Heart Function In Patients Research Articles

Evaluating heart function in patients with POEMS syndrome.

Our aim is to investigate the characterized echocardiographic cardiac measurements of POEMS syndrome and determine its relationship with clinical manifestations. The cross-sectional study included 27 treatment-naïve patients with newly diagnosed POEMS syndrome and 26 age- and sex-matched healthy volunteers. Information of clinical manifestations, serological tests, pulmonary function tests, and both conventional echocardiograph and tissue Doppler imaging (TDI) were collected and analyzed. Pearson's correlation coefficient was used for determining the related clinical and echocardiographic parameters. Compared to healthy people, left ventricular (LV) mass index (LVMI) was elevated in patients with POEMS syndrome (41.3±11.0g/m2.7 , P<.05). LV systolic dysfunction was found by decreased mitral S' (9.0±2.2m/sec, P<.01), and diastolic dysfunction by mitral E'/A' (1.10±0.42, P<.05), E/E' (8.69±4.06, P<.001) on lateral, and E/E' (7.90±3.28, P=.133) on septal mitral annulus. The presence of decreased tricuspid annular plane systolic excursion (TAPSE) (22.2±3.5mm, P<.01) and lateral tricuspid S' (11.1±1.8m/sec, P<.05) suggested deterioration of right ventricular (RV) systolic function. Parameters obtained from standard echocardiograph (tricuspid E/A ratio and DT) and TDI ((lateral tricuspid annulus E'/A' and E/E') indicated reduced RV diastolic function. Pulmonary hypertension (PH) was presented in six patients. Correlation analysis suggested that PH was related to total lung capacity (TLC) and diffusion capacity of carbon monoxide (DLCO). Echocardiographic measurements found that there was elevation of LVMI, pulmonary artery hypertension, and subclinical impairment of systolic and diastolic functions of both the right and left heart in patients with POEMS syndrome.

Assessment of RV Systolic Function by Two-Dimensional Speckle Tracking Echocardiography in Patients with Preeclampsia before and after Labor

Background: preeclampsia (PE) is one of the most common causes of maternal mortality and morbidity worldwide. Although cardiovascular (CV) risk is increased after PE, a direct causative relationship has not yet been determined. Aim of the Work: to evaluate and detect subclinical RV dysfunction by 2D speckle tracking echocardiography in preeclamptic patients before and after labor. Patients and Methods: 60 pregnant women were selected for this sectional comparative study which was conducted at Cardiology Department, Faculty of Medicine, Al-Azhar University during the period from October 2018 to June 2019. Results: comparison between before labor and 6 weeks after labor of the right ventricle of the preeclamptic patients showed that tricuspid annular plane systolic excursion (TAPSE) was 22.33 ±3.08 and 26.48 ±2.20, respectively with change of 4.15 (18.6%), with a statistically highly significant difference (p <0.001), end-systolic pulmonary arterial pressure (ESPAP) was 14.65 ±1.63 mmHg and 8.35 ±1.76 mmHg, respectively with change of -6.3 (43%), it showed a statistically highly significant difference (p <0.001), fractional area change (FAC) was 50.55 ±2.25 and 53.40 ±1.66, respectively with change of 2.85 (5.6%), it showed a statistically highly significant difference (p <0.001), right ventricular index of myocardial performance (RIMP) was 41.45 ±2.11 and 33.28 ±2.34, respectively with change of -8.17 (19.7%). Conclusions: two-dimensional speckle echocardiography proved to be acceptable, and applicable for assessing rightsided heart function in patients with preeclampsia. Using this image modality demonstrated significant differences in right ventricular measurements to overcome further morbidity and mortality of those patients

Assessment of RV Systolic Function by Two-Dimensional Speckle Tracking Echocardiography in Patients with Preeclampsia before and after Labor

