A brief period of intensive cardiac rehabilitation improves global longitudinal strain and diastolic function after a first uncomplicated myocardial infarction
Gabriella MalfattoMiriam ReveraGiovanna BranziFrancesca CiambellottiAlessia GiglioSimonetta BlenginoMatteo OldaniCamilla FacchiniGianfranco ParatiMario Facchini
14
Citation
36
Reference
10
Related Paper
Citation Trend
Abstract:
Objectives In patients with abnormal left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI), cardiac rehabilitation with physical training prevents cardiac remodelling. To define the role of rehabilitation in the recovery of ventricular function in less severe cases, we studied its effects on more refined indexes of left ventricular function in uncomplicated, low-risk patients. Methods and results Fifty-five patients underwent percutaneous coronary revascularization after uncomplicated first AMI. Thirty-four started cardiac rehabilitation with counselling and physical training; 21 patients did not train, followed a counselling program and were taken as controls. Echocardiography was performed at baseline, after rehabilitation or counselling program and at six months follow-up. We measured: global strain (GS%) with speckle tracking analysis, E/e' by tissue Doppler imaging (TDI), left ventricular elastance (KLV) from the deceleration time (DT), LVEF, systolic and diastolic volumes, wall motion score index (WMSI). At baseline, groups had similar GS%, KLV, LVEF, DT, E/e', systolic and diastolic volumes, WMSI. Rehabilitation increased peak VO2 by 18% (P < 0.05) and improved GS%, KLV, LVEF, E/e' and WMSI (P < 0.02) that were unchanged in controls. The improvement persisted at six months. Conclusions After a first uncomplicated AMI, abnormalities of left systolic and diastolic ventricular function may be present persisting over time despite a normal LVEF, which are fully reverted by cardiac rehabilitation.Objective To assess the effect of atorvastatin on BNP level and cardiac function in patients with chronic heart failure(CHF).Methods Ninety-five patients with CHF were randomly divided into treatment group and control group.The control group was treated with routine application of ACEI and digoxin,while the treatment group was randomly divided into groups A,B and C,which were treated with different doses of atorvastatin on the basis of control group respectively.Left ventricular ejection fraction(LVEF) and plasma BNP concentrations were measured before treatment and 6 weeks,12 weeks after treatment.Results The BNP level and LVEF level in the treatment group showed significant differences with those in the control group(P0.05).Six weeks after treatment,the plasma BNP level and LVEF in the groups B and C were significantly lower than those in group A.However,the BNP level and LVEF between groups B and C showed no significant difference(P0.05).Twelve weeks after treatment,BNP level and LVEF in groups B and C showed no significant difference with what they were on the sixth week(P0.05).Conclusion Atorvastatin can significantly decrease the level of plasma BNP and improve LVEF in patients with chronic heart failure,which can do benefit to the improvement of cardiac function.
Cite
Citations (0)
Cite
Citations (0)
AIM To investigate the efficacy of trimetazidine(TMZ) in patients with heart failure with normal left ventricular ejection fraction(HFNEF).METHODS After received routine treatment of 6 weeks,98 patients with HFNEF were divided into control group(n = 50) and observation group(n = 48).The patients were given conventional treatment or TMZ treatment(20 mg,po,tid) in the control group and the observation group,respectively.All patients underwent echocardiography and echocardiographic indices were recorded before and 12 months after the treatment.N-terminal pro-B-type natriuretic peptide(NT-proBNP) and cardiac function(NYHA classification) were examined.RESULTS Both left ventricular end diastolic diameter(LVEDD) and NT-proBNP levels were significantly decreased in the observation group compared with the control group((41.8 ± 2.8) mm vs.(43.7 ± 2.6) mm,P 0.05;(782 ± 238) pg.mL-1vs.(873 ± 252) pg.mL-1,P 0.05 respectively).Compared with the control group,cardiac function in patients treated with TMZ was significantly improved(P 0.05).No significant difference between the two groups was noted in LVEF,though TMZ treatment trended towards enhanced LVEF((68.2 ± 2.8) % vs.(67.0 ± 2.5) %,P 0.05).CONCLUSION TMZ improves the cardiac function of patients with HFNEF and alleviates the symptoms of heart failure.
