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Effects of exercise training on diastolic and systolic dysfunction in patients with chronic heart failure

World Journal of Cardiology 2021年第9期13卷 514-525页

作者： Ioannis Chaveles Ourania Papazachou Manal al Shamari Dimitrios Delis Argirios Ntalianis Niki Panagopoulou Serafim Nanas Eleftherios Karatzanos 1st Department of Cardiology-Clinical Ergospirometry Exercise and Rehabilitation Laboratory“Evaggelismos”HospitalAthens 10676Greece Department of Cardiology ”Helena Venizelou”HospitalAthens 10676Greece Clinical Ergospirometry Exercise and Rehabilitation Laboratory”Evaggelismos”HospitalSchool of MedicineNational and Kapodistrian University of AthensAthens 10676Greece Heart Failure Unit Department of Clinical Therapeutics”Alexandra”HospitalNational and Kapodistrian University of AthensAthens 11528Greece

BACKGROUND Chronic heart failure(CHF)is a complex syndrome characterized by a progressive reduction of the left ventricular(LV)contractility,low exercise tolerance,and increased mortality and morbidity.diastolic dysfunction(DD)of the LV,is a keystone in the pathophysiology of CHF and plays a major role in the progression of most cardiac diseases.Also,it is well estimated that exercise training induces several beneficial effects on patients with CHF.AIM To evaluate the impact of a cardiac rehabilitation program on the DD and LV ejection fraction(EF)in patients with CHF.METHODS Thirty-two stable patients with CHF(age:56±10 years,EF:32%±8%,88%men)participated in an exercise rehabilitation program.They were randomly assigned to aerobic exercise(AER)or combined aerobic and strength training(COM),based on age and peak oxygen uptake,as stratified randomization criteria.Before and after the program,they underwent a symptom-limited maximal cardiopulmonary exercise testing(CPET)and serial echocardiography evaluation to evaluate peak oxygen uptake(VO2peak),peak workload(Wpeak),DD grade,right ventricular systolic pressure(RVSP),and EF.RESULTS The whole cohort improved VO2peak,and Wpeak,as well as DD grade(P0.05).CONCLUSION Exercise rehabilitation improves indices of diastolic and systolic dysfunction.Exercise protocol was not observed to affect outcomes.These results need to be further investigated in larger samples.

关键词： Chronic heart failure Cardiovascular effects Cardiac rehabilitation Aerobic exercise Strength training diastolic dysfunction

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Interventions of side branches in the management of left ventricular dysfunction： a study based on the virtual dual chamber of the left ventricle

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Chinese Medical Journal 2012年第22期125卷 4126-4129页

作者： Thach Nguyen Dan Le James Nguyen Joseph Hackler Katrina Nguyen Hung Phan Tuan D Nguyen Quoc Nguyen Department of Cardiology Community Healthcare SystemSt Mary Medical CenterHobart IndianaUSA Cardiology Fellow Heart Failure-Transplant programthe University of Alabama in Birmingham(UAB)BirminghamAlabamaUSA Cardiology Fellow the University of Arizona Medical Center TucsonArizonaUSA Undergraduate Program at the University of California at San Diego San DiegoCaliforniaUSA Department of Medicine Weiss Memorial HospitalChicagoIllinoisUSA Staff Research Associate University of California at Los AngelesSchool of Public HealthLos AngelesCAUSA University of Indianapolis IndianapolisIndianaUSA

For interventional cardiologists, it is very challenging to do percutaneous coronary interventions （PCI） in lesions of ihe left main, bifilrcations or of chronic total occlusion types. However, it is more challenging to demonstrate an evidence based rationale supporting the indications of PCI in these lesions. In this article, new questions are raised on the benefits and the mechanism of benefits for PCI of bifilrcations revolving large side branches such as the diagonal （DIAG）,

关键词： diastolic dysfunction percutaneous coronary interventions, bifurcation lesions

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Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta

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Congenital Heart Disease 2022年第6期17卷 605-615页

作者： Irene Martin de Miguel C.Charles Jain Alexander C.Egbe Jason H.Anderson Heidi M.Connolly William R.Miranda Department of Cardiovascular Medicine Mayo ClinicRochesterMinnesotaUSA Department of Pediatric and Adolescent Medicine Division of Pediatric CardiologyMayo ClinicRochesterMinnesotaUSA

