Ejection Fraction In Patients Research Articles

The pacemaker ventricular lead position and outcomes in patients upgrading to crt

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Adverse hemodynamic effects of right ventricular pacing are known, and the optimal right ventricular lead position is still being a matter of debate. According to the guidelines, upgrade to cardiac resynchronization therapy (CRT) is recommended in patients with indication for pacemaker and left ventricular ejection fraction less than 50% or who need more than 40% of ventricular pacing. Purpose To compare clinical outcomes and ejection fraction in patients with previous pacemaker (apical versus septal right ventricular pacing) who are upgrated to CRT. Methods Single-center retrospective study of 94 consecutive patients who had previous pacemaker and upgraded to CRT over a 4-year period. Of these patients, 64 had previous apical lead pacemaker and 30 had previous septal lead pacemaker. Data on comorbidities, New York Heart Association (NYHA), left ventricular ejection fraction and hospitalizations due to heart failure were collected. The results were obtained using Chi-square, Mann-Whitney and t-test. Results Patients with septal pacemaker had significantly more diabetes (p = 0.04) and chronic obstructive pulmonary disease (p = 0.01), tended to be more symptomatic (p = 0.198) and had more days of hospitalization before and after pacemaker implantation (12 ± 3 versus 7 ± 2 days and 8 ± 4 versus 3 ± 1 days, respectively), mostly due heart failure decompensation. Although there were no significant differences in the initial ejection fraction in patients with apical or septal pacemaker implantation (31.2 ± 1.2% and 29.1 ± 1.5%, respectively, p = 0.323), the time to upgrade to CRT was significantly shorter in patients with septal pacemaker implantation (1999 ± 227 days versus 3005 ± 279 days, p = 0.005). After upgrading to CRT, patients with apical lead had a significant increase in ejection fraction (8.2%, p = 0.011), while patients with septal lead had a non-significant improvement of ejection fraction (4.5%, p = 0.448). In both, apical and septal lead patients, there was a significant improvement in NYHA class after upgrade to CRT (p = 0.03 and p = 0.02, respectively). Conclusion Although patients with septal lead had more comorbidities and hospitalizations due to heart failure, they do not benefit from the upgrade to CRT, unlike what happens in patients with apical lead. These findings can be explained by the fact that the septal lead minimizes ventricular desynchrony induced by right ventricular pacing.

Predictors for early mortality in patients with implantable cardiac defibrillator for heart failure with reduced ejection fraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Implantable cardiac defibrillators (ICD) are recommended in heart failure with reduced ejection fraction (HFrEF) patients to reduce arrhythmic deaths. The only contraindication for not implanting ICD is life expectancy of less than 1 year. We aimed to identify risk factors associated with mortality within 1 year following the device implantation. Methods Data from our hospital’s electronic database system was extracted for patients who were implanted ICD secondary to HFrEF between 2009 and 2019. Those who died within 1 year following the device implantation were analyzed in the present paper. Multiple Cox regression analysis using the backward logistical regression method was applied to determine the best predictors that affect 1-year mortality Results Overall 1107 patients were included in the present analysis. ICD was implanted in 77.2% and 22.8% for ischemic and non-ischemic HFrEF respectively. Mortality rate at 1-year following the device implantation was 4.7%. In multivariate analysis age [Hazard ratio (HR), 1.04; Confidence 95% Intervals (CI), 1.02 – 1.06; P = 0.001], atrial fibrillation (AF) (HR, 4.12; 95% CI, 2.34 – 7.24, P < 0.001), NYHA class > 2 symptoms (HR, 5.33; 95% CI, 2.92 – 9.73, P < 0.001), blood urea nitrogen (BUN) (HR, 1.02; 95% CI, 1.00 – 1.03, P = 0.03) and albumin (HR, 0.52; 95% CI, 0.34 – 0.80, P = 0.003) independently predicted 1-year mortality Conclusion In patients with HFrEF and implanted ICD, older age, presence of AF and NYHA class > II symptoms, elevated BUN and reduced albumin levels predicted 1-year mortality. Table 1 Multivariate analysis P value HR (95% CI) Age 0.001 1.038 (1.015 - 1.062) Atrial fibrillation <0.001 4.119 (2.342 - 7.241) NYHA > 2 <0.001 5.328 (2.917 - 9.731) Blood urea nitrogen 0.034 1.017 (1.001- 1.034) Albumin 0.003 0.520 (0.337 - 0.801) Multivariate Cox regression analyses for 1-year mortality after implantation

Evaluation of p-wave Dispersion and Left Atrium Ejection Fraction in Patients with Cardioembolic Ischemic Stroke