Background: preeclampsia (PE) is one of the most common causes of maternal mortality and morbidity worldwide. Although cardiovascular (CV) risk is increased after PE, a direct causative relationship has not yet been determined. Aim of the Work: to evaluate and detect subclinical RV dysfunction by 2D speckle tracking echocardiography in preeclamptic patients before and after labor. Patients and Methods: 60 pregnant women were selected for this sectional comparative study which was conducted at Cardiology Department, Faculty of Medicine, Al-Azhar University during the period from October 2018 to June 2019. Results: comparison between before labor and 6 weeks after labor of the right ventricle of the preeclamptic patients showed that tricuspid annular plane systolic excursion (TAPSE) was 22.33 ±3.08 and 26.48 ±2.20, respectively with change of 4.15 (18.6%), with a statistically highly significant difference (p <0.001), end-systolic pulmonary arterial pressure (ESPAP) was 14.65 ±1.63 mmHg and 8.35 ±1.76 mmHg, respectively with change of -6.3 (43%), it showed a statistically highly significant difference (p <0.001), fractional area change (FAC) was 50.55 ±2.25 and 53.40 ±1.66, respectively with change of 2.85 (5.6%), it showed a statistically highly significant difference (p <0.001), right ventricular index of myocardial performance (RIMP) was 41.45 ±2.11 and 33.28 ±2.34, respectively with change of -8.17 (19.7%). Conclusions: two-dimensional speckle echocardiography proved to be acceptable, and applicable for assessing rightsided heart function in patients with preeclampsia. Using this image modality demonstrated significant differences in right ventricular measurements to overcome further morbidity and mortality of those patients

Characterisation of Right Heart Function in Patients with Non-Ischaemic Cardiomyopathy

Characterisation of Right Heart Function in Patients with Non-Ischaemic Cardiomyopathy

The Effect of Atrial Fibrillation on Right Heart Function in Patients with Heart Failure with Reduced Ejection Fraction

Background: Left (LV) and right ventricular (RV) function are proposed to be intimately linked. We previously demonstrated that RV dysfunction increases with severity of LV dysfunction. Atrial fibrillation (AF) is an established cause of LV systolic dysfunction, but its effect on RV size and function in this population is not well characterised. We aim to evaluate the effect of AF on RV systolic function in a cohort of non-ischaemic cardiomyopathy patients. Methods: We compared 64 consecutive patients in sinus rhythm (SR) with 32 patients in AF with stable HFrEF in the absence of coronary artery, significant valvular, congenital, or pulmonary disease. Patients in both SR and AF were categorised based on LVEF (mild 40–49%, moderate 30–39%, severe <30%). Standard and novel echocardiographic parameters of right heart were assessed. RV free wall peak systolic strain (RVFWS) was measured (TomTec Image Arena, Germany v4.6). Results: Patients with SR (mean age 56 ± 19 y; 61% male), and AF (mean age 67 ± 11 y; 75% male) groups had similar proportions of patients in the mild, moderate and severe groups (SR: n = 25, 21, 18 vs AF n = 10, 12, 10, respectively). Conditional regression analysis revealed that patients with AF had significantly worse RV impairment compared to patients with SR as defined by RV fractional area change (RVFAC; p < 0.001) and RVFWS (p < 0.001) across all grades of LV impairment. Conclusions: Our results demonstrate that AF is associated with worse RV impairment compared to patients in SR as defined by RVFAC and RVFWS. This highlights the potential benefits of restoration of SR in this cohort of HFrEF patients.

The association among biomarkers of renal and heart function in patients with heart failure: the role of NGAL.

The NGAL is a biomarker of renal injury associated with the progression of heart failure (HF). We examine the association of NGAL with galectin-3 in patients with chronic HF. We consecutively enrolled 115 subjects with stable ischemic HF of reduced ejection fraction. Serum levels of galectin-3, b-type natriuretic peptide and NGAL were measured. NGAL levels were positively correlated with galectin-3 (rho=0.26; p=0.04) and b-type natriuretic peptide levels (rho=0.30; p=0.005) and inversely correlated with ejection fraction (rho= -0.31; p=0.02) and creatinine clearance levels. The NGAL was independently associated with galectin-3 levels. A positive correlation between NGAL and galectin-3 in HF patients was found, revealing a potential association between renal injury and myocardial fibrosis and remodeling in HF.

Black Garlic Improves Heart Function in Patients With Coronary Heart Disease by Improving Circulating Antioxidant Levels.

Background: Black garlic (BG) has many health-promoting properties.Objectives: We aimed to explore the clinical effects of BG on chronic heart failure (CHF) in patients with coronary heart disease (CHD).Design: The main components of BG were measured by gas chromatography–mass spectrometry (GC–MS) and its antioxidant properties were determined by the clearance rate of free radicals. One hundred twenty CHF patients caused by CHD were randomly and evenly assigned into BG group and placebo group (CG). The duration of treatment was 6 months. Cardiac function was measured according to the New York Heart Association (NYHA) functional classification system. The following parameters were measured, including walking distance, BNP precursor N-terminal (Nt-proBNP), left-ventricular ejection fraction (LVEF) value, and the scores of quality of life (QOL). The circulating antioxidant levels were compared between two groups.Results: There are 27 main compounds in BG with strong antioxidant properties. BG treatment improved cardiac function when compared with controls (P < 0.05). The QOL scores and LVEF values were higher in the BG group than in the CG group while the concentration of Nt-proBNP was lower in the BG group than in the CG group (P < 0.05). Circulating antioxidant levels were higher in the BG group than in the CG group. Antioxidant levels had positive relation with QOL and LVEF values, and negative relation with Nt-proBNP values.Conclusion: BG improves the QOL, Nt-proBNP, and LVEF in CHF patient with CHD by increasing antioxidant levels.

Association Between 3-Iodothyronamine (T1am) Concentrations and Left Ventricular Function in Chronic Heart Failure.

Thyroid hormone metabolites might affect the heart. The endogenous aminergic metabolite 3-iodothyronamine (T1am) reduces left ventricular ejection fraction (LVEF) in rodents. To investigate concentration of T1am and its association with LVEF and biomarkers of heart function in patients with chronic heart failure (CHF) without thyroid disease, including patients with cardiac cachexia (nonedematous weight loss >5% over 6 months). Cross-sectional study. CHF was characterized by LVEF <45% and symptoms. Three groups were included (n = 19 in each group, matched on age, sex, and kidney function): patients with cachexia (CAC), patients without (non-CAC), and control (C) patients with prior myocardial infarction and LVEF >45%. T1am was measured by a monoclonal antibody-based chemiluminescence immunoassay. N-amino terminal pro-BNP (NT-proBNP) concentrations were also analyzed. Mean (SD) LVEF: CAC, 32 ± 9%; non-CAC, 38 ± 8%; and C, 60 ± 8% (P < 0.0001). TSH, T4, and T3 levels did not differ between groups and did not correlate to T1am. Serum T1am (nmol/L) concentrations were higher in CHF: CAC (mean ± SD), 12.4 ± 6.6; non-CAC, 9.1 ± 5; and C, 7.3 ± 2.9. A negative association between T1am and LVEF was present after adjusting for sex, age, T3, and estimated glomerular filtration rate (P = 0.03). Further, serum T1am levels tended to be associated with NT-proBNP (P = 0.053). Serum T1am levels were increased in patients with CHF and numerically highest (although nonsignificant) in patients with cardiac cachexia. Increasing T1am concentrations were independently associated with reduced LVEF, suggesting a direct effect on the human heart.

GW29-e1212 The Effect of Fragmented QRS Complex on the Left Ventricular Remodeling and Heart Function in Patients with Acute Myocardial Infarction in short-term and long-term

GW29-e1212 The Effect of Fragmented QRS Complex on the Left Ventricular Remodeling and Heart Function in Patients with Acute Myocardial Infarction in short-term and long-term

Short-Term Effects of Tolvaptan in Tricuspid Insufficiency Combined with Left Heart Valve Replacement-Caused Volume-Overload Patients: Results of a Prospective Pilot Study.

