Chronic Heart Failure: Diagnosis and Management beyond LVEF Classification

Triposkiadis, Filippos; Starling, Randall C.

doi:10.3390/jcm11061718

Cited by 10 publications

(9 citation statements)

References 17 publications

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“…LVEF is a crucial factor for the diagnosis, classi cation and treatment of heart failure [34]. research has shown that an increase in LVEF can largely improve the prognosis of patients with heart failure [35].Our pooled results demonstrated that an increase in LVEF was associated with a corresponding decrease risk of HF-RAEs in patients with HCM (HR=0.96,95%CI(0.95,0.97)).…”

Section: Discussionmentioning

confidence: 61%

the incidence rate and prognostic factors of heart failure-related adverse events in hypertrophic cardiomyopathy: A systematic review and meta-analysis

Jiang

Sun

et al. 2023

Preprint

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Introduction heart failure is a common comorbidities of hypertrophic cardiomyopathy（HCM）, The mortality and hospitalization rates of heart failure-related in patients with HCM is constantly increasing，However, Prognosis and risk assessment of heart failure-related adverse events（HF-RAEs）in patients with HCM is controversial. Therefore, this study aimed to systematically review and conduct a meta-analysis of the incidence rate and predictors of HF-RAEs in patients with HCM. Methods PubMed, Embase, Web of science, and Cochrane library were searched to identify studies that compared the incidence rate and predictors of HF-RAEs in patients with HCM. The outcomes of interest included the incidence rate and predictors of HF-RAEs, such as sex, atrial fibrillation, hypertension, left ventricular ejection fraction (LVEF), left atrial diameter. Results fourteen studies comprising 6,903 patients were included. The pooled results showed a higher incidence (11%) of HF-RAEs in patients with HCM. Some clinical and imaging parameters, such as male gender (HR = 1.963, 95% CI (1.354, 2.847)), atrial fibrillation（HR=2.60,95%CI（1.87,3.61））, left atrial diameter (HR = 1.06, 95% CI (1.04, 1.07)) ,and LVEF (HR=0.96,95%CI(0.95,0.97)) could be used as predictors of the occurrence of HF-RAEs in patients with HCM, while hypertension (HR=1.47,95%CI (0.99,2.20) could not. Conclusion Patients with HCM have a higher incidence of HF-RAEs. Clinical indicators, as well as imaging parameters could predict the risk of HF-RAEs in patients with HCM. These risk factors should be closely monitored to effectively prevent the occurrence of HF-RAEs in HCM.

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Section: Discussionmentioning

confidence: 61%

the incidence rate and prognostic factors of heart failure-related adverse events in hypertrophic cardiomyopathy: A systematic review and meta-analysis

Jiang

Sun

et al. 2023

Preprint

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“…Current knowledge leads to a wide phenotype spectrum with frequent overlapping [ 72 ]. A novel HF classification could be developed from new technologies and scientific discoveries that will allow a deeper understanding of HF beyond LVEF [ 73 ]. A multi-modality model including cardiac function assessment, vascular adaptations, detailed environmental and lifestyle information, and laboratory and biomolecular fingerprints coming from big data analysis may clarify the distinct phenotype and address a specific therapeutic response.…”

Section: The Favourable Data Coming From Hfpef Trials Beyond Ejection...mentioning

confidence: 99%

Does the Measurement of Ejection Fraction Still Make Sense in the HFpEF Framework? What Recent Trials Suggest