Introduction: Studies show that p-wave dispersion and left atrial ejection fraction are predictors of cardiovascular events. Purpose: To verify the association of p-wave dispersion and left atrial ejection fraction with cardioembolic ischemic stroke. Methods: This is an observational, cross-sectional, case-control study with 61 patients, mean age of 65.6, with sinus rhythm ischemic stroke who underwent clinical evaluation with CHA2DS2-VASc score, electrocardiogram, echocardiogram and ultrasonography with Doppler of both carotid and vertebral arteries. The groups were divided into cardioembolic (cases) and non-cardioembolic (controls). The p-wave dispersion was obtained with a 12-lead electrocardiographic tracing at 50 mm/s by subtracting the largest p-wave by the smallest one. Left atrial ejection fraction was obtained using the modified biplane Simpson method. This study was approved by the UERN Research Ethics Committee (# 2,536,483). Results: Mean values for p-wave dispersion were 62.5 ms for cases and 49 ms for controls (p = 0.025). For left atrial ejection fraction, the cases presented a mean of 42.9% and the controls a mean of 55.8% (p = 0.003). For the CHA2DS2-VASc score, the mean values were 3.6 and 3.1 for cases and controls, respectively (p = 0.35). Cardiovascular risk factors showed similar distribution in both groups. Conclusion: p-wave dispersion and left atrial ejection fraction were associated with the cardioembolic patients with sinus rhythm that have gone through ischemic stroke.

A Novel Pulmonary Valve Replacement Surgery Strategy Using Contracting Band for Patients With Repaired Tetralogy of Fallot: An MRI-Based Multipatient Modeling Study.

Patients with repaired Tetralogy of Fallot (ToF), a congenital heart defect which includes a ventricular septal defect and severe right ventricular outflow obstruction, account for the majority of cases with late-onset right ventricle (RV) failure. Current surgery procedures, including pulmonary valve replacement (PVR) with right ventricle remodeling, yield mixed results. PVR with active band insertion was hypothesized to be of clinical usage on improving RV function measured by ejection fraction (EF). In lieu of risky open-heart surgeries and experiments on animal and human, computational biomechanical models were adapted to study the impact of PVR with five band insertion options. Cardiac magnetic resonance (CMR) images were acquired from seven TOF patients before PVR surgery for model construction. For each patient, five different surgery plans combined with passive and active contraction band with contraction ratio of 20, 15, and 10% were studied. Those five plans include three single-band plans with different band locations; one plan with two bands, and one plan with three bands. Including the seven no-band models, 147 computational bi-ventricle models were constructed to simulate RV cardiac functions and identify optimal band plans. Patient variations with different band plans were investigated. Surgery plan with three active contraction bands and band active contraction ratio of 20% had the best performance on improving RV function. The mean ± SD RV ejection fraction value from the seven patients was 42.90 ± 5.68%, presenting a 4.19% absolute improvement or a 10.82% relative improvement, when compared with the baseline models (38.71 ± 5.73%, p = 0.016). The EF improvements from the seven patients varied from 2.87 to 6.01%. Surgical procedures using active contraction bands have great potential to improve RV function measured by ejection fraction for patients with repaired ToF. It is possible to have higher right ventricle ejection fraction improvement with more bands and higher band active contraction ratio. Our findings with computational models need to be further validated by animal experiments before clinical trial could become possible.

Clinical profile and causes of death according to ejection fraction in patients with heart failure cared for in a specialized Cardiology unit

Background and objectivePatients with heart failure are classified into three phenotypes based on left ventricular ejection fraction. This work aimed to compare the clinical profile, treatment, prognosis, and causes of death of patients with heart failure and reduced (<40%, HF-rEF), preserved (≥50%, HF-pEF), or mid-range (40–49%, HF-mrEF) left ventricular ejection fraction. MethodsAn analysis was conducted on the clinical data included in a prospective registry of patients with heart failure who were referred to a specific Cardiology unit from 2010 to 2019. ResultsA total of 1404 patients with HF-rEF, 239 patients with HF-mrEF, and 266 patients with HF-pEF were analyzed. Significant differences were observed among the groups in regard to several clinical characteristics and the frequency of prescription of neurohormonal blocking drugs. A multivariate Cox regression revealed an increased risk of all-cause mortality in patients with HF-pEF (hazard ratio 1.36; 95% confidence interval 1.03–1.80; p = 0.028) and patients with HF-mrEF (hazard ratio 1.36; 95% confidence interval 1.03–1.78; p = 0.029) as compared to patients with HF-rEF. Heart failure was the most frequent cause of death in the three subgroups. A higher relative weight of sudden death as a cause of death was observed among patients with HF-rEF while the relative weight of non-cardiovascular causes of death was higher among patients with HF-pEF and HF-mrEF. ConclusionsThis study confirms the existence of significant differences among patients with HF-rEF, HF-mrEF, and HF-pEF with regard to their clinical profile, therapeutic management, prognosis, and causes of death.

