In the community, more than half of patients with HF have preserved EF, and isolated diastolic dysfunction is present in more than 40% of cases. Ejection fraction and diastolic dysfunction are independently related to higher levels of BNP. Heart failure with preserved EF is associated with a high mortality rate, comparable to that of patients with reduced EF.

Background-Mechanisms purported to contribute to the pathophysiology of heart failure with normal ejection fraction (HFnlEF) include diastolic dysfunction, vascular and left ventricular systolic stiffening, and volume expansion. We characterized left ventricular volume, effective arterial elastance, left ventricular end-systolic elastance, and left ventricular diastolic elastance and relaxation noninvasively in consecutive HFnlEF patients and appropriate controls in the community. Methods and Results-Olmsted County (Minn) residents without cardiovascular disease (nϭ617), with hypertension but no heart failure (nϭ719), or with HFnlEF (nϭ244) were prospectively enrolled. End-diastolic volume index was determined by echo Doppler. End-systolic elastance was determined using blood pressure, stroke volume, ejection fraction, timing intervals, and estimated normalized ventricular elastance at end diastole. Tissue Doppler eЈ velocity was used to estimate the time constant of relaxation. End-diastolic volume (EDV) and Doppler-derived end-diastolic pressure (EDP) were used to derive the diastolic curve fitting (␣) and stiffness (␤) constants (EDPϭ␣EDV ␤ ). Comparisons were adjusted for age, sex, and body size. HFnlEF patients had more severe renal dysfunction, yet smaller end-diastolic volume index and cardiac output and increased EDP compared with both hypertensive and healthy controls. Arterial elastance and ventricular end-systolic elastance were similarly increased in hypertensive controls and HFnlEF patients compared with healthy controls. In contrast, HFnlEF patients had more impaired relaxation and increased diastolic stiffness compared with either control group. Conclusions-From these cross-sectional observations, we speculate that the progression of diastolic dysfunction plays a key role in the development of heart failure symptoms in persons with hypertensive heart disease.

This study demonstrates that a significant improvement in endothelial function may be obtained after six months of antihypertensive therapy and clearly identifies patients who possibly have a more favorable prognosis.

In the community, MR is frequent and often silent after MI. It carries information to predict heart failure or death among 30-day survivors independently of age, gender, EF, and Killip class. These findings, which are applicable to a large community-based MI cohort, suggest that the assessment of MR should be included in post-MI risk stratification.

Background Few reports described outcomes of complete compared with infarct-related artery (IRA)-only revascularisation in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). Moreover, no studies have compared the simultaneous treatment of non-IRA with the IRA treatment followed by an elective procedure for the other lesions (staged revascularisation). Methods The outcomes of 214 consecutive patients with STEMI and multivessel CAD undergoing primary angioplasty were studied. Before the first angioplasty patients were randomly assigned to three different strategies: culprit vessel angioplasty-only (COR group); staged revascularisation (SR group) and simultaneous treatment of non-IRA (CR group). Results During a mean follow-up of 2.5 years, 42 (50.0%) patients in the COR group experienced at least one major adverse cardiac event (MACE), 13 (20.0%) in the SR group and 15 (23.1%) in the CR group, p<0.001. Inhospital death, repeat revascularisation and rehospitalisation occurred more frequently in the COR group (all p<0.05), whereas there was no significant difference in re-infarction among the three groups. Survival free of MACE was significantly reduced in the COR group but was similar in the CR and SR groups. Conclusions Culprit vessel-only angioplasty was associated with the highest rate of long-term MACE compared with multivessel treatment. Patients scheduled for staged revascularisation experienced a similar rate of MACE to patients undergoing complete simultaneous treatment of non-IRA.Primary percutaneous coronary intervention (PCI) is currently the treatment of choice in patients with acute ST-segment elevation myocardial infarction (STEMI). Coronary artery disease (CAD) is a diffuse process and patients presenting with a coronary syndrome in 20e40% of cases have multiple significant coronary lesions, which confer a substantially increased risk of cardiovascular morbidity and mortality. Contemporary guidelines recommend dilating only the infarct-related artery (IRA) during the urgent procedure, leaving the other stenosed vessels untreated (culprit-only revascularisation) or to dilate during a second elective procedure (staged revascularisation). Simultaneous treatment of IRA and non-IRA is recommended only in patients with cardiogenic shock.4 5 However, these guidelines are based on the results of earlier studies. With advancing technology and newer antiplatelet drugs, outcomes have improved even in patients undergoing multivessel and higher-risk elective procedures. 6 Yet, few reports have described outcomes of multivessel compared with IRA-only revascularisation in patients undergoing urgent mechanical reperfusion for STEMI, 7 8 and none have distinguished simultaneous treatment of non-IRA from the staged approach. Therefore, the optimal management of patients with multivessel disease in this setting remains still unclear.The aim of this study was to compare long-term outcomes of three different strategies during primary PCI in patients with STEMI ...