Background: Coarctation of the aorta (CoA) is associated with a generalized arteriopathy and long-term complicationsdespite repair. Data on invasive exercise hemodynamics in this population are lacking. Accordingly, wereviewed adults with CoA undergoing exercise catheterization to assess 1. hemodynamic profile;2. feasibilityfor assessment of CoA severity. Methods: Twenty patients undergoing exercise cardiac catheterization (12 armadduction and 8 supine cycle ergometry) at a quaternary care center between 2004 and 2021 were identified. Restingand exercise hemodynamic data were abstracted from the procedure logs. Results: Mean age was 43.6 ±12.0 years. Eleven patients (55%) had resting pulmonary arterial wedge pressure (PAWP) >15 mmHg;amongthose undergoing arterial catheterization, left ventricular end-diastolic pressure was >15 mmHg in 63%. Elevenpatients (55%) had pulmonary hypertension: 7 (35%) combined and 4 (20%) isolated post-capillary. At peak exercise,ΔPAWP/Δcardiac output (CO) ≥2 and Δmean pulmonary artery pressure/ΔCO ≥3 mmHg/l/min were foundin 7 (78%) and 6 (67%) patients, respectively;the composite of exercise PAWP ≥25 mmHg or ΔPAWP/ΔCO>2 was seen in 12 (86%). CoA peak-to-peak gradients at baseline (n = 14) and during exercise (n = 9) were 12(3–16) and 16 mmHg (9–28), respectively. Only 2 patients had an increase in CoA gradient to >20 mmHg withexercise. Conclusions: diastolic dysfunction and pulmonary hypertension were highly prevalent, with exerciseunmasking abnormal diastolic and pulmonary vascular reserve in some individuals. Most patients failed to showsignificant increases in CoA peak-to-peak gradients with exercise. Further studies are warranted to establish thebest diagnostic method for CoA severity assessment.

关键词： Coarctation of the aorta exercise heart catheterization diastolic dysfunction hypertension

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Risks of incident heart failure with preserved ejection fraction in Chinese patients hospitalized for cardiovascular diseases

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Journal of Geriatric Cardiology 2019年第12期16卷 885-893页

作者： Jun-Xia ZHANG Yi-Xian LIU Chun-Lei XIA Peng CHU Xin-Liang QU Lin-Lin ZHU Shao-Liang CHEN Department of Cardiology Nanjing First Hospital Nanjing Medical University

Background Endogenous aldehyde damages DNA and potentiates an ageing phenotype. The aldehyde dehydrogenase 2(ALDH2) rs671 polymorphism has a prevalence of 30%–50% in Asian populations. In this study, we aimed to analyze risk factors contributing to the development of heart failure with preserved ejection fraction(HFpEF) along with the genetic exposure in Chinese patients hospitalized with cardiovascular diseases(CVD). Methods From July 2017 to October 2018, a total of 770 consecutive Chinese patients with normal left ventricular ejection fractions(LVEF) and established CVD(hypertension, coronary heart diseases, or diabetes) were enrolled in this prospective cross-sectional study. HFpEF was defined by the presence of at least one of symptom(dyspnoea and fatigue) or sign(rales and ankle swelling) related to heart failure;N-terminal pro-B-Type natriuretic peptide(NT pro-BNP ≥ 280 pg/mL);LVEF ≥ 50%;and at least one criterion related to elevated ventricular filling pressure or diastolic dysfunction(left atrial diameter > 40 mm, E/E’ ≥ 13, E’/A’ < 1 or concurrent atrial fibrillation). Logistic regression was performed to yield adjusted odds ratios(ORs) for HFp EF incidence associated with traditional and/or genetic exposures. Results Finally, among 770 patients with CVD, 92(11.9%) patients were classified into the HFpEF group according to the diagnostic criteria. The mean age of the participants was 67 ± 12 years, and 278(36.1%) patients were females. A total of 303(39.4%) patients were ALDH2*2 variant carriers. In the univariate analysis, eight exposures were found to be associated with HFpEF: atrial fibrillation, ALDH2*2 variants, hypertension, age, anaemia, smoking, alcohol consumption and sex. Multivariable logistic regression showed that 4 ‘A’ variables(atrial fibrillation, ALDH2*2 variants, age and anaemia) were significantly associated with an increased risk of HFpEF. Atrial fibrillation was associated with a 3.8-fold increased HFpEF risk(95% CI: 2.21–6.61, P < 0.001), and the other three exposures associated wi

关键词： Aldehyde dehydrogenase 2 Cardiovascular diseases diastolic dysfunction Heart failure with preserved ejection fraction Riskfactor

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Left atrial physiology and pathophysiology:Role of deformation imaging

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World Journal of Cardiology 2015年第6期7卷 299-305页

作者： Johannes Tammo Kowallick Joachim Lotz Gerd Hasenfuβ Andreas Schuster DZHK(German Centre for Cardiovascular Research) partner site G ttingen Institute for Diagnostic and Interventional Radiology Georg-August University Department of Biomedical Engineering Division of Imaging SciencesThe Rayne InstituteSt Thomas HospitalKing’s College School of Medicine London Department of Cardiology and Pneumology Georg-August University

The left atrium(LA) acts as a modulator of left ventricular(LV) filling. Although there is considerable evidence to support the use of LA maximum and minimum volumes for disease prediction,theoretical considerations and a growing body of literature suggest to focus on the quantification of the three basic LA functions:(1) Reservoir function:collection of pulmonary venous return during LV systole;(2) Conduit function:passage of blood to the left ventricle during early LV diastole; and(3) Contractile booster pump function(augmentation of ventricular filling during late LV diastole. Tremendous advances in our ability to non-invasively characterize all three elements of atrial function include speckle tracking echocardiography(STE),and more recently cardiovascular magnetic resonance myocardial feature tracking(CMR-FT). Corresponding imaging biomarkers are increasingly recognized to have incremental roles in determining prognosis and risk stratification in cardiac dysfunction of different origins. The current editorial introduces the role of STE and CMR-FT for the functional assessment of LA deformation as determined by strain and strain rate imaging and provides an outlook of how this exciting field may develop in the future.

