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Echocardiographic Hemodynamic Heterogeneity of Advanced Heart Failure Patients as Compared to Patients with „Pre-Heart Failure”

Elena-Laura Antohi
Elena-Laura Antohi
, 
Oliviana Geavlete
Oliviana Geavlete
, 
Razvan Radu
Razvan Radu
, 
Ovidiu Chioncel
Ovidiu Chioncel
 und 
Serban Mihaileanu
Serban Mihaileanu
   | 03. Mai 2022
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Article Category: Original Article
Online veröffentlicht: 03. Mai 2022
Seitenbereich: 351 - 359
DOI: https://doi.org/10.47803/rjc.2021.31.2.351
Schlüsselwörter
© 2021 Elena-Laura Antohi et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Study design.SBP systolic blood pressure, DBP diastolic blood pressure, PP pulse pressure, HR heart rate, LVEF left ventricular ejection fraction, ESV end-systolic volume, EDV end-diastolic volume, ESVi indexed ESV, EDVi indexed EDV, EDT E wave deceleration time, CI cardiac index, CPO cardiac power output, VTI velocity time integral, VAC ventricular-arterial coupling, Ea effective arterial elastance, Ees ventricular elastance, SV stroke volume, FU follow-up
Study design.SBP systolic blood pressure, DBP diastolic blood pressure, PP pulse pressure, HR heart rate, LVEF left ventricular ejection fraction, ESV end-systolic volume, EDV end-diastolic volume, ESVi indexed ESV, EDVi indexed EDV, EDT E wave deceleration time, CI cardiac index, CPO cardiac power output, VTI velocity time integral, VAC ventricular-arterial coupling, Ea effective arterial elastance, Ees ventricular elastance, SV stroke volume, FU follow-up

Figure 2

Pressure-volume analyses demonstrating the normal PV loop (PVL) and the determinants of ventricular function, including the ESPVR (characterized by the slope [Ees] and the volume axis intercept [V0] and the EDPVR. Shifts in the ESPVR are often equated with changes in inotropic state (rightward shift with decreased LVEF), while remodelling with increased valumes shifts the EDPVR. Stroke volume is EDV - ESV; SW is the PVL area, which multiplied by heart rate results in cardiac power.Ea, effective arterial elastance; EDPVR, end-diastolic pressure–volume relationship; EDPVR, end diastolic pressure volume relation, Ees, end-systolic elastance; ESPVR, end-systolic pressure–volume relationship; V0, volume at a Pes of 0 mmHg. SV, Stroke volume; EDV, end-diastolic volume; ESV, end-systolic volume; SW, stroke work.
Pressure-volume analyses demonstrating the normal PV loop (PVL) and the determinants of ventricular function, including the ESPVR (characterized by the slope [Ees] and the volume axis intercept [V0] and the EDPVR. Shifts in the ESPVR are often equated with changes in inotropic state (rightward shift with decreased LVEF), while remodelling with increased valumes shifts the EDPVR. Stroke volume is EDV - ESV; SW is the PVL area, which multiplied by heart rate results in cardiac power.Ea, effective arterial elastance; EDPVR, end-diastolic pressure–volume relationship; EDPVR, end diastolic pressure volume relation, Ees, end-systolic elastance; ESPVR, end-systolic pressure–volume relationship; V0, volume at a Pes of 0 mmHg. SV, Stroke volume; EDV, end-diastolic volume; ESV, end-systolic volume; SW, stroke work.

Figure 3

Pulsed wave Doppler (PW) envelope in left ventricular ejection fraction. showing systolic times and acceleration to peak systolic LVOT velocity. Measurements are averaged over 3 cycles.PEP preejection time, measured from beginning of QRS to start of ejection; LVET ejection time, measured from beginning to end of the PW envelope; TTP time to peak systolic velocity, Green arrow depicts the initial systolic acceleration.
Pulsed wave Doppler (PW) envelope in left ventricular ejection fraction. showing systolic times and acceleration to peak systolic LVOT velocity. Measurements are averaged over 3 cycles.PEP preejection time, measured from beginning of QRS to start of ejection; LVET ejection time, measured from beginning to end of the PW envelope; TTP time to peak systolic velocity, Green arrow depicts the initial systolic acceleration.

Figure 4

The variation of LV ejection fraction (LV EF) compared to that of effective arterial elastance (Ea) in patients with advanced HF (r=0.434, p=0.72).
The variation of LV ejection fraction (LV EF) compared to that of effective arterial elastance (Ea) in patients with advanced HF (r=0.434, p=0.72).

Correlation analysis between LV ejection fraction (LVEF) and hemodynamic variables in advanced HF patients

Ea Ees VAC LV Force
LVEF r −.434 −.225 −.324 .405
p .072 .370 .190 .119

Demographic and clinical data in advanced (stage D) HF patients compared to asymptomatic ‘pre-HF’ (stage B) patients

Variable adavanced HF patients (n=18) ‘pre-HF’ patients (n=12) p value
Age (y) 59+/−9,3 56+/−13,8 0.48
Males (%) 100 (n=18) 77 (n=8) 0.018
BSA (mean) 1,97+/−0,14 1,91+/−0,19 0.32
Hemoglobin g/dl (mean) 13,1+/−1,7 13,6+/−0,9 0.5
Hypertension (%) 77 (n=14) 83 (n=10) 1
Diabetes mellitus (%) 44 (n=8) 25 (n=3) 0.44
Chronic kidney disease (%) 66 (n=12) 17 (n=2) 0.010
Ischