Myocardial efficiency in patients with different aetiologies and stages of heart failure

Liu

Front. Cardiovasc. Med.

et al. 2023

Valvular heart disease (VHD)-related heart failure (HF) is a special subtype of HF with an increasingly concerned heterogeneity in pathophysiology, clinical phenotypes, and outcomes. The mechanism of VHD-related HF involves not only mechanical damage to the valve itself but also valve lesions caused by myocardial ischemia. The interactions between them will lead to the occurrence and development of VHD-related HF subtypes. Due to the spatial (combination of different valvular lesions) and temporal effects (sequence of valvular lesions) of valvular damages, it can make the patient's condition more complicated and also make the physicians deal with a dilemma when deciding on a treatment plan. This indicates that there is still lack of deep understanding on the pathogenic mechanism of VHD-related HF subtypes. On the other hand, mitochondrial dysfunction (MitD) is not only associated with the development of numerous cardiac diseases such as atherosclerosis, hypertension, diabetes, and HF but also occurs in VHD. However, the role of MitD in VHD-related HF is still not fully recognized. In this comprehensive review, we aim to discuss the current findings and challenges of different valvular damages derived from HF subtypes as well as the role of MitD in VHD-related HF subtypes.

Section: Aortic Valve Damages and Hfrefmentioning

confidence: 99%

Section: Aortic Valve Damages and Hfrefmentioning

confidence: 99%

Different heart failure phenotypes of valvular heart disease: the role of mitochondrial dysfunction

Liu

Front. Cardiovasc. Med.

et al. 2023

“…Other domains of cardiac phenotyping are continuously evolving [ 57 ]. A number of omics technologies are available that can contribute to the biological characterization of these patients and various computational methods are being investigated for the utilization of large amounts of data to identify pathways of disease [ 58 – 60 ]. Techniques such as MR spectroscopy may further contribute to our understanding of ongoing energy deficits in these patients [ 61 ].…”

Section: How Can Disease Etiology and Underlying Disease Activity Inf...mentioning

confidence: 99%

Your Heart Function Has Normalized—What Next After TRED-HF?

Kasiakogias,

Ragavan,

Halliday

2023

Curr Heart Fail Rep

Purpose of Review With the widespread implementation of contemporary disease-modifying heart failure therapy, the rates of normalization of ejection fraction are continuously increasing. The TRED-HF trial confirmed that heart failure remission rather than complete recovery is typical in patients with dilated cardiomyopathy who respond to therapy. The present review outlines key points related to the management and knowledge gaps of this growing patient group, focusing on patients with non-ischaemic dilated cardiomyopathy. Recent Findings There is substantial heterogeneity among patients with normalized ejection fraction. The specific etiology is likely to affect the outcome, although a multiple-hit phenotype is frequent and may not be identified without comprehensive characterization. A monogenic or polygenic genetic susceptibility is common. Ongoing pathophysiological processes may be unraveled with advanced cardiac imaging, biomarkers, multi-omics, and machine learning technologies. There are limited studies that have investigated the withdrawal of specific heart failure therapies in these patients. Diuretics may be safely withdrawn if there is no evidence of congestion, while continued therapy with at least some disease-modifying therapy is likely to be required to reduce myocardial workload and sustain remission for the vast majority. Summary Understanding the underlying disease mechanisms of patients with normalized ejection fraction is crucial in identifying markers of myocardial relapse and guiding individualized therapy in the future. Ongoing clinical trials should inform personalized approaches to therapy.

European Heart Journal - Cardiovascular Imaging

“… 93–95 Furthermore, it may be reduced in the presence of relatively preserved ejection fraction as shown in patients with hypertrophic cardiomyopathy, 96 cardiac amyloidosis, 97 and severe valvular heart disease. 91 , 95 Myocardial efficiency is directly associated with systolic dysfunction and inversely related to afterload, activation of the sympathetic nervous system, increased wall stress and left ventricular hypertrophy, 93 , 94 , 98 the contributions of each varying depending on aetiology, and stage of the underlying cardiac disease. Although myocardial oxygen consumption may be similar or even reduced in heart failure when compared with healthy controls, it is increased in relation to mechanical work.…”

Section: Introductionmentioning

confidence: 99%

Phenotyping heart failure by nuclear imaging of myocardial perfusion, metabolism, and molecular targets

Saraste

Knuuti

Bengel

2023

Nuclear imaging techniques can detect and quantify pathophysiological processes underlying heart failure, complementing evaluation of cardiac structure and function with other imaging modalities. Combined imaging of myocardial perfusion and metabolism can identify left ventricle dysfunction caused by myocardial ischemia that may be reversible after revascularization in the presence of viable myocardium. High sensitivity of nuclear imaging to detect targeted tracers has enabled assessment of various cellular and subcellular mechanisms of heart failure. Nuclear imaging of active inflammation and amyloid deposition is incorporated into clinical management algorithms of cardiac sarcoidosis and amyloidosis. Innervation imaging has well documented prognostic value with respect to heart failure progression and arrhythmias. Emerging tracers specific for inflammation and myocardial fibrotic activity are in earlier stages of development, but have demonstrated potential value in early characterization of the response to myocardial injury and prediction of adverse left ventricular remodeling. Early detection of disease activity is a key for transition from broad medical treatment of clinically overt heart failure towards a personalized approach aimed at supporting repair and preventing progressive failure. This review outlines the current status of nuclear imaging in phenotyping heart failure, and combines it with discussion on novel developments.