关键词： Left atrium Strain Strain rate Physiology Pathophysiology Cardiovascular magnetic resonance Echocardiography Feature tracking Speckle tracking diastolic dysfunction

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Diagnosis and treatment of heart failure with preserved ejection fraction

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South China Journal of Cardiology 2015年第3期16卷 193-200页

作者：辛坤丽张金国 Department of Cardiology Affiliated Hospital of Jining Medical University

Heart failure, a primary worldwide public health burden, is a complicated clinical syndrome manifested in hemodynamic and symptomatic changes. There are 2 subtypes of heart failure, with ejection frac- tion preserved （HFpEF） and reduced （HFrEF）. The morbidity of HFpEF derived from epidemic data accounts for 50% of total HF patients which is expected to continuously increase with the increase of elderly population in the future. The relevant risk factors for HFpEF include aging, female gender, hypertension, ischemic heart dis- ease, atrial fibrillation and diabetes mellitus. The essence of HFpEF is recognized as an increase in left ventricu- lar filling pressure implicated in certain interlinked physiological systems. The treatments are mainly aimed to re- lieve the symptoms and control risk factors such as anti-hypertension, prevention of myocardial ischaemia, ve- nous pressure reduction, management of atrial fibrillation and management of diabetes. In addition, some new treatments are being tested in clinical trails such as phosphodiesterase-5 （PDE5） inhibitor, tetrahydrobiopterin （BH4）, late Na current inhibitor, cardiac resynchronization therapy and angiotensin receptor neprilysin inhibitor LCZ696. Here, we briefly review the diagnosis and treatment in heart failure with preserved ejection fraction.

关键词： diastolic heart failure heart failure with preserved ejection fraction diastolic dysfunction

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An unusual echocardiographic performance of impaired left ventricular diastolic function in systolic heart failure patients:normal ratios of both mitral E/A and annulus e'/a'

An unusual echocardiographic performance of impaired left ve...

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中国超声医学工程学会第十四届全国超声心动图学术会议

作者： Yali Yang Wenjing Zhang Mingxing Xie Xinfang Wang Qing L Jing Wang Li Zhang Jinfeng Liu Department of Ultrasound Union HospitalTongji Medical CollegeHuazhong University of Science and Technology Hubei Province Key Laboratory of Molecular Imaging

Objective:To assess the left ventricular(LV) diastolic function in patients with normal mitral E/A and annulus e’/a’ ratios but decreased left ventricular contraction by echocardiography,and discuss formation mechanism of this unusual echo performance.Methods:Tei index,multiple mitral and pulmonary venous flow Doppler parameters and mitral annular tissue Doppler parameters of case group(Group A) were measured by two-dimensional(2 D)echocardiography.The findings were compared with those of control groups which were divided into four groups according to mitral E/A and annulus e’/a’ ratios,including Group Bo with normal LV diastolic function,Group B with impaired LV relaxation,Group B with pseudonormalized filling and Group B3 with restrictive filling.The left atrial and ventricular volume-time curves of each group were also depicted by real-time three-dimensional(3 D) echocardiography and 3 D parameters,such as atrial or ventricular volume index,atrial emptying fraction,were measured based on them.Result:① Tei index and most 2 D diastolic function parameters of Group A,such as IVRT,EDT,E/e’,e’,PVs,PVd,etc,were abnormal.Compared with Group Bo,the left atrial and ventricular volume indexes in different phases were all significant statistically increased(all Pdiastolic function parameters including E/e’,EDT and PVs/(PVs+PV) presented increasing or decreasing trend in order of Group B,B,A to B;③ Compared with Groups Bo,B and B,the second peak of the left atrial(LA) volume-time curve in late diastole was low or disappeared,and the plateau disappearance and the main peak retroposition of the LV volume-time curve in late diastole were also found in Groups A and B;④ The atrial and ventricular volume indexes of Group A were significant statistically higher than Groups B and B,but lower than Group B(all P<0.01).The LA emptying fraction of Group A was significantly lower than Group B and B,but higher than Group B(all P<0.01).SV between case and control groups had no statistically significant difference(all

关键词： heart failure diastolic dysfunction echocardiography pseudo)normalization

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