Biventricular cardiac power reserve in heart failure with preserved ejection fraction.

Autor: Alogna A; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.; Department of Cardiology, Angiology and Intensive Care Medicine, German Heart Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany., Omar M; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.; Department of Cardiology, Odense University Hospital, Odense, Denmark.; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark., Popovic D; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA., Sorimachi H; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA., Omote K; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA., Reddy YNV; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA., Pieske B; Department of Cardiology, Angiology and Intensive Care Medicine, German Heart Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany., Borlaug BA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2023 Jul; Vol. 25 (7), pp. 956-966. Date of Electronic Publication: 2023 Apr 24.
DOI: 10.1002/ejhf.2867
Abstrakt: Aims: Cardiac and extracardiac abnormalities play important roles in heart failure with preserved ejection fraction (HFpEF). Biventricular cardiac power output (BCPO) quantifies the total rate of hydraulic work performed by both ventricles, suggesting that it may help to identify patients with HFpEF and more severe cardiac impairments to better individualize treatment.
Methods and Results: Patients with HFpEF (n = 398) underwent comprehensive echocardiography and invasive cardiopulmonary exercise testing. Patients were categorized as low BCPO reserve (n = 199, < median of 1.57 W) or preserved BCPO reserve (n = 199). As compared to those with preserved BCPO reserve, those with low reserve were older and leaner, with more atrial fibrillation, higher N-terminal pro-B-type natriuretic peptide levels, worse renal function, more impaired left ventricular (LV) global longitudinal strain, worse LV diastolic function and right ventricular longitudinal function. Cardiac filling pressures and pulmonary artery pressures at rest were higher in low BCPO reserve, but central pressures were similar during exercise to those with preserved BCPO reserve. Exertional systemic and pulmonary vascular resistances were higher and exercise capacity was more impaired in those with low BCPO reserve. Reduced BCPO reserve was associated with increased risk for the composite endpoint of heart failure hospitalization or death over 2.9 (interquartile range 0.9-4.5) years of follow-up (hazard ratio 2.77, 95% confidence interval 1.73-4.42, p < 0.0001).
Conclusions: Inability to enhance BCPO during exercise is associated with more advanced HFpEF, increased systemic and pulmonary vascular resistance, reduced exercise capacity and increased adverse events in patients with HFpEF. Novel therapies that enhance biventricular reserve merit further investigation for patients with this phenotype.
(© 2023 European Society of Cardiology.)
Databáze: MEDLINE
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