Palazzuoli

Correale²,

Iacoviello³

et al. 2023

JCM

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Left ventricular ejection fraction (LVEF) is universally accepted as a cardiac systolic function index and it provides intuitive interpretation of cardiac performance. Over the last two decades, it has erroneously become the leading feature used by clinicians to characterize the left ventricular function in heart failure (HF). Notably, LVEF sets the basis for structural and functional HF phenotype classification in current guidelines. However, its diagnostic and prognostic role in patients with preserved or mildly reduced contractile function is less clear. This is related to several concerns due to intrinsic technical, methodological and hemodynamic limitations entailed in LVEF measurement that do not describe the chamber’s real contractile performance as expressed by pressure volume loop relationship. In patients with HF and preserved ejection fraction (HFpEF), it does not reflect the effective systolic function because it is prone to preload and afterload variability and it does not account for both longitudinal and torsional contraction. Moreover, a repetitive measurement could be assessed over time to better identify HF progression related to natural evolution of disease and to the treatment response. Current gaps may partially explain the causes of negative or neutral effects of traditional medical agents observed in HFpEF. Nevertheless, recent pooled analysis has evidenced the positive effects of new therapies across the LVEF range, suggesting a potential role irrespective of functional status. Additionally, a more detailed analysis of randomized trials suggests that patients with higher LVEF show a risk reduction strictly related to overall cardiovascular (CV) events; on the other hand, patients experiencing lower LVEF values have a decrease in HF-related events. The current paper reports the main limitations and shortcomings in LVEF assessment, with specific focus on patients affected by HFpEF, and it suggests alternative measurements better reflecting the real hemodynamic status. Future investigations may elucidate whether the development of non-invasive stroke volume and longitudinal function measurements could be extensively applied in clinical trials for better phenotyping and screening of HFpEF patients.

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“…28 The echocardiographically estimated LVEF is used as a study indicator of Pacing-Induced Cardiomyopathy, knowing, of course, the limitations of this indicator in terms of the impact of clinical endpoints and mortality in patients with heart failure. 29 The older studies by Zanon 2018) included 75 patients in each study, recording less heart failure hospitalization and a trend in lower mortality in patients with >40% ventricular pacing, as well as no difference in patients with atrial fibrillation, in HBP group. 27,33 The largest study is that of Abdelrahman et al (2018), a two-center study that included 304 consecutive patients with HBP and 433 patients with RV pacing at a sister hospital.…”

Section: Pacing For Bradycardiamentioning

confidence: 99%

Conduction System Pacing: How far are we from the “electrical” bypass?

Sdogkos

Iliodromitis²,

Xanthopoulos

et al. 2023

Preprint

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Conduction system pacing is an alternative practice to conventional right ventricular apical pacing. It is a method that maintains physiologic ventricular activation, based on a correct pathophysiological basis, in which the pacing lead bypasses the lesion of the electrical fibers, and the electrical impulse transmits through the intact adjacent conduction system. For this reason, it might reasonably characterized by the term “electrical bypass” compared to the coronary artery bypass in revascularization therapy. In this review reference is made to the sequence of events that conventional right ventricular pacing may cause adverse outcomes. Furthermore, there is a reference to alternative strategies and pacing sites. Interest focuses on the modalities for which there is data from the literature, namely for the Right Ventricular (RV) septal pacing, the His Bunde pacing (HBP), and the Left Bundle Branch pacing (LBBP). A more extensive reference is about the HBP, for which there are the most updating data. We analyze the considerations that limit HBP wide application in three axes, and we also present the data for the implantation and follow-up of these patients. Then, the indications with their most important studies to date are described in detail, not only in their undoubtedly positive findings but also in their weak aspects, because of which, this pacing mode has not yet received a strong recommendation for implementation. Finally, there is a report on LBBP, focusing mainly on its points of differentiation from HBP.

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Chronic Heart Failure: Diagnosis and Management beyond LVEF Classification

Abstract: The classification, phenotyping, and management of heart failure (HF) has been based on the left ventricular (LV) ejection fraction (LVEF) [...]

Cited by 10 publications

References 17 publications

the incidence rate and prognostic factors of heart failure-related adverse events in hypertrophic cardiomyopathy: A systematic review and meta-analysis

the incidence rate and prognostic factors of heart failure-related adverse events in hypertrophic cardiomyopathy: A systematic review and meta-analysis

Does the Measurement of Ejection Fraction Still Make Sense in the HFpEF Framework? What Recent Trials Suggest

Conduction System Pacing: How far are we from the “electrical” bypass?

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