Progrostic impact of a pre-existing heart failure with preserved ejection fraction in patients with acute pulmonary embolism or paroxysmal atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf none Introduction heart failure with preserved ejection fraction (HFpEF) is a growing public health problem. Its prevalence among heart failure patients increases over time, accounting for at least 50 % of all hospital admissions for HF. Nevertheless, no single guideline exists for diagnosis or treatment for HFpEF, and older age or comorbidities are additional factors that confuse etiology and complicate prognosis. Moreover, there are few data regarding the consequences of HFpEF on other recurrent pathologies. Aims to assess the prognostic impact of a pre-existing HFpEF on patients ospidalized for intercurrent episodes of atrial fibrillation (AF) or acute pulmonary embolism (PE) Methods We performed a retrospective evaluation of 194 patients, consecutively hospitalized in our unit of Cardiology with a diagnosis of paroxysmal AF or acute PE, from April 2017 to October 2020. We recruited exclusively patients with normal cardiac function and HFpEF patients. Heart failure with reduced FEVS patients were excluded from the study. We have described for each patient the demographic and clinical characteristics, comorbidities, instrumental test results and clinical outcomes. In order to assess, for each group, the relationship between patient characteristics and clinical outcomes, the Chi-square test or alternatively the Pearson-Spearman correlation coefficients were calculated. Results the 194 patients studied had an average age of 73,7 years (min. 27, max 94). 59 AF patients had pre-existing HFpEF, whereas AF patients without HF were 67. Patients with pre-existing HFpEF and newly-onset AF had a more advanced age (76,7 y vs 72,9 y), and greater comorbidity (meanly 4 vs 3) rather than AF patients without HFpEF. Moreover, percentage of converting arrhythmia were significantly higher in AF patients without HFpEF. . Patients with acute PE and pre-existing HFpEF were 38, whereas PE patients without HF were 30. Acute PE patients with pre-existing HFpEF had older age, a prevalence for femal sex, more comorbidities, an average longer hospitalizations, but no significantly different rates of severe complications (ictus, hemorrhagies, needs for ventilation, pulmonary infarction or deaths) rather than PE patients without HFpEF. Conclusions the patients with AF or PE and concomitant HFpEF that were hospitalized from April 2017 to October 2020, showed an average longer hospitalization, a lower percentage of converting arrhythmia, probably due to the older age and the greater comorbidity.

Prognostic value of ejection fraction in patients admitted with acute coronary syndrome

Left ventricular (LV) systolic dysfunction after an acute coronary syndrome (ACS) is a frequent complication, which is influenced by several factors. Importantly, its presence increases the risk of death. The aim of this study was to examine the relationship between left ventricular ejection fraction (LVEF) with long-term prognosis in a cohort of patients with ACS. This is a prospective observational study of 404 patients consecutively admitted for ACS from January 2019 to November 2019. We studied 404 patients presented with ACS: seventy-nine of them (19.55%) had LVEF < 40% (first group) and 325 (80.45%) had LVEF ≥ 40% (second group). In the first group the prevalence of ST elevated myocardial infarction (STEMI) (73% vs. 49%; P < 0.001) was significantly more important than Non-ST elevated myocardial infarction (NSTEMI) (26% vs. 50%; P < 0.001). Anterior STEMI has a significant higher prevalence when EF was less than 40% (77% vs. 45%; P < 0.001) than the inferior one (22% vs. 57%; P < 0.001). Failure of thrombolysis was associated to LV dysfunction (82% vs. 46%; P = 0.007). Culprit artery in the first group was mostly the left anterior descending artery (LADA) (88% vs. 73%; P = 0.006). The first group patients had a significant longer hospital stay (4 days ± 2 vs. 3 days ± 1; P < 0.001). Kaplan–Meier curves showed that the mortality during the 12 months after the ACS was statistically higher if LVEF < 40% (Log rank = 0.04). Kaplan–Meier curves did not show that MACE was statistically different depending on LVEF (Log rank = 0.7) ( Fig. 1 ). In ACS, long-term prognosis is considerably worse in patients who develop LV dysfunction with an ejection fraction less than 40% than in patients with LVEF ≥ 40.

