Stroke Volume

IJCS

Editorial

HFrEF, HFmrEF, and HFpEF: Are They a Continuum or Different Faces of a Syndrome?

Even Edilce Mol et al. Camila Hartmann Lídia Ana Zytynski Moura

Heart failure (HF) is a significant and growing public health problem. Recent projections have shown that the prevalence of HF in the United States will increase by 46% between 2012 and 2030. This is driven by an increase in the life expectancy of the population combined with a reduction in mortality from the disease resulting from advances in therapies in recent years.

Of all the classifications of HF, the most used one is based on left ventricular ejection fraction (LVEF), which is categorized into three groups: HF with preserved ejection fraction (HFpEF) (LVEF ≥50%), HF with reduced ejection fraction (HFrEF) (LVEF ≤40%), and HF with moderate or mildly reduced ejection fraction (HFmrEF) (LVEF 41–49%). Although the prognosis appears to be similar among HF subtypes based on ejection fraction, ^, there are differences between the groups in terms of clinical-epidemiologic profile and functional capacity.

[…]

Ler artigo completo

IJCS

Original Article

Cognitive Alterations in Elderly Patients with Heart Failure’

Fernanda Guedes Afiune et al. Salvador Rassi Abrahão Afiune Neto

Abstract

Background:

Among the various pathologies that affect the elderly, Heart Failure (HF) stands out. Recently, an attempt has been made to verify the existence of cognitive impairment associated with HF.

Objectives:

To compare the cognitive performance of elderly people with heart failure with that of age-matched individuals without this pathology. Check the existence of marked impairment in some cognitive functions in the clinical group.

Methods:

The sample consisted of 78 elderly people, whose inclusion criterion was the presence of HF and no HF (control group); age over 60 years, both sexes, and any level of education. The control group consisted of 37 individuals (with a median age of 68 years – Interquartile range of 12) and the HF group, with 41 individuals (with a median age of 67 years – Interquartile range of 11). The subjects were matched in terms of education level, with a predominance of elderly people with 0 to 4 years of education (65.9% in the Clinical Group and 59.5% in the Control Group). Eleven neuropsychological tests covering cognitive functions were used: attention, language, memory, mood, and executive function. Statistical analysis was performed using SPSS software, version 23, with a significance level of 5%. The Chi-square test and the Mann-Whitney test were applied.

Results:

The results showed significant differences between the groups, mainly in executive functions, which include the ability to plan, switch, and recall previously stored information.

Conclusion:

Our study showed differences between the cognitive performance of elderly people with HF and elderly people without HF. The main alteration was found in the so-called executive functions, attention, and memory.

Ler artigo completo

IJCS

Review Article

Transcatheter Interatrial Shunts for the Treatment of Heart Failure with Preserved Ejection Fraction

Anju Bhardwaj et al. Vishal Y. Parikh Ajith Nair

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome, which accounts for about 50% of patients with heart failure (HF). The morbidity and mortality associated with HFpEF is similar to HFrEF. Clinical trials to date have failed to show a benefit of medical therapy for HFpEF, which may due to lack of uniform phenotypes and heterogeneous population. In addition, medical therapy proven for HFrEF may not address the pathophysiologic basis for HFpEF. Left atrial remodeling and dysfunction is central to HFpEF and accounts for secondary pulmonary hypertension and pulmonary vascular congestion that frequently occurs with exertion. Interatrial shunts represent a novel treatment modality for HFpEF. These shunts allow for left atrial decongestion and a reduction in pulmonary venous hypertension during exercise leading to improvements in hemodynamics, functional status and quality of life. Trials to date have demonstrated safety and short-term efficacy of these devices for HFpEF. The long-term benefits are currently being evaluated in ongoing trials. If effective, the use of interatrial shunts may be a new therapeutic paradigm for the treatment of HFpEF.

Ler artigo completo

IJCS

Original Article

Prognosis of Heart Failure with Preserved Ejection Fraction in Primary Care by the H2FPEF Score

Antonio Jose Lagoeiro Jorge et al. Maria Luiza Garcia Rosa Wolney de Andrade Martins Adson Leite … Dayse Mary da Silva Correia Maria Auxiliadora Nogueira Saad Humberto Villacorta Sergio Chermont Ronaldo Altenburg Gismondi Breno Macedo Almeida Evandro Tinoco Mesquita

Abstract

Background:

Primary care physicians have difficulty dealing with patients who have HF with preserved LVEF(HFpEF). The prognosis of HFpEF is poor, and difficult to predict on primary care.