Our objective was to explore the effects of tolvaptan as a new therapeutic approach in patients with right heart failure with tricuspid insufficiency (TI). This prospective, multicenter, non-randomized controlled pilot study enrolled patients (N = 40) with TI from the Shanghai Chest Hospital and Shanghai Tongren Hospital who fulfilled inclusion criteria between March 2015 and June 2016. Participants were assigned to receive either tolvaptan combined with torasemide (n = 20) or torasemide monotherapy (n = 20; control group). The primary endpoints were changes in patient weight and in tricuspid annular plane systolic excursion (TAPSE) after 10days of treatment. The secondary endpoints included net fluid balance and cardiac functions before and after medication from the first to the tenth day of treatment. Safety was evaluated by monitoring adverse and serious adverse events. TAPSE significantly increased in the tolvaptan group compared with the control group after 10days of medication (P = 0.029). Daily weight losses in the tolvaptan group significantly increased as the time of treatment increased (time × group, P = 0.022). Recovery to New York Heart Association (NYHA) grade I occurred 4days earlier in the tolvaptan group. In addition, the net fluid balance and median net fluid balance were significantly higher in the tolvaptan group. Eight adverse events and one serious adverse event were recorded in the tolvaptan group and 15 adverse events were recorded in the control group. Our results indicate that tolvaptan might be a useful and safe drug to improve heart function in patients with right heart failure with TI after left heart valve replacement. ClinicalTrials.gov identifier no. NCT02644616.

Myocardial Injury and Cardiac Reserve in Patients With Heart Failure and Preserved Ejection Fraction

BackgroundCardiac reserve is depressed in patients with heart failure and preserved ejection fraction (HFpEF). The mechanisms causing this are poorly understood. ObjectivesThe authors hypothesized that myocardial injury might contribute to the hemodynamic derangements and cardiac reserve limitations that are present in HFpEF. Markers of cardiomyocyte injury, central hemodynamics, ventricular function, and determinants of cardiac oxygen supply–demand balance were measured. MethodsSubjects with HFpEF (n = 38) and control subjects without heart failure (n = 20) underwent cardiac catheterization, echocardiography, and expired gas analysis at rest and during exercise. Central venous blood was sampled to measure plasma high-sensitivity troponin T levels as an index of cardiomyocyte injury. ResultsCompared with control subjects, troponins were more than 2-fold higher in subjects with HFpEF at rest and during exercise (p < 0.0001). Troponin levels were directly correlated with left ventricular (LV) filling pressures (r = 0.52; p < 0.0001) and diastolic dysfunction (r = −0.43; p = 0.002). Although myocardial oxygen demand was similar, myocardial oxygen supply was depressed in HFpEF, particularly during exercise (coronary perfusion pressure–time integral; 44 ± 9 mm Hg × s × min−1 × l × dl−1 vs. 30 ± 9 mm Hg × s × min−1 × l × dl−1; p < 0.0001), and reduced indices of supply were correlated with greater myocyte injury during exercise (r = −0.44; p = 0.0008). Elevation in troponin with exercise was directly correlated with an inability to augment LV diastolic (r = −0.40; p = 0.02) and systolic reserve (r = −0.57; p = 0.0003), greater increases in LV filling pressures (r = 0.55; p < 0.0001), blunted cardiac output response (r = −0.44; p = 0.002), and more severely depressed aerobic capacity in HFpEF. ConclusionsLimitations in LV functional reserve and the hemodynamic derangements that develop secondary to these limitations during exercise in HFpEF are correlated with the severity of cardiac injury, assessed by plasma levels of troponin T. Further study is warranted to determine the mechanisms causing myocyte injury in HFpEF and the potential role of ischemia, and to identify and test novel interventions targeted to these mechanisms. (EXEC [Study of Exercise and Heart Function in Patients With Heart Failure and Pulmonary Vascular Disease]; NCT01418248)

The molecular mechanism of serum microRNA124b induced coronary heart disease by inducing myocardial cell senescence.