Trimetazidine
Ventricular Function
Cite
Citations (0)
Abstract Background Re-worsening left ventricular ejection fraction (LVEF) after initial recovery occurs in some patients with dilated cardiomyopathy (DCM). However, prevalence and predictors of re-worsening LVEF in longitudinal follow-up are unclear. Late gadolinium enhancement of cardiovascular magnetic resonance (LGE-CMR) can evaluate the damage of myocardial tissue. Purpose This study sought to evaluate the clinical parameters including LGE-CMR to predict re-worsening LVEF in patients with recent-onset DCM. Methods We included patients with recent-onset DCM who had an LVEF <45% and underwent LGE-CMR at diagnosis. We performed yearly echocardiographc follow-up [median 6 [4–8.3] years]. Initial LVEF recovery defined as patients increased in >5% LVEF from baseline and had an LVEF≥45% after medical therapy. Patients were divided into three groups: (1) Improved: defined as those with sustained LVEF ≥45% after initial LVEF recovery; (2) Re-worse: those with decreased >5% and had an LVEF <45% after initial LVEF recovery. and (3) Not-improved: those with no initial LVEF recovery during follow-up. To evaluate the prognostic factors for Re-worsening LVEF after initial LVEF recovery, multivariate logistic regression analysis performed between the Improved group and the Re-worse group. Cardiac events defined as hospitalization due to heart failure and sudden death. Results Of 138 patents, 82 patients (59%) were the Improved group, 42 patients (30%) were the Re-worse group, and 14 (10%) were the Not-improved group. Loess curves of long-term LVEF trajectories showed that LVEF in the Re-worse group increased first 2 years and declined slowly thereafter (Fig. 1A). Re-worsening LVEF occurred 4.5±2.2 years after initial LVEF recovery. Multivariate logistic regression analysis demonstrated that LGE area at baseline (Odds ratio: 1.09, 95% confidence interval (CI) 1.02–1.18, p=0.014) and Log brain natriuretic peptide (BNP) at initial LVEF recovery (Odds ratio: 1.53, 95% confidence interval (CI) 1.01–2.31, p=0.042) were independent predictors for Re-worsening LVEF. Kaplan Meier analysis demonstrated that the risk of cardiac events in the Re-worse group was significantly higher (hazard ratio: 3.93, 95% CI 1.49–10.36, p=0.006) than in the Improved group and lower risk than in the Not-improved group (hazard ratio: 0.28, 95% CI 0.12–0.62, p=0.002) (Fig. 1B). Conclusion Re-worsening LVEF occurred in 30% of patients in patients with recent-onset DCM. LGE area and BNP at initial LVEF recovery were independently associated with re-worsening LVEF after initial LVEF recovery. Figure 1 Funding Acknowledgement Type of funding source: None
Dilated Cardiomyopathy
Cite
Citations (0)
Objective To investigate the relationship between serum brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF) and cardiac function in more than 80-year-old patients with coronary heart disease.Methods Serum BNP,LVEF and each cardiac functional class in 222 patients were analyzed with variance analysis method.Correlation analysis was carried out at the same time.Results The cardiac functional class was positively correlated with the serum BNP.The serum BNP levels had a statistically significant differences in patients with different cardiac functional class.The cardiac functional class was negatively correlated with the LVEF.The LVEF had a statistically significant difference in patients with different cardiac functional class.Conclusion The serum BNP and LVEF correlate with cardiac functional class,but neither of them may be a unique diagnosis standard of cardiac functional class.
Brain natriuretic peptide
Cite
Citations (0)
Objective To explore the effect of atorvastatin intervention in the treatment of heart failure patients,and to analyze the levels of serum adiponectin.Methods Sixty patients with congestive heart failure admitted to our hospital from January 2011 to June 2012 were selected,which were randomly divided into the study group and the control group,with 30 patients in each group.The two groups were both were given conventional treatment,and the study group added atorvastatin statin 20 mg,once daily for 3 months.The levels of APN were detected before and after treatment using enzyme-linked immunosorbent assay,and the left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD) were detected by ultrasound ECG.Results ① Among the 60 patients,APN levels in patients with grade Ⅱ,Ⅲ,IV cardiac function were(5.71±1.85) mg/L,(11.08±2.78) mg/L and(15.08±3.72) mg/L,respectively.The APN levels in patients with heart failure increased gradually with deteriorating of cardiac function(P0.01).② Before treatment,APN,LVEF,LVEDD showed no significant difference between the two groups(P0.05).After treatment,LVEF was significantly increased,while LVEDD,APN significantly decreased(P0.05).After treatment,LVEF in the study group was higher than that of the control group,while LVEDD,APN in the study group were lower.APN after intervention was significantly lower than that before intervention(P0.05).Conclusion The serum adiponectin levels in chronic heart failure patients are abnormally elevated,and gradually increased with the deterioration of cardiac function in patients.The atorvastatin intervention can improve heart function in patients and lower the serum adiponectin levels.