Objective:

The aim of the study is to apply the H2FPEF score to primary care patients and verify its power to assess the risk of death or hospitalization due to cardiovascular disease.

Methods:

This longitudinal study included 402 individuals, with signs or symptoms of HF, aged≥45 years and, underwent an evaluation which included clinical examination, BNP and echocardiogram. The diagnosis of HFpEF was confirmed by the criteria of the European Society of Cardiology. After five years, the patients were reassessed as to the occurrence of the composite outcome, death from any cause or hospitalization for cardiovascular disease. H2FPEF used six variables: body mass index, medications for hypertension, age, pulmonary artery systolic pressure, atrial fibrillation and E/e’ ratio ranged from 0 to 9 points. The level of statistical significance was p<0.05.

Results:

HFpEF was diagnosed in 58(14.4%). Among patients with H2FPEF≥4, 30% had HFpEF and in those with a score≤4, HFpEF was present in 12%. Patients with HFpEF and H2FPEF≥4 had 53% of outcomes, whereas patients with HFpEF and a score ≤4 had a 21% of outcomes. BNP values were higher in patients with HFpEF compared to those without HFpEF(p<0.0001).

Conclusion:

H2FPEF≥4 indicated a worse prognosis in patients with HFpEF assisted in primary care. H2FPEF may be a simple and useful tool for risk stratification in patients with HFpEF at the primary care.

Ler artigo completo

IJCS

Editorial

Heart Failure – Pathophysiology and Current Therapeutic Implications

Mariana Vieira de Oliveira Bello et al. Fernando Bacal

The concept of translational medicine involves promoting the rapid transfer of observations made in the areas of research and pathophysiological understanding to the medical practice. This approach is a reality in major Brazilian research centers which link academia and clinical practice.

Heart failure (HF) is a complex syndrome that can manifest itself as heart failure with preserved ejection fraction (HFpEF), acute heart failure, or chronic heart failure with reduced ejection fraction (HFrEF). Here, we will cover the type of HF whose pathophysiology is understood the best and thus has disease-modifying treatments: HFrEF.

[…]

Ler artigo completo

IJCS

Viewpoint

Severe Cardiovascular Complications of COVID-19: a Challenge for the Physician

Nathalie Cristina Crivelari et al. Gisele Queiroz de Oliveira Clarice Hyesuk Lee Park Gregorio da Cruz Riemma … Isabela Bispo Santos da Silva Costa Marcus Vinícius Guimarães de Lacerda Glaucia Maria Moraes de Oliveira Francisco Carlos da Costa Darrieux Luciana Sacilotto Ludhmila Abrahão Hajjar

Introduction

Since December 31, 2019, when China reported the appearance of cases of acute respiratory failure caused by a new species of coronavirus, SARS-CoV-2, which causes the disease called COVID-19, almost 20 million cases were confirmed, causing 726 thousand deaths worldwide. In Brazil, on August 8^th, 2020, there was approximately 3 million cases and 100 thousand death by the disease.

Its rapid spread, its high potential for hospitalization, and its high lethality, especially in the most fragile groups such as geriatric patients and those with comorbidities, particularly cardiovascular ones, make this pandemic a challenge never faced by modern medicine. To date, we have no specific medication that has effective and safe results for the treatment of COVID-19. The scientific community has sought to research drugs with therapeutic plausibility, and controlled and randomized studies are underway. Many therapeutic proposals are based on in vitro experiments. The medications used are described in case records, with no solid scientific evidence for their use, and with a high probability of causing damage due to their adverse effects alone or in combination.

[…]

Ler artigo completo

IJCS

Viewpoint

Heart Failure with Preserved Ejection Fraction and COVID-19: a Pernicious Relationship

Evandro Tinoco Mesquita et al. Antonio Jose Lagoeiro Jorge Humberto Villacorta Luiz Claudio Danzmann Wolney de Andrade Martins

Introduction

The ongoing pandemic of Severe Acute Respiratory Virus-2 (SARS-CoV2) infection was first recognized in China in 2019 and brought significant health and economic threats around the world. On January 31, 2020, the World Health Organization (WHO) declared the disease caused by SARS-CoV2 an international public health emergency and on March 11, 2020, the WHO declared it a pandemic.^, Three months after the initial WHO declaration, there are more than 5 million confirmed cases worldwide and 300,000 deaths. In Brazil, in the same time interval, there were more than 850,000 cases and 43,000 deaths, with an upward trend.