The incidence and mortality of coronary heart disease are rapidly increasing in recent years. Myocardial cell dysfunction and cell senescence may play a role in coronary heart disease. MicroRNA controls a variety of biological processes, but leaving its role in coronary heart disease has yet to be explored. Patients with coronary heart disease were regarded as subjects, and healthy volunteers as the control, on both of which microRNA124b level of serum was studied by Real-time PCR, and the heart function of patients was detected by using ultrasound. The relationship between serum microRNA124b level and cardiac function was analyzed along with the model of rat coronary artery disease; the level of aging proteins P21 and P53 in cardiac muscle cells was also tested. MicroRNA124b in the serum of patients with coronary heart disease was increased, and the heart function of patients was decreased (p < 0.05). Serum level of microRNA124b in a rat model of coronary heart disease was increased, and the cardiac function was decreased (p < 0.05). When myocardial cell appeared ageing, the level of P21 and P53 was increased, and the level of microRNA124b was related with P53. The level of microRNA124b in the serum of coronary heart disease patients and rat model may be related to the occurrence of coronary heart disease; microRNA124b may lead to the occurrence of coronary heart disease by causing cell senescence.

Comparison of Clinical Effects between Percutaneous Transluminal Septal Myocardial Ablation and Modified Morrow Septal Myectomy on Patients with Hypertrophic Cardiomyopathy

Background:Percutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy (HCM). This study aimed to determine the clinical outcome of these two strategies.Methods:From January 2011 to January 2015, 226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, after operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher's exact tests. Quantitative variables were compared using the paired samples t-test.Results:Interventricular septal thickness was significantly reduced in both groups (21.27 ± 4.43 mm vs. 18.72 ± 4.13 mm for PTSMA, t = 3.469, P < 0.001, and 21.83 ± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P < 0.001, respectively). The left ventricular outflow tract (LVOT) pressure gradient (PG) significantly decreased after the operations in two groups (70.30 ± 44.79 mmHg vs. 39.78 ± 22.07 mmHg for PTSMA, t = 5.041, P < 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P < 0.001, respectively). Seven patients (10.29%) in the PTSMA group required a repeat operation in the follow-up. Eight (11.76%) patients were evaluated for New York Heart Association (NYHA) III/IV in the PTSMA group, which was significantly more than the five (3.16%) in the same NYHA classes for the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up.Conclusions:Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.

A Retrospective Evaluation of Echocardiograms to Establish Normative Inferior Vena Cava and Aortic Measurements for Children Younger Than 6 Years.

The ability to plot the inferior vena cava (IVC) size on a normal curve for pediatric patients may prove beneficial. First, in patients with normal cardiac anatomy who present in shock, assessing IVC size may be valuable for evaluating the degree of dehydration. Second, in children with heart disease, understanding how a child's IVC size compares to normal could be particularly beneficial for patients with right heart disease. We sought to create normal curves for the IVC and aorta in children younger than 6 years. Data were gathered from 347 echocardiograms of healthy children younger than 6 years in a retrospective study at a quaternary care children's hospital. From the subcostal long- and short-axis images, maximum diameters in the transverse and longitudinal views were obtained for both the IVC and the aorta. Both IVC and aortic dimensions increased in a linear fashion and had excellent correlations with the body surface area, body mass, and height (IVC, r = 0.78-0.81; P < .0001; aorta, r = 0.82-0.86; P < .0001). In children younger than 6 years, the IVC and aorta increase linearly as the children grow. Such normal curves will be beneficial for assessing a pediatric patient's hydration status or right heart function in patients with congenital heart disease.

Left ventricular function of patients with pregnancy-induced hypertension evaluated using velocity vector imaging echocardiography and N-terminal pro-brain natriuretic peptide.