Artificial intelligence-enabled electrocardiograms for identification of patients with low ejection fraction: a pragmatic, randomized clinical trial.

We have conducted a pragmatic clinical trial aimed to assess whether an electrocardiogram (ECG)-based, artificial intelligence (AI)-powered clinical decision support tool enables early diagnosis of low ejection fraction (EF), a condition that is underdiagnosed but treatable. In this trial ( NCT04000087 ), 120 primary care teams from 45 clinics or hospitals were cluster-randomized to either the intervention arm (access to AI results; 181 clinicians) or the control arm (usual care; 177 clinicians). ECGs were obtained as part of routine care from a total of 22,641 adults (N = 11,573 intervention; N = 11,068 control) without prior heart failure. The primary outcome was a new diagnosis of low EF (≤50%) within 90 days of the ECG. The trial met the prespecified primary endpoint, demonstrating that the intervention increased the diagnosis of low EF in the overall cohort (1.6% in the control arm versus 2.1% in the intervention arm, odds ratio (OR) 1.32 (1.01-1.61), P = 0.007) and among those who were identified as having a high likelihood of low EF (that is, positive AI-ECG, 6% of the overall cohort) (14.5% in the control arm versus 19.5% in the intervention arm, OR 1.43 (1.08-1.91), P = 0.01). In the overall cohort, echocardiogram utilization was similar between the two arms (18.2% control versus 19.2% intervention, P = 0.17); for patients with positive AI-ECGs, more echocardiograms were obtained in the intervention compared to the control arm (38.1% control versus 49.6% intervention, P < 0.001). These results indicate that use of an AI algorithm based on ECGs can enable the early diagnosis of low EF in patients in the setting of routine primary care.

Hyperuricemia as a Marker of Reduced Left Ventricular Ejection Fraction in Patients with Atrial Fibrillation: Results of the POL-AF Registry Study.

Background: Hyperuricemia is an established risk factor for cardiovascular disease, including atrial fibrillation (AF). The prevalence of hyperuricemia and its clinical significance in patients with already diagnosed AF remain unexplored. Methods: The Polish Atrial Fibrillation (POL-AF) registry includes consecutive patients with AF hospitalized in 10 Polish cardiology centers from January to December 2019. This analysis included patients in whom serum uric acid (SUA) was measured. Results: From 3999 POL-AF patients, 1613 were included in the analysis. The mean age of the subjects was 72 ± 11.6 years, and the mean SUA was 6.88 ± 1.93 mg/dL. Hyperuricemia was found in 43% of respondents. Eighty-four percent of the respondents were assigned to the high cardiovascular risk group, and 45% of these had SUA >7 mg/dL. Comparison of the extreme SUA groups (<5 mg/dL vs. >7 mg/dL) showed significant differences in renal parameters, total cholesterol concentration, and left ventricular ejection fraction (EF). Multivariate regression analysis showed that SUA >7 mg/dL (OR 1.74, 95% CI 1.32–2.30) and GFR <60 mL/min/1.73 m2 (OR 1.94, 95% CI 1.46–2.48) are significant markers of EF <40% in the study population. Female sex was a protective factor (OR 0.74, 95% CI 0.56–0.97). The cut-off point for SUA with 60% sensitivity and specificity indicative of an EF <40% was 6.9 mg/dL. Conclusions: Although rarely assessed, hyperuricemia appears to be common in patients with AF. High SUA levels may be a significant biomarker of reduced left ventricular EF in AF patients.

Effects of sacubitril/valsartan on clinical symptoms, echocardiographic parameters, and outcomes in HFrEF and HFmrEF patients with coronary heart disease and chronic kidney disease