Cite
Citations (0)
Cite
Citations (0)
To describe the impact of ejection fraction on the prognosis during 2 years after coronary artery bypass grafting (CABG).All patients in western Sweden who underwent CABG without concomitant valve surgery between June 1988 and June 1991.In all, 2121 patients were operated upon and information on ejection fraction was available for 1961 patients (92%). Of these patients, 178 (9%) had an ejection fraction < 40%, 517 (26%) an ejection fraction of 40-59% and 1266 (65%) an ejection fraction > or = 60%. In these groups the mortalities during the first 30 days after CABG were 5.1, 4.3 and 2.2%, respectively (P < 0.01). The corresponding values for mortalities between 30 days and 2 years were 7.7, 4.3 and 3.3%, respectively (P < 0.01). Patients with a lower ejection fraction were more frequently men and more frequently had a history of cardiovascular disease. In multivariate analysis the preoperative ejection fraction was an independent predictor for total 2-year mortality. Patients with a low ejection fraction died more frequently in association with ventricular fibrillation. Morbidity was, with the exception of that for rehospitalization due to heart failure and infection, not associated significantly with the preoperative ejection fraction.During the 2 years after CABG a low preoperative ejection fraction was associated with a higher mortality, but the association with morbidity was more complex.
Concomitant
Cite
Citations (9)
Diastolic heart failure (DHF) currently accounts for more than 50% of all heart failure patients. DHF is also referred to as heart failure with normal left ventricular (LV) ejection fraction (HFNEF) to indicate that HFNEF could be a precursor of heart failure with reduced LVEF. Because of improved cardiac imaging and because of widespread clinical use of plasma levels of natriuretic peptides, diagnostic criteria for HFNEF needed to be updated. The diagnosis of HFNEF requires the following conditions to be satisfied: (i) signs or symptoms of heart failure; (ii) normal or mildly abnormal systolic LV function; (iii) evidence of diastolic LV dysfunction. Normal or mildly abnormal systolic LV function implies both an LVEF > 50% and an LV end-diastolic volume index (LVEDVI) <97 mL/m(2). Diagnostic evidence of diastolic LV dysfunction can be obtained invasively (LV end-diastolic pressure >16 mmHg or mean pulmonary capillary wedge pressure >12 mmHg) or non-invasively by tissue Doppler (TD) (E/E' > 15). If TD yields an E/E' ratio suggestive of diastolic LV dysfunction (15 > E/E' > 8), additional non-invasive investigations are required for diagnostic evidence of diastolic LV dysfunction. These can consist of blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, electrocardiographic evidence of atrial fibrillation, or plasma levels of natriuretic peptides. If plasma levels of natriuretic peptides are elevated, diagnostic evidence of diastolic LV dysfunction also requires additional non-invasive investigations such as TD, blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, or electrocardiographic evidence of atrial fibrillation. A similar strategy with focus on a high negative predictive value of successive investigations is proposed for the exclusion of HFNEF in patients with breathlessness and no signs of congestion. The updated strategies for the diagnosis and exclusion of HFNEF are useful not only for individual patient management but also for patient recruitment in future clinical trials exploring therapies for HFNEF.
Cite
Citations (2,730)
Background: A significant proportion of patients diagnosed as heart failure have preserved ejection fraction. However, the differentiation between heart failure with reduced & preserved ejection fraction is difficult. The objectives of the study include: To assess the BNP levels in both patients with Heart failure with preserved LV ejection fraction and those with reduced LV ejection fraction. To study the correlation between the BNP levels and LVEF in both the groups and to ascertain whether BNP can be an useful tool in diagnosis of Heart failure with preserved LV ejection fraction]. Methods: The medical records of young patients (20–40 years) admitted during the two years 2014 & 2015 and diagnosed with Heart Failure were scrutinized in an attempt to determine the proportion of patients with preserved vs reduced ejection fraction and to assess the relationship between their Brain-type Natriuretic Peptide (BNP) levels & Left Ventricular Ejection Fraction (LVEF) in both the groups. Results: After Statistical analysis, it was found that around 36% of heart failure patients had preserved ejection fraction. There was a negative correlation between BNP levels & LVEF in both heart failure with reduced ejection fraction (HFrEF) as well as that with preserved ejection fraction (HFpEF). Majority of patients in HFpEF group were females. Mean BNP level in HFpEF group was significantly lower than that in the HFrEF group. Conclusion: Around one third of patients had Heart Failure with preserved systolic function, of which majority are females. There is a strong negative correlation between BNP levels and LVEF% in both the groups. Thus BNP levels can be used in the differentiation of HFpEF and HFrEF.
Brain natriuretic peptide
Cite
Citations (1)