested. The negative predictive value for B-type natriuretic peptide was 96.9%. Compared with electrocardiography, B-type natriuretic peptide reduced the need for echocardiography by 308 tests per million population per year. The estimated cost of implementation in Scotland is approximately £220,000 per annum, equating to £64.93 per patient correctly diagnosed with heart failure, with a potential saving in echocardiography of £110,800. In this pilot study, measurement of plasma B-type natriuretic peptide in a 'real life' setting in primary care had a similar sensitivity, specificity and negative predictive value to that observed in trial populations. B-type natriuretic peptide aids early diagnosis of heart failure in primary care and may help to facilitate prompt introduction of evidence based therapies to modify patient outcomes. The costs of measuring plasma B-type natriuretic peptide in suspected cases of heart failure are modest, and its use would increase the diagnostic capacity of primary care if supported by local cardiology services.

Evidence of the Biomarkers from the Sub-analysis Data of Clinical Trials and Registries

Biomarkers are substances derived from organs, which can be measured and evaluated as indicators of normal biology, pathogenic process or pharmacological response to a therapeutic intervention. Their measurements is not subject to inter-observer variability. An ideal biochemical marker should be a prognostic indicator, assist in the early diagnosis of heart failure (HF), reliably reflect the therapeutic response, and help grading the risk associated with each stage of HF. While several biochemical markers have been studied for their prognostic value in the setting of chronic and acute HF, their clinical applications have not been systematically discussed. Moreover, change of ideal biomarkers should correlate the change of cardiovascular events. The relationship between cardiac remodeling and these biomarkers also should be elucidated. Finally, an ideal biochemical marker should be applicable to patients at the risk stage of HF. Biomarkers, such as CRP, BNP, collagen marker and high sensitive cardiac troponin has been reported as a prognostic marker of cardiovascular events in general population.In this symposium, we review biomarkers from the sub-analysis data of clinical trials and registries from, risk stage to overt HF. Biomarkers are substances derived from organs, which can be measured and evaluated as indicators of normal biology, pathogenic process or pharmacological response to a therapeutic intervention. Their measurements is not subject to inter-observer variability. An ideal biochemical marker should be a prognostic indicator, assist in the early diagnosis of heart failure (HF), reliably reflect the therapeutic response, and help grading the risk associated with each stage of HF. While several biochemical markers have been studied for their prognostic value in the setting of chronic and acute HF, their clinical applications have not been systematically discussed. Moreover, change of ideal biomarkers should correlate the change of cardiovascular events. The relationship between cardiac remodeling and these biomarkers also should be elucidated. Finally, an ideal biochemical marker should be applicable to patients at the risk stage of HF. Biomarkers, such as CRP, BNP, collagen marker and high sensitive cardiac troponin has been reported as a prognostic marker of cardiovascular events in general population. In this symposium, we review biomarkers from the sub-analysis data of clinical trials and registries from, risk stage to overt HF.

2-Aminobutyric Acid, a Potential Indicator of Oxidative Stress in Failing Hearts

Early diagnosis of heart failure (HF) remains difficult and identification of more sensitive biomarkers than conventional ones is an urgent task. We conducted the comprehensive quantification of water-soluble metabolites in blood of atrial septal defect (ASD) patients using a gas chromatograph-mass spectrometry. We found the mean level of 2-Aminobutyric acid (2-AB) in ASD patients was significantly higher than that in healthy volunteers, and 1 month after transcatherter closure of ASD, serum 2-AB levels in patients decreased to almost the same levels as healthy volunteers.

Clinical analysis of 56 gestational hypertension patients with heart disease

Objective To investigate the early diagnosis and preventive measures for gestational hypertensive patients with heart disease.Methods Clinical data of 56 gestational hypertensive patients with heart disease were retrospectively analyzed.Results Aggressive treatment of maternal deaths occured in 1 case,2 cases of stillbirth,and the other 55 cases had good maternal prognosis.Conclusion Treatment of hypertensive heart disease in pregnancy should be based on the strong heart vasodilator,diuretic,caution magnesium sulfate.In the control of heart failure after 6-8h,shall terminate the pregnancy.Active treatment of the primary disease,to correct anemia and hypoproteinemia,early diagnosis of heart failure and strictly control expansion of indications can help to improve the prognosis of hypertensive heart disease in pregnancy. Key words: Gestational hypertension; Heart disease; Heart failure

Heart 'omics' in AGEing (HOMAGE): design, research objectives and characteristics of the common database.

