Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure

Autor: Jan Komtebedde, Emil Wolsk, Nir Uriel, Barry A. Borlaug, Elke S. Hoendermis, Gerd Hasenfuß, David M. Kaye, Finn Gustafsson, Jan M. Griffin, Daniel Burkhoff, Sheldon E. Litwin, Sanjiv J. Shah
Rok vydání: 2020
Předmět:
Physiology
interatrial
Invasive hemodynamics
DEVICE
Hemodynamics/physiology
030204 cardiovascular system & hematology
BICYCLE EXERCISE
0302 clinical medicine
Clinical Studies
Exercise/physiology
Mechanisms
030212 general & internal medicine
Cardiac Output
Aged
80 and over
Exercise Tolerance
Ejection fraction
exercise
Pulmonary Wedge Pressure/physiology
REST
Prostheses and Implants
Middle Aged
Exercise capacity
3. Good health
exercise capacity
PRESERVED EJECTION FRACTION
Cardiology
Heart Atria/physiopathology
Cardiology and Cardiovascular Medicine
Shunt (electrical)
Adult
RENAL-FUNCTION
Cardiac Output/physiology
medicine.medical_specialty
Nitric Oxide
03 medical and health sciences
Internal medicine
Contemporary Review
Exercise Tolerance/physiology
WEDGE PRESSURE
Cyclic GMP-Dependent Protein Kinases
medicine
Humans
In patient
Heart Atria
Pulmonary Wedge Pressure
Aged
Heart Failure
REDUCE LAP-HF
business.industry
MORTALITY
Hemodynamics
Stroke Volume
TRANSCATHETER TREATMENT
Heart Failure/drug therapy
medicine.disease
LEFT ATRIAL PRESSURE
shunt
Stroke Volume/physiology
Case-Control Studies
Nitric Oxide/metabolism
Heart failure
Heart failure with preserved ejection fraction
business
Zdroj: Griffin, J M, Borlaug, B A, Komtebedde, J, Litwin, S E, Shah, S J, Kaye, D M, Hoendermis, E, Hasenfuß, G, Gustafsson, F, Wolsk, E, Uriel, N & Burkhoff, D 2020, ' Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure ', Journal of the American Heart Association, vol. 9, no. 17, e016760 . https://doi.org/10.1161/JAHA.120.016760
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.120.016760
Popis: Approximately 50% of patients with heart failure have preserved ejection fraction. Although a wide variety of conditions cause or contribute to heart failure with preserved ejection fraction, elevated left ventricular filling pressures, particularly during exercise, are common to all causes. Acute elevation in left‐sided filling pressures promotes lung congestion and symptoms of dyspnea, while chronic elevations often lead to pulmonary vascular remodeling, right heart failure, and increased risk of mortality. Pharmacologic therapies, including neurohormonal modulation and drugs that modify the nitric oxide/cyclic GMP‐protein kinase G pathway have thus far been limited in reducing symptoms or improving outcomes in patients with heart failure with preserved ejection fraction. Hence, alternative means of reducing the detrimental rise in left‐sided heart pressures are being explored. One proposed method of achieving this is to create an interatrial shunt, thus unloading the left heart at rest and during exercise. Currently available studies have shown 3‐ to 5‐mm Hg decreases of pulmonary capillary wedge pressure during exercise despite increased workload. The mechanisms underlying the hemodynamic changes are just starting to be understood. In this review we summarize results of recent studies aimed at elucidating the potential mechanisms of improved hemodynamics during exercise tolerance following interatrial shunt implantation and the current interatrial shunt devices under investigation.
Databáze: OpenAIRE
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