Objective To compare the effects of Angiotensin Receptor-Neprilysin inhibitor (ARNI) on the clinical symptoms, echocardiographic parameters, and outcomes (cardiovascular death and hospitalization) in heart failure with reduced ejection fraction (HFrEF) and heart failure with mid-range ejection fraction (HFmrEF) patients with coronary heart disease and chronic kidney disease. Method A retrospective observational study was conducted from January 2018 to May 2019, with a follow-up period of 95.4 ± 57.8 days (8 months). Data from 127 patients were included. Results A statistically significant increase of 68.8% was observed in left ventricular ejection fraction (LVEF) in HFrEF patients compared to that in HFmrEF patients, with an increase of 27.2% at 8 months of follow-up. Sacubitril/valsartan significantly reduced left ventricular end-systolic volumes (LVESV) in HFrEF patients unlike in HFmrEF patients. The decrease in LVESV was 28.8% in HFrEF patients and 17.1% in HFmrEF patients. A significant reduction in the prevalence of severe secondary mitral regurgitation (EROA > 0.4 cm2) was observed in HFrEF compared to that in HFmrEF patients with the use of sacubitril/valsartan. A reduction of 15.6% was observed in HFrEF patients, whereas a reduction of 7.1% was observed in HFmrEF patients. Improvement in functional classification (NYHA) was observed during follow-up. The prevalence of (NYHA III) reduced from 50% to 15.7% in HFrEF patients, whereas a reduction from 21.1% to 8.8% was observed in HFmrEF patients. There was a significant reduction in NT-proBNP in HFrEF patients compared to that in HFmrEF patients. A reduction of 52% was observed in HFrEF patients, whereas a reduction of 28.7% was observed in HFmrEF pateints. Sacubitril/valsartan reduced primary endpoint events in both groups. The prevalence of HF-related hospitalization was higher in HFrEF than in HFmrEF patients: 12.1% vs 7.5%, respectively. The prevalence of CV death in HFrEF vs HFmrEF patients was 3.7% vs 0.5%, respectively. Cardiovascular (CV) death was higher in patients with atrial fibrillation in both groups. Conclusion Sacubitril/valsartan significantly improved morphofunctional remodeling parameters and clinical symptoms in HFrEF patients than in HFmrEF patients.

Hospitalization for Heart Failure Among Patients With Diabetes Mellitus and Reduced Kidney Function Treated With Metformin Versus Sulfonylureas: A Retrospective Cohort Study.

BackgroundMetformin and sulfonylurea are commonly prescribed oral medications for type 2 diabetes mellitus. The association of metformin and sulfonylureas on heart failure outcomes in patients with reduced estimated glomerular filtration rate remains poorly understood.Methods and ResultsThis retrospective cohort combined data from National Veterans Health Administration, Medicare, Medicaid, and the National Death Index. New users of metformin or sulfonylurea who reached an estimated glomerular filtration rate of 60 mL/min per 1.73 m2 or serum creatinine of 1.5 mg/dL and continued metformin or sulfonylurea were included. The primary outcome was hospitalization for heart failure. Echocardiogram reports were obtained to determine each patient's ejection fraction (EF) (reduced EF <40%; midrange EF 40%–49%; ≥50%). The primary analysis estimated the cause‐specific hazard ratios for metformin versus sulfonylurea and estimated the cumulative incidence functions for heart failure hospitalization and competing events. The weighted cohort included 24 685 metformin users and 24 805 sulfonylurea users with reduced kidney function (median age 70 years, estimated glomerular filtration rate 55.8 mL/min per 1.73 m2). The prevalence of underlying heart failure (12.1%) and cardiovascular disease (31.7%) was similar between groups. There were 16.9 (95% CI, 15.8–18.1) versus 20.7 (95% CI, 19.5–22.0) heart failure hospitalizations per 1000 person‐years for metformin and sulfonylurea users, respectively, yielding a cause‐specific hazard of 0.85 (95% CI, 0.78–0.93). Among heart failure hospitalizations, 44.5% did not have echocardiogram information available; 29.3% were categorized as reduced EF, 8.9% as midrange EF, and 17.2% as preserved EF. Heart failure hospitalization with reduced EF (hazard ratio, 0.79; 95% CI, 0.67–0.93) and unknown EF (hazard ratio, 0.84; 95% CI 0.74–96) were significantly lower in metformin versus sulfonylurea users.ConclusionsAmong patients with type 2 diabetes mellitus who developed worsening kidney function, persistent metformin compared with sulfonylurea use was associated with reduced heart failure hospitalization.

MITRAL ANNULAR PLANE SYSTOLIC EXCURSION-DERIVED FORMULA TO CALCULATE THE EJECTION FRACTION: A SIMPLE, EASY AND RAPID ECHOCARDIOGRAPHY PARAMETER TO ASSES LEFT VENTRICLE SYSTOLIC DYSFUNCTION

