High prevalence of exercise-induced heart failure with normal ejection fraction in post-heart transplant patients

Meluzı́n, Jaroslav; Hude, Petr; Leinveber, Pavel; Krejčí, Jan; Špinarová, Lenka; Bedáňová, Helena; Podroužková, Helena; Štěpánová, Radka; Němec, Petr

doi:10.5507/bp.2013.095

Cited by 5 publications

(3 citation statements)

References 39 publications

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“…As Meluzin et al reported 10 —16% of HTx subjects had signs of diastolic dysfunction in rest conditions (14.6% in this study), but other 58% showed signs of diastolic impairment in stress conditions 10 . While the difference in PTT was not significant, PTTc, PTT_S and PTTc_S were significantly lower in the CCS group than the HTx_A subgroup, which follows our assumption.…”

Section: Discussionsupporting

confidence: 50%

“…PTT has already shown to be increased in both heart failure with reduced and preserved ejection fraction 6 , 9 . As previously published by Meluzin et al 10 , by pulmonary capillary wedge pressure acquired by right heart catheterization, 16% of patients after heart transplant (HTx) showed signs of diastolic dysfunction in rest condition, but in stress condition, another 58% showed these signs 10 . Therefore, we hypothesise that in a population after HTx, the stress biomarkers will be prolonged compared to a group of patients without any signs of systolic or diastolic function impairment.…”

Section: Introductionmentioning

confidence: 75%

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Stress pulmonary circulation parameters assessed by a cardiovascular magnetic resonance in patients after a heart transplant

Opatřil

Panovský

Mojica-Pisciotti

et al. 2022

Sci Rep

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Rest pulmonary circulation parameters such as pulmonary transit time (PTT), heart rate corrected PTT (PTTc) and pulmonary transit beats (PTB) can be evaluated using several methods, including the first-pass perfusion from cardiovascular magnetic resonance. As previously published, up to 58% of patients after HTx have diastolic dysfunction detectable only in stress conditions. By using adenosine stress perfusion images, stress analogues of the mentioned parameters can be assessed. By dividing stress to rest biomarkers, potential new ratio parameters (PTT ratio and PTTc ratio) can be obtained. The objectives were to (1) provide more evidence about stress pulmonary circulation biomarkers, (2) present stress to rest ratio parameters, and (3) assess these biomarkers in patients with presumed diastolic dysfunction after heart transplant (HTx) and in childhood cancer survivors (CCS) without any signs of diastolic dysfunction. In this retrospective study, 48 patients after HTx, divided into subgroups based on echocardiographic signs of diastolic dysfunction (41 without, 7 with) and 39 CCS were enrolled. PTT was defined as the difference between the onset time of the signal intensity increase in the left and the right ventricle. PTT in rest conditions were without significant differences when comparing the CCS and HTx subgroup without diastolic dysfunction (4.96 ± 0.93 s vs. 5.51 ± 1.14 s, p = 0.063) or with diastolic dysfunction (4.96 ± 0.93 s vs. 6.04 ± 1.13 s, p = 0.13). However, in stress conditions, both PTT and PTTc were significantly lower in the CCS group than in the HTx subgroups, (PTT: 3.76 ± 0.78 s vs. 4.82 ± 1.03 s, p < 0.001; 5.52 ± 1.56 s, p = 0.002). PTT ratio and PTTc ratio were below 1 in all groups. In conclusion, stress pulmonary circulation parameters obtained from CMR showed prolonged PTT and PTTc in HTx groups compared to CCS, which corresponds with the presumption of underlying diastolic dysfunction. The ratio parameters were less than 1.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 75%

Stress pulmonary circulation parameters assessed by a cardiovascular magnetic resonance in patients after a heart transplant

Opatřil

Panovský

Mojica-Pisciotti

et al. 2022

Sci Rep

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“…Of the 30 patients with evidence of HFNEF, 6 (20%) had only exercise-induced HFNEF. In an invasive study of patients after orthotopic heart transplantation with normal LVEF, the same group of researchers 10 analyzed the response of pulmonary capillary wedge pressure (PCWP) to submaximal exercise. Of the 81 patients, 21 (26%) had no evidence of HFNEF (PCWP at rest < 15 mmHg, maximal PCWP was elevated.…”

Section: Prevalence and Clinical Importance Of Isolated Only Exercismentioning

confidence: 99%

Can we diagnose isolated, exercise-induced heart failure with normal ejection fraction?

Meluzı́n¹,

Gregorová²,

Špinarová³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. A significant proportion of patients with exertional dyspnea require exercise to diagnose heart failure with normal ejection fraction (HFNEF). Methods and Results. In this review article, we evaluate current data on the prevalence, clinical significance and specifically the establishment of a diagnosis of isolated, exercise-induced HFNEF. Despite the unquestioned clinical importance and high prevalence of exercise-induced HFNEF, there are limited and conflicting data on making a diagnosis of exercise-induced HFNEF. This mostly relies on the evidence of exercise-induced elevation in left ventricular filling pressure (LVFP). At present, there is no agreement on the ability of exercise echocardiographic parameteres to predict exercise-induced LVFP elevation. In addition, even invasively measured exercise LVFP faces the problem of defining normal exercise LVFP values. More data and probably new diagnostic approaches are necessary to reliably diagnose exercise HFNEF. Conclusions. There are conflicting results and significant problems associated with the diagnosis of exercise HFNEF. This review hopefully will encourage further research in this difficult but clinically important area of heart failure.

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Heart Failure with Preserved Ejection Fraction in Children

et al. 2022

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High prevalence of exercise-induced heart failure with normal ejection fraction in post-heart transplant patients

Cited by 5 publications

References 39 publications

Stress pulmonary circulation parameters assessed by a cardiovascular magnetic resonance in patients after a heart transplant

Stress pulmonary circulation parameters assessed by a cardiovascular magnetic resonance in patients after a heart transplant

Can we diagnose isolated, exercise-induced heart failure with normal ejection fraction?

Heart Failure with Preserved Ejection Fraction in Children

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