To investigate whether acute and transient pressure overload in patients with pregnancy-induced hypertension (PIH) affects left ventricular (LV) systolic function. From pregnancy to 3months after delivery, 82 patients were analyzed: 27, 25, and 30 with gestational hypertension, preeclampsia, and the healthy control group, respectively. Conventional echocardiography and velocity vector imaging (VVI) were performed, and blood levels of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were analyzed. Compared with the control group, patients with gestational hypertension had significantly lower mean LV peak global longitudinal strain. Importantly, during both pregnancy and after delivery, patients with preeclampsia had significantly lower global longitudinal, circumferential, and radial strain compared with the control group. The NT-pro-BNP levels were significantly higher in patients with PIH compared with normotensive pregnancies, and this situation continued for 3months after delivery in women with preeclampsia. In pregnancies complicated by pregnancy-induced hypertension, especially preeclampsia, the systolic function is impaired and NT-pro-BNP levels are elevated compared with normal pregnancy. Velocity vector imaging (VVI) is more sensitive than left ventricular ejection fraction to evaluate heart function in patients with PIH.

Increased risk of congestive heart failure in patients with acetaminophen poisoning: A nationwide cohort study.

Acetaminophen poisoning increases cytochrome P450 2E1 expression and reactive oxygen species production, which may lead to maladaptive myocardial remodeling and congestive heart failure (CHF). We conducted a nationwide cohort study to investigate the incidence and risk of CHF in patients with acetaminophen poisoning. We identified a cohort of adult patients with newly diagnosed acetaminophen poisoning in the inpatient claims of the Taiwan National Health Insurance Research Database for the 1998-2011 period. A comparison cohort was frequency matched at a 4:1 ratio for sex, age and index year. All patients were followed up until the occurrence of CHF, withdrawal from the National Health Insurance program, or December 31, 2011. Cox proportional hazards models were employed to calculate the risk of CHF in the acetaminophen poisoning cohort compared with the comparison cohort, and the hazard ratios with 95% confidence intervals are presented. A total of 3546 and 14 184 patients with and without acetaminophen poisoning were followed up for a total of 25 856 and 102 119 person-years, respectively. The overall incidence of CHF was higher in the acetaminophen poisoning cohort than in the comparison cohort (8.12 vs. 5.19 per 10 000 person-years). After adjustment for covariates, the acetaminophen poisoning cohort exhibited a 1.59-fold higher risk of CHF (adjusted hazard ratio = 1.59; 95% confidence interval = 1.43-1.75) than did the comparison cohort. Patients with acetaminophen poisoning exhibited a significantly higher risk of CHF compared with the comparison cohort. Clinicians should follow up heart function in patients with acetaminophen poisoning.

Improvement of increased cQTd is associated with heart function in patients with ischemic heart failure.

BackgroundChronic heart failure (CHF) is life-threatening without timely or effective intervention. In this study, we investigated the association between QT dispersion corrected for heart rate (cQTd) and heart function in patients with CHF.MethodsFrom January 2013 to December 2015, we continuously enrolled 240 patients categorized as New York Heart Association functional class (NYHA) III–IV with a left ventricular ejection fraction (LVEF) < 40%. Based on the etiology, the patients were divided into a dilated cardiomyopathy (DCM) group (n = 120) and an ischemic cardiomyopathy (ICM) group (n = 120). Then, based on the cQTd width, the ICM group was divided into two subgroups: a QS group (cQTd ≤ 60 ms, n = 70) and a QL group (cQTd > 60 ms, n = 50). All patients were examined by echocardiography and 12-lead electrocardiography (ECG) at 1, 3, 6, and 12 months after enrollment.ResultsAfter one year of optimized medical treatment, patients in both groups showed significant improvement in LVEF and NYHA classification from baseline. However, the cQTd in the ICM group, especially the QL, was significantly shorter than that in the DCM group at each time point. In addition, the cQTd was negatively correlated with LVEF and 6-min walking test and positively correlated with NYHA class in the ICM group.ConclusionsThe present findings clearly demonstrate that cQTd is a meaningful parameter for assessing heart function in the follow-up of ICM patients.