Aims &amp; Objectives - MAPSE DERIVED EJECTION FRACTION CAN BE USED AS AN ALTERNATIVE TO THE CONVENTIONAL ECHOCARDIORAPHIC MEASUREMENTS OF EJECION FRACTION IN EVERY DAY CLINICAL PRACTICE WITH PATIENTS WITH LV SYSTOLIC DYSFUNTION &amp; VALIDATION OF MITRAL ANNULAR PLANE SYSTOLIC EXCURSION DERIVED FORMULA TO CALCULATE THE EJECTION FRACTION IN PATIENTS WITH LV SYSTOLIC DYSFUNCTION EF=4.8XMAPSE(mm)+5.8 in adult male &amp; 4.2X MAPSE(mm)+20 in adult female. Our study is Material and Methodobservational, prospective study with cross sectional data collection done in a period of nov 2018 to nov 2019, The study included 151 adult male and female patients with LV systolic dysfunction fullling all inclusion criteria, LVEF measured by average MAPSE and LVEF measured by visual inspection, M–mode, and modied Simpson's rule was statistically correlated to know the validity of MAPSE derived ejection in case of LVsystolic dysfunction. The current study showed a signicant positive correlation Result - between average MAPSE and EF measured by Mmode (r =0.980, P &lt; 0.001), EF measured by Simpson's rule (r =0.968, P &lt; 0.001), and EF measured by visual inspection(r =0.960, P &lt; 0.001). The mean differences in the EF derived by MAPSE formula between the inter-observer was(-0.14 ± 3.18 ). MAPSE-derived EF using Conclusion - the equation EF = 4.8 × MAPSE (mm) + 5.8 for male and EF = 4.2×MAPSE (mm)+20 for female, is a valid echocardiographic parameter in adult males and females with impaired LV systolic function to asses global LV longitudinal function with minimal interobserver variability.

CORRELATION OF SERUM URIC ACID WITH SEVERITY OF HEART FAILURE

OBJECTIVE: To evaluate serum uric acid levels in patients with heart failure and to study the relationship of serum uric acid level with left ventricular Ejection Fraction in patients of heart failure. METHOD: The study was a hospital based observational cross-sectional study conducted in MLN Medical College, Prayagraj, carried out over a period of 12 months from March 2019 to February 2020. 130 patients presenting with Heart Failure as diagnosed by Framingham Criteria of Heart Failure were included in this study. RESULT: Out of 130 subjects with heart failure 10 (7.7%) had preserved ejection fraction, 49 (37.7%) had mid-range EF and 71 (54.6%) reduced ejection fraction. Serum Uric acid level was increased in more than two-third (72.3%) of our study population. Mean serum uric acid of study subjects was 8.19±2.56 mg/dl. Mean serum uric acid was signicantly increased with severity of heart failure. In NYHAclass I/II mean serum uric acid was 6.82±1.80 and in NYHAclass IV it was 10.37±3.36mg/dl. CONCLUSION: Moderate negative correlation was observed between Serum uric acid level and left ventricular ejection fraction which was found statistically signicant (r value =-0.37; p value &lt;0.001).

Theoretical and practical aspects of the use of biomarkers in chronic heart failure

Heart failure (HF) remains a major problem in the modern healthcare system, which is a significant cause of hospitalizations, disability and mortality among the population. Left ventricular (LV) ejection fraction (EF) remains one of the main criteria for distribution HF patients into groups and on which the tactics of observation and treatment depend. The European Society of Cardiology distinguishes HF with preserved EF, HF with mid‑range EF, and HF with a reduced EF. Recently, to assess the risks, scientists have divided patients with HF into the following phenotypes according to the left ventricular ejection fraction: stable HF with preserved EF, stable HF with a reduced EF, HF with an increase in EF and HF with a decrease in EF. It has been proven that the lowest mortality rate in the HF group with an increase in EF is 17 %, and the highest mortality rate in the HF group with a decrease in EF is 43 %. From this point of view, special attention is drawn to the HF with mid‑range EF group, since the left ventricular ejection fraction in patients of this group changes more actively than in others (according to studies, after 1 year, the left ventricular ejection fraction increased in 44 % of patients, and decreased in 16 % of cases). To predict changes in the left ventricular ejection fraction, it is promising to determine the levels of biomarkers in the blood. It is known that NT‑proBNP is the most studied and informative cardiac biomarker. Its level in blood plasma correlates with the left ventricular ejection fraction, but focusing only on it is impossible to predict changes in the left ventricular ejection fraction. Moreover, the accuracy of NT‑proBNP determination in the diagnosis and prediction of heart failure is only 75 — 80 %. Other most researched biomarkers, such as galectin‑3, sST‑2, GDF‑15, and high‑sensitivity troponins, separately from each other, were ineffective in predicting changes in left ventricular ejection fraction. Therefore, a multi‑marker forecasting strategy is gaining popularity. The article talks about chronic heart failure (CHF), gives its definition and classification by the left ventricular ejection fraction. A review of modern studies demonstrating the relevance of predicting changes in left ventricular ejection fraction is given, data on the main promising cardiac biomarkers, such as NP, galectin‑3, sST‑2, GDF‑15 and highly sensitive troponins, their advantages and disadvantages in diagnosis and risk stratification in patients with CHF. Including the results of studies of furin, which is a pro‑BNP‑convertase and a promising cardiac biomarker as a component of a multimarker model for predicting the course of heart failure.