The epidemiological and clinical severity of the pandemic by COVID-19 was initially supported by 4 alarming elements: (a) respiratory transmission with a high infectivity rate; (b) high lethality in specific subgroups; (c) high demand for intensive care and mechanical ventilation; and (d) no effective vaccine or specific treatment. Given the magnitude of the problem and the scarcity of resources, there was a recommendation for hospitalizing critically ill patients and providing them with supportive treatment and, above all, mitigation via social isolation aimed at flattening out the epidemic curve.^–

[…]

Ler artigo completo

IJCS

Original Article

Echocardiographic Assessment of Right Ventricular Function by Two-Dimensional Strain In Patients with Left-Sided Valvular Heart Disease: Comparison with Three-Dimensional Echocardiography

Alex dos Santos Felix et al. Ana Paula dos Reis Velloso Siciliano Luciano Herman Juacaba Belém Fabiula Schwartz de Azevedo … Sergio Salles Xavier Andrea Rocha De Lorenzo Clerio Francisco de Azevedo Filho

Abstract

Background:

Right ventricular (RV) dysfunction is a well-known predictor of mortality in patients with valvular heart disease (VHD). The assessment of RV function is often difficult due to complex geometry and hemodynamic factors. We aim to analyze RV function in patients with severe mitral and/or aortic valve disease using two-dimensional strain (2DS) imaging and conventional echocardiographic parameters, comparing it with right ventricular ejection fraction (RVEF) measured by three-dimensional echocardiography (3DE).

Methods:

Fifty-three patients with severe mitral and/or aortic VHD underwent complete transthoracic echocardiogram in the preoperative setting for cardiac surgery, including conventional echocardiographic parameters of RV function and speckle-tracking derived 2DS indices: RV global longitudinal strain (RVGS) and RV free wall longitudinal strain (RVFWS). Conventional echocardiographic and 2DS parameters were compared with real-time 3DE RVEF using Spearman correlation test. For comparison between two groups of patients based on the presence of RV dysfunction (normal RVEF ≥ 44% – A, abnormal RVEF < 44% – B), we used nonparametric Mann-Whitney U test. ROC (receiver operating characteristic) curve analysis was used to assess the clinical utility of all RV function variables in defining RV dysfunction. P values <0,05 were considered statistically significant.

Results:

We found a significant correlation between all parameters and RVEF (p<0.05), with best results for RV fractional area change (FAC), RVGS, and RVFWS. Dividing the population into two-groups based on RVEF, we found 14 patients with RV dysfunction (27.4%), and significant differences between the groups for all RV function variables. For detection of RV dysfunction defined by 3DE, ROC curve analysis showed the best area under the curve (AUC) for RVGS (0.872), RVFWS (0.851) and FAC (0.932).

Conclusions:

We observed significant correlation between RVGS, RVFWS and RVEF, with good accuracy in detecting RV dysfunction, comparable to FAC and better than other conventional parameters of RV function assessment. The evaluation of RV myocardial deformation with 2DS may have additional diagnostic and prognostic value in patients with severe left-sided VHD. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0).

Ler artigo completo

IJCS

Review Article

Phenotype mapping of heart failure with preserved ejection fraction

Evandro Tinoco Mesquita et al. Debora Carvalho Grion Miguel Camargo Kubrusly Bernardo Barcelos Fernandes Fumagalli Silva Érico Araújo Reis Santos

Abstract

Heart failure with preserved ejection fraction (HFPEF) has become the main phenotypic model of heart failure (HF) in community and referral patients in Brazil and in the world. Despite advances in the development of new drugs for HF treatment, there has been no significant improvement in mortality of this condition.

According to many studies, this can be explained by the heterogeneous nature of HF physiopathology, whose basic mechanisms may result in different clinical presentations, culminating in the emerging of different phenogroups in this syndrome. In this context, phenotype mapping of HFPEF has emerged as a possible solution, since it enables the development of clinical trials that establish specific therapeutic strategies for each phenotypic profile.

New technologies in the field of artificial intelligence have enabled the assessment of a large volume of data and infer intrinsic patterns and different outcomes. Thereby, it is possible to obtain mutually exclusive categories of HFPEF, with a phenotype mapping of the syndrome and grouping of patients according to their phenotypic features. Besides, other diseases can have the same clinical phenotype but different pathophysiological basis, the so called “phenocopies”.

These tools enable the analysis and categorization of the wide spectrum of heart failure, contributing to solve the dilemmas of the treatment of this syndrome.

Ler artigo completo