New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure

Mandoli, Giulia Elena; Pastore, María; Benfari, Giovanni; Setti, Martina; Nistor, D; D’Ascenzi, Flavio; Focardi, Marta; Baccani, Bernardo; Patti, Giuseppe; Valente, Serafina; Mondillo, Sergio; Cameli, Matteo

doi:10.1002/ehf2.13722

Cited by 9 publications

(4 citation statements)

References 40 publications

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“…Pulmonary artery systolic pressure was estimated using Doppler echocardiography by calculating the RV to right atrial pressure gradient during systole. Right atrial pressure, estimated on the basis of echocardiographic characteristics of IVC, 18 was then added to the calculated gradient. The stroke volume multiplied by heart rate revealed cardiac output, and the cardiac output divided by body surface area (BSA) revealed cardiac index.…”

Section: Methodsmentioning

confidence: 99%

Hydralazine combined with conventional therapy improved outcomes in severe systolic dysfunction and mitral regurgitation

Hsiao,

Shiau

et al. 2023

ESC Heart Failure

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AimsPatients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF) accompanied by significant mitral regurgitation (MR) had poor outcome. Several vasodilator trials showed neutral results. We aimed to investigate the effect of early up‐titration of hydralazine combined with conventional treatment in acute HF with severe systolic dysfunction and significant MR.Methods and resultsThe study was open‐labelled, one‐to‐one ratio randomized designed. Consecutively hospitalized patients with decompensated HF symptoms, LVEF < 35%, and MR more than moderate severity were enrolled after exclusion. All participants with inadequate preload should have intake promotion with/without fluid supply. Patients receiving evidence‐based medications (EBMs) as conventional treatment served as the control. Hydralazine + conventional treatment group received up‐titration of hydralazine at Days 1–5 of the index admission combined with EBMs and throughout the course of follow‐up. The endpoints included cardiovascular (CV) death and HF rehospitalization. Totally, 408 patients were enrolled (203 in conventional treatment and 205 in hydralazine + conventional treatment). The mean follow‐up period was 3.5 years. The mean dose of hydralazine was 191 mg at index admission and 264 mg at study end in hydralazine + conventional treatment group. Both groups did not significantly differ in prescription rates and dosages of EBMs (all P > 0.05) at study end. Side effects did not differ between the two groups. Finally, 51% (104 out of 203 cases) reached endpoints in conventional group and 34.6% (71 out of 205 cases) in hydralazine + conventional treatment group, which had a significant reduction in CV events (hazard ratio 0.613, 95% confidence interval 0.427–0.877, P < 0.001). In‐hospital death during the index admission was significantly higher in conventional group (5.4% vs. 0.5%, respectively; P = 0.001).ConclusionsWhen administered without inadequate preload, combining early up‐titration of hydralazine with EBMs improves outcome in patients with severe systolic dysfunction and significant MR, and it is safe and well tolerated.

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Section: Methodsmentioning

confidence: 99%

Hydralazine combined with conventional therapy improved outcomes in severe systolic dysfunction and mitral regurgitation

Hsiao,

Shiau

et al. 2023

ESC Heart Failure

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“…Following the full-text review, 68 studies were excluded due to not meeting the inclusion criteria. Consequently, a total of 17 studies that included 7,787 patients with HF were analyzed in the final analysis (4,(6)(7)(8)(9)(10)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The screening process and results are shown in Figure 1.…”

Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

Prognostic Value of Left Atrial Strain in Heart Failure: A Systematic Review and Meta-Analysis