Improvement of Ejection Fraction in Patients undergoing Coronary Artery Bypass Grafting with Impaired Left Ventricular Function

Background Myocardial revascularization surgery has shown better long term survival expectancy compared to medical therapy in patient with impaired left ventricular function.&#x0D; Objective To evaluate the change in ejection fraction after 90 days in patients who underwent coronary artery bypass surgery and had preoperative left ventricular ejection fraction of less than and equal to 45% in a single cardiac center of Nepal over the period of 2 years.&#x0D; Method Out of 82 eligible patients during 2 years, 3 patients expired in immediate postoperatively and 24 patients had loss of 90 days’ follow up. So, they were excluded from the study. Total 55 patients were taken for the study for whom statistical analysis was done to compare preoperative ejection fraction with post-operative 90 days’ ejection fraction.&#x0D; Result Single vessel disease was present in 2(3.6%) patients, double vessel disease in 7(12.7%) patients and triple vessel disease in 46(83.6%) of the patients. In 2(3.6%) patients 2 grafts, in 18(32.7%) patients 3 grafts, in 33(60%) patients 4 grafts and in 2(3.6%) patients 5 grafts were placed for revascularization. The mean left ventricular EF in preoperative patients was 37.12±5.69% which improved to 45.80±10.00% in postoperative follow up at 90 days which was statistically significant (p=0.000).&#x0D; Conclusion Surgical revascularization of myocardium in preoperatively impaired left ventricular function patients helps improve left ventricular ejection fraction postoperatively. So we suggest surgical revascularization in patient with low ejection fraction for improvement of myocardial function. Hence improve survival rate in these patients.

Clinical impact of the correction of the value of the left ventricular ejection fraction in patients with mitral valve regurgitation

Clinical impact of the correction of the value of the left ventricular ejection fraction in patients with mitral valve regurgitation

Global Left Ventricular Myocardial Work Efficiency and Long-Term Prognosis in Patients After ST-Segment-Elevation Myocardial Infarction.

Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction in patients with ST-segment-elevation myocardial infarction. However, LV global longitudinal strain does not take into consideration the effect of afterload. Novel speckle-tracking echocardiographic indices of myocardial work integrate blood pressure measurements (afterload) with LV global longitudinal strain. The present study aimed to investigate the prognostic value of global LV myocardial work efficiency (GLVMWE; reflecting LV performance) obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction. A total of 507 ST-segment-elevation myocardial infarction patients (mean age, 61±11 years; 76% men) were retrospectively analyzed. LV ejection fraction and GLVMWE were measured by transthoracic echocardiography within 48 hours of admission. GLVMWE was defined as the ratio of constructive work divided by the sum of constructive and wasted work in all LV segments and expressed as a percentage. Spline curve analysis was used to define the association between reduced GLVMWE and all-cause death. After a median follow-up of 80 months (interquartile range, 67-97 months), 40 (8%) patients died. Patients with reduced GLVMWE (<86%) showed higher cumulative rates of all-cause mortality (17.5% versus 4.7%; log-rank P<0.001) in comparison with patients with preserved GLVMWE (≥86%). Reduced GLVMWE (<86%) showed an independent association with all-cause mortality (hazard ratio, 3.167 [95% CI, 1.679-5.972]; P<0.001). Reduced GLVMWE (<86%) measured by transthoracic echocardiography within 48 hours of admission in ST-segment-elevation myocardial infarction patients is associated with worse long-term survival.

Association of Pulmonary Hypertension With Inflammatory Markers and Volume Status in Hemodialysis Patients of End-Stage Renal Disease.