Tei index for monitoring changes in left heart function in patients with cirrhosis before and after propranolol treatment

Tei index for monitoring changes in left heart function in patients with cirrhosis before and after propranolol treatment

Does Septoplasty Improve Heart Functions of Patients With Septum Deviation in Terms of Echocardiography Findings?

The authors aimed to determine pulmonary artery pressure and right heart functions in patients with nasal septum deviation (NSD) with echocardiography (EchoCG) and compare the postoperative changes of EchoCG parameters with preoperative findings. Seventy-six patients who underwent septoplasty composed the study group. Average age of patients was 23.50 ranging between 18 and 48 years of age. There were 53 males (69.7%) and 23 females (30.3%). Mean pulmonary artery pressure, tricuspid annular-plane systolic excursion, right ventricular diameter, and e/a ratio were measured by EchoCG preoperatively and same parameters were reobtained 3 months after surgery. Mean pulmonary artery pressure reduced from 23.88 ± 6.36 to 19.80 ±3.95 mm Hg and tricuspid annular-plane systolic excursion increased from 22.36 ±3.85 to 23.57±3.00 3 months after surgery. It represented statistically significant improvement at right heart functions postoperatively (P < 0.001). Although they were not statistically significant, there was also some improvement in right ventricular diameter and e/a ratio values postoperatively. Nasal septum deviation was associated with higher PAP values, which were improved after surgery. Although at a lower extent, a negative effect of NSD on right heart functions was also suspected. Thus, treatment of NSD without delay was proposed, not only to treat the nasal symptoms but possible future cardiovascular complications as well.

Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction

BackgroundAortic stiffening and reduced nitric oxide (NO) availability may contribute to the pathophysiology of heart failure with preserved ejection fraction (HFpEF). ObjectivesThis study compared indices of arterial stiffness at rest and during exercise in subjects with HFpEF and hypertensive control subjects to examine their relationships to cardiac hemodynamics and determine whether exertional arterial stiffening can be mitigated by inorganic nitrite. MethodsA total of 22 hypertensive control subjects and 98 HFpEF subjects underwent hemodynamic exercise testing with simultaneous expired gas analysis to measure oxygen consumption. Invasively measured radial artery pressure waveforms were converted to central aortic waveforms by transfer function to assess integrated measures of pulsatile aortic load, including arterial compliance, resistance, elastance, and wave reflection. ResultsArterial load and wave reflections in HFpEF were similar to those in control subjects at rest. During submaximal exercise, HFpEF subjects displayed reduced total arterial compliance and higher effective arterial elastance despite similar mean arterial pressures in control subjects. This was directly correlated with higher ventricular filling pressures and depressed cardiac output reserve (both p < 0.0001). With peak exercise, increased wave reflections, impaired compliance, and increased resistance and elastance were observed in subjects with HFpEF. A subset of HFpEF subjects (n = 52) received sodium nitrite or placebo therapy in a 1:1 double-blind, randomized fashion. Compared to placebo, nitrite decreased aortic wave reflections at rest and improved arterial compliance and elastance and central hemodynamics during exercise. ConclusionsAbnormal pulsatile aortic loading during exercise occurs in HFpEF independent of hypertension and is correlated with classical hemodynamic derangements that develop with stress. Inorganic nitrite mitigates arterial stiffening with exercise and improves hemodynamics, indicating that arterial stiffening with exercise is at least partially reversible. Further study is required to test effects of agents that target the NO pathway in reducing arterial stiffness in HFpEF. (Study of Exercise and Heart Function in Patients With Heart Failure and Pulmonary Vascular Disease [EXEC]; NCT01418248. Acute Effects of Inorganic Nitrite on Cardiovascular Hemodynamics in Heart Failure With Preserved Ejection Fraction; NCT01932606. Inhaled Sodium Nitrite on Heart Failure With Preserved Ejection Fraction; NCT02262078)