Jia

Chen

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundHeart failure (HF) is a global health problem with high morbidity and mortality. Recently, the association between peak atrial longitudinal strain (PALS) and clinical outcomes of HF has gained increasing attention. Our aim was to systematically assess the prognostic value of PALS for adverse events in HF.MethodsPubMed, Embase, and Scopus databases were systematically searched from inception to 30 April 2022. Studies in which PALS was assessed to predict adverse outcomes in adult patients with HF were included. Study selection, quality assessment, and data extraction were performed independently by two authors. The primary endpoints were all-cause death and cardiac hospitalization.ResultsAmong 7,787 patients in 17 included studies, 3,029 (38.9%) experienced the primary endpoint. Patients with events had lower PALS than those without events [weighted mean difference (WMD) 6.17, 95% confidence interval (CI) 3.09–9.26, p < 0.001]. Each unit increment of PALS was independently associated with decreased risk for the primary endpoint [hazard ratio (HR) 0.96, 95% CI 0.94–0.98, p < 0.001]. The addition of PALS significantly improved the predictive power of conventional risk models [net reclassification index (NRI) 0.22, 95% CI 0.06–0.39, p = 0.008].ConclusionPeak atrial longitudinal strain was an independent predictor for all-cause mortality and cardiac hospitalization in patients with HF, highlighting the clinical importance of left atrial (LA) deformation in the prognosis of HF.Systematic Review Registration[www.crd.york.ac.uk/prospero/], identifier [CRD42020185034].

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“…On the other hand, left atrial (LA) reservoir strain has recently been introduced in the European association of cardiovascular imaging (EACVI) recommendations as a standard parameter in the diagnostic algorithm of diastolic function in HF with preserved ejection fraction (HFpEF) (7), due to the high amount of evidence regarding its value as early and sensitive marker of elevated LV filling pressures (8,9) and myocardial fibrosis (10). LA strain has also showed to be a good prognostic marker both in HFrEF (11)(12)(13)(14) and HFpEF (15, 16). However, LA reservoir strain is thought to be strictly related to LV strain in chronic HF, because of LV dysfunction in chronic increase of LV filling pressures where LV global longitudinal strain (GLS) is one of the main determinants of reservoir peak atrial longitudinal strain (PALS) (9).…”

Section: Introductionmentioning

confidence: 99%

The loss of left atrial contractile function predicts a worse outcome in HFrEF patients

Mandoli

Pastore

Benfari

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIn chronic heart failure, high intracardiac pressures induce a progressive remodeling of small pulmonary arteries up to pulmonary hypertension. At the end of left atrial conduit function, pulmonary and left heart end-systolic pressures equalization might affect left atrial systole. In this single-center prospective study, we aimed to investigate whether peak atrial contraction strain (PACS), measured by speckle tracking echocardiography, was independently associated with prognosis in heart failure with reduced ejection fraction (HFrEF).Materials and methodsOutpatients with HFrEF and sinus rhythm referred to our echo-labs were enrolled. After clinical and echocardiographic evaluation, off-line speckle tracking echocardiography analysis was performed. Primary and secondary endpoint were cardiovascular death and heart failure hospitalization, respectively. Spline knotted survival model identified the optimal prognostic cut-off for PACS.ResultsThe 152 patients were stratified based on PACS <8% (n = 76) or PACS ≥8% (n = 76). Patients with PACS <8% had lower left ventricle and left atrial reservoir strain and higher New York Heart Association (NYHA) class and left atrial volume index (LAVI). Over a mean follow-up of 3.4 ± 2 years, 117 events (51 cardiovascular death, 66 heart failure hospitalizations) were collected. By univariate and multivariate Cox analysis, PACS emerged as a strong and independent predictor of cardiovascular death and heart failure hospitalization, after adjusting for age, sex, left ventricle strain, and E/e’, LAVI (HR 0.6 per 5 unit-decrease in PACS). Kaplan–Meier curves showed a sustained divergence in event-free survival rates for the two groups.ConclusionThe reduction of PACS significantly and independently affects cardiovascular outcome in HFrEF. Therefore, its assessment, although limited to patients with sinus rhythm, could offer additive prognostic information for HFrEF patients.

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New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure

Cited by 9 publications

References 40 publications

Hydralazine combined with conventional therapy improved outcomes in severe systolic dysfunction and mitral regurgitation

Hydralazine combined with conventional therapy improved outcomes in severe systolic dysfunction and mitral regurgitation

Prognostic Value of Left Atrial Strain in Heart Failure: A Systematic Review and Meta-Analysis

The loss of left atrial contractile function predicts a worse outcome in HFrEF patients

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