Heart failure is common in older people and its prevalence is increasing. The Heart ‘omics’ in AGEing (HOMAGE) project aims to provide a biomarker approach that will improve the early diagnosis of heart failure. A large clinical database, based on (1) prospective population studies or (2) cross-sectional, prospective studies or randomized controlled trials (RCTs) of patients at risk for or with overt cardiovascular disease will be constructed to determine most promising ‘omics’-based biomarkers to identify the risk of developing heart failure and/or comorbidities. Population studies, patient cohorts and RCTs are eligible for inclusion in the common database, if they received ethical approval to obtain and share data and have baseline information on cardiovascular risk factors. Currently, the HOMAGE database includes 43,065 subjects, from 20 studies in eight European countries, including healthy subjects from three population studies in France, Belgium and Italy (n = 7,124), patients with heart failure (n = 4,312) from four cohorts in the UK, Spain and Switzerland and patients at high risk for cardiovascular disease (n = 31,629) in 13 cohorts. It is anticipated that more partners will join the consortium and enlarge the pooled data. This large merged database will be a useful resource with which to identify candidate biomarkers that play a role in the mechanism underlying the onset and progression of heart failure.

Heat Shock Protein 70 Acts as a Potential Biomarker for Early Diagnosis of Heart Failure

Early identification for heart failure (HF) may be useful for disease modifying treatment in order to reduce heart disease progression or even to reverse it. In our previous studies, we have revealed a group of heat shock proteins (HSPs) which might be related to neonatal rat cardiomyocyte hypertrophy by proteomic approach. Here, we confirm that HSPs, including HSP27 and HSP70, altered in the early stage of cardiac remodeling in vivo animal model. Furthermore, plasma concentrations of those HSPs and their potential screening value were evaluated at different stages in 222 patient subjects. Plasma HSP27, HSP70 and HSP90 were measured using enzyme-linked immunosorbent assay. Results indicate that HSP70 was positively correlated to the severity (progression) of HF (r = 0.456, p<0.001). The area under the rate of change (ROC) curve was 0.601 (p = 0.017) in patients with stage B HF and 0.835 (p<0.001) in those with stage C HF. However, HSP27 and HSP90 did not display significant changes in any stage of HF in this study. Taken together, plasma concentrations of HSP70 elevated with the progression of HF and might act as a potential screening biomarker for early diagnosis of HF.

Diagnosis of elderly patients with heart failure

The prevalence and mortality of heart failure (HF) increase with age. As a result, the early diagnosis of HF in this population is useful to reduce cardiovascular morbidity and probably mortality. However, the diagnosis of HF in the elderly is a challenge. These challenges arise from the under-representation of elderly patients in diagnostic studies and clinical trials, the increasing prevalence of HF with relatively normal ejection fraction, the difficulty in accurate diagnosis, the underuse of diagnostic tests, and the presence of co-morbidities. Particularly in the elderly, symptoms and signs of HF may be atypical and can be simulated or disguised by co-morbidities such as respiratory disease, obesity, and venous insufficiency. This review aims to provide a practical clinical approach for the diagnosis of older patients with HF based on the scarce available evidence and our clinical experience. Therefore, it should be interpreted in many aspects as an opinion paper with practical implications. The most useful clinical symptoms are orthopnoea and paroxysmal nocturnal dyspnoea. However, confirmation of the diagnosis always requires further tests. Although natriuretic peptides accurately exclude cardiac dysfunction as a cause of symptoms, the optimal cut-off level for ruling out HF in elderly patients with other co-morbidities is still not clear. In our opinion, echocardiography should be performed in all elderly patients to confirm the diagnosis of HF, except in those cases with low clinical probability and a concentration of brain natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) lower than 100 or 400 pg/mL, respectively.