How to Estimate the Optimal Heart Rate in Patients with Heart Failure with Preserved Ejection Fraction

Izumida, Toshihide; Imamura, Teruhiko; Fukui, Takuya; Koi, Takatoshi; Ueno, Yohei; Hori, Masakazu; Nakagaito, Masaki; Tanaka, Shuhei; Kataoka, Naoya; Ushijima, Ryuichi; Sobajima, Mitsuo; Fukuda, Nobuyuki; Ueno, Hiroshi; Kinugawa, Koichiro

doi:10.1536/ihj.20-788

Cited by 7 publications

(6 citation statements)

References 16 publications

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“…Our team recently found that a "zero" overlap between E wave and A wave in the trans-mitral echocardiography flow was associated with maximum cardiac output and greater clinical outcomes in patients with systolic heart failure [7]. We expanded this concept and proposed formulas to estimate optimal HR using deceleration time alone for those with preserved ejection fraction (HFpEF) [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Optimal Heart Rate and Prognosis in Patients with Cardiac Amyloidosis

Izumida

Imamura

Kinugawa

2021

JCDD

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Background: Optimal heart rate (HR) that associates with higher cardiac output and greater clinical outcomes in patients with cardiac amyloidosis remains unknown. Methods: Consecutive patients with sinus rhythm who were diagnosed with cardiac amyloidosis at our institute between February 2015 and February 2021 were retrospectively included. Ideal HR, at which E-wave and A-wave stand adjacent without any overlaps in the trans-mitral flow echocardiography, was calculated by the formula: 86.8−0.08 × deceleration time (msec). The association between optimal HR and cardiac death or heart failure readmission was investigated. Results: Ten patients (median 74 years old, 8 men) were included. On median, actual HR was 64 bpm and ideal HR was 69 bpm. An incidence rate of the primary endpoint in the sub-optimal HR group tended to be higher than optimal HR group: one of the four patients in optimal HR group had events (25%); two of the two patients in higher HR group had events (100%); two of the four patients in lower HR group had events (50%). Conclusions: The optimal HR was associated with greater clinical outcomes in patients with cardiac amyloidosis. The clinical impact of aggressive HR optimization in this cohort remains the next concern.

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Section: Introductionmentioning

confidence: 99%

Optimal Heart Rate and Prognosis in Patients with Cardiac Amyloidosis

Izumida

Imamura

Kinugawa

2021

JCDD

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“…In patients with diastolic dysfunction, the optimal heart rate might be relatively high, and aggressive beta-blocker therapy might reduce cardiac output. 10 The optimal medical therapy following the recovery of the LVEF, as found in our patient, also remains a future concern. Patisiran, which is currently used only for hereditary cardiac ATTR, might be more useful to achieve reverse remodeling than tafamidis.…”

Section: Discussionmentioning

confidence: 77%

Combination therapy using tafamidis and neurohormonal blockers for cardiac amyloidosis and a reduced ejection fraction: a case report

et al. 2022

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Cardiac amyloidosis usually presents with diastolic dysfunction, but sometimes systolic dysfunction develops, particularly at its advanced stage. However, the therapeutic strategy for patients with cardiac amyloidosis and systolic dysfunction remains unknown. We report a 77-year-old man who was diagnosed with wild-type cardiac amyloidosis and systolic dysfunction with a left ventricular ejection fraction of 27%. Following 6-month medical therapy of tafamidis 80 mg and neurohormonal blockers (carvedilol 5.0 mg, enalapril 2.5 mg, and spironolactone 25 mg), the left ventricular ejection fraction improved to 55%. Tafamidis-incorporated neurohormonal blocker therapy might be a promising strategy to facilitate cardiac reverse remodeling in patients with cardiac amyloidosis and systolic dysfunction.

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“…The presence of pulmonary congestion is associated with a significantly increased risk of cardiovascular mortality and morbidity in patients with acute-on-chronic heart failure [2]. The recent literature has shown that persistent elevations of ReDS values during index hospitalization were associated with a higher risk of all-cause death and incident heart failure hospitalization [12]. A previous retrospective study demonstrated that the post-discharge immediate measurement of ReDS values and medication adjustment was associated with a lower risk of 30-day cardiovascular admission [8].…”

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confidence: 99%

Clinical Implications of Remote Dielectric Sensing-Guided Management

Nomoto,

Imamura,

Izumida

et al. 2024

JCM

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Background: Remote dielectric sensing (ReDS) systems can quantify the degree of pulmonary congestion rapidly and non-invasively. However, the clinical implications of ReDS-guided medication adjustment remain uncertain. Methods: Patients hospitalized to treat cardiovascular diseases, including heart failure, valvular disease, and coronary artery disease, and underwent ReDS measurement before index discharge between 2021 and 2022 were included. According to our institutional protocol, ReDS values were blinded to the attending clinicians until February 2022 (blind period). After the period, ReDS values were timely opened to the attending clinicians, and medications such as diuretics were adjusted according to the ReDS values (target value between 20% and 35%) before index discharge (open period). A composite primary outcome of all-cause death and heart failure readmissions was compared between the two groups. Results: A total of 183 patients were included (median 79 years old, 101 men), consisting of 138 patients in the blind period and 45 patients in the open period. During a median of 646 (401, 818) days after the index discharge, 33 patients experienced the primary outcome of interest. Management during the open period, where medications were adjusted according to ReDS values, was independently associated with a lower incidence of the primary outcome with an adjusted hazard ratio of 0.22 (95% confidence interval 0.05–0.94, p = 0.041), as compared with those of the blind period. Conclusions: According to the findings of the present retrospective study, ReDS-guided management may have the potential to reduce the risk of mortality and heart failure admission in individuals hospitalized for cardiovascular diagnoses. Further prospective randomized control trials involving those with a variety of background etiologies and clinical scenarios are warranted to validate our findings and establish optimal ReDS-guided management.

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How to Estimate the Optimal Heart Rate in Patients with Heart Failure with Preserved Ejection Fraction

Cited by 7 publications

References 16 publications

Optimal Heart Rate and Prognosis in Patients with Cardiac Amyloidosis

Optimal Heart Rate and Prognosis in Patients with Cardiac Amyloidosis

Combination therapy using tafamidis and neurohormonal blockers for cardiac amyloidosis and a reduced ejection fraction: a case report

Clinical Implications of Remote Dielectric Sensing-Guided Management

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