Background and objectivesPulmonary hypertension (PH) is an independent risk factor for increased mortality, especially in patients undergoing hemodialysis (HD), but the mechanism of its development is unknown. This study aimed at evaluating volume overload and inflammation as potential variables to cause its development in patients undergoing maintenance hemodialysis.Materials and methodsThis was an observational cross-sectional study conducted on patients undergoing hemodialysis at a tertiary hospital in northern India. Patients of end-stage renal disease, aged 18 years or more, on maintenance hemodialysis for over two months were included in the study. The patients were divided into two groups based on the presence or absence of PH, determined by measuring systolic pulmonary arterial pressure (SPAP). The severity of PH was defined as: mild (SPAP 35-45 mmHg), moderate (SPAP 46-55 mmHg), and severe (SPAP> 55mmHg). The two groups were evaluated for demographic variables, type of vascular access, biochemical parameters, and markers of inflammation and fluid overload. Data between the two groups were compared statistically.ResultsThis study included a total of 82 patients showing the prevalence of PH to be 25.6% with a men-to-women ratio of 2:1. Out of 21 cases of PH, mild PH was found in seven (33.3%) cases, moderate in 14 (66.7%), and cases with severe PH were none. The two groups differed significantly in ejection fraction and markers of inflammation and volume status. Laboratory data associated with PH were alpha-1-acid glycoprotein (p<0.05) and pro-b-type natriuretic peptide (p <0.05).ConclusionThe present study showed higher levels of inflammatory markers alpha-1-acid glycoprotein and pro-b-type natriuretic peptide and lower levels of ejection fraction in patients undergoing HD, indicating a significant association with PH.

Novel algorithms for diagnosing heart failure with preserved ejection fraction in patients with hypertension and obesity

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome associated with frequent hospitalizations, high mortality rates, and an absence of proven effective therapy. This type of heart failure is often accompanied by comorbidity that complicate the diagnosis of the underlying disease. The algorithm developed in 2016 does not take into account the heterogeneity of patients and course of HFpEF. Recently, new diagnostic algorithms (H2FPEF, HFA-PEFF) and biomarkers have appeared that allow detecting HFpEF at an early stage, taking into account the pathogenesis, which may contribute to development of new effective treatment methods.

Late improvement of left ventricular ejection fraction in patients with persistent severe systolic dysfunction under guideline-directed medical therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background. A consistent proportion of patients with dilated cardiomyopathy (DCM) experience left ventricular reverse remodelling (LVRR) during the first 24 months of guideline-directed medical therapy (GDMT). However, important decisions, such as the need for ICD, are requested after 3 months of GDMT. The evolution of left ventricular ejection fraction (LVEF) during the first years after GDMT in DCM is unknown. Purpose. Our study aims to investigate the proportion and characterise DCM patients experiencing late LVEF improvement. Methods. We analysed DCM patients consecutively enrolled with short disease duration, recent initiation of GDMT (≤ 3 months) and a LVEF ≤ 35% at 6-month follow-up evaluation. LVEF &amp;gt; 35% at 24-month was the primary end-point of the study. Results. Among 131 patients (mean age 53 ± 14, male sex 74%), 88 (67%) improved their LVEF at 24 months above 35%. A &amp;gt; 10% reduction of the indexed left ventricular end-diastolic diameter (LVEDDi) between enrolment and 6-month evaluation emerged as the only independent predictor of late LVEF improvement. During the subsequent follow-up, the late LVEF improvement was associated with a lower cumulative incidence of major arrhythmic events, compared to patients with persistent LVEF ≤ 35% (p = 0.010). Conclusions. A high proportion of DCM patients improve their LVEF after more than 3-6 months of GDMT, which is associated with lower long-term arrhythmic risk. The early evaluation of dynamic parameters, such as the reduction of LVEDDi could help to identify those patients. Baseline population characteristics Total (131) LVEF &amp;gt; 35% at 24 months (88) LVEF ≤ 35% at 24 months (43) p Age (years) 53 ± 14 52 ± 14 54 ± 14 0.52 LVEF (%) 28.4 ± 5.6 29.2 ± 5.3 26.7 ± 5.8 0.02 LVEDDi (mm/m2) 34.9 ± 4.6 34.1 ± 4.7 36.5 ± 4.1 0.01 LVEDVi (ml/m2) 89.4 ± 34.2 83.7 ± 28.5 101.0 ± 41.5 0.01 RV dysfunction normalisation or persistence of normal RV function* 92 (84.4) 59 (84.3) 33 (84.6) 0.96 RFP disappearance* 115 (93.5) 80 (95.2) 35 (89.7) 0.25 MR improvement or persistence of mild/absent MR* 91 (72.2) 66 (78.6) 25 (59.5) 0.02 LVEF improvement* 30 (22.9) 21 (23.9) 9 (20.9) 0.7 LVEDDi reduction* 28 (23.7) 25 (32.1) 3 (7.5) 0.003 Values are presented as n (%) or mean ± SD. *Dynamic parameters are evaluated as change from enrollment to the 6-months evaluation. LVEDDi left ventricular end-diastolic diameter indexed; LVEDVi: left ventricular end diastolic volume indexed; LVEF: left ventricular ejection fraction; MR: mitral regurgitation; RFP: restrictive filling pattern; RV: right ventricular. Abstract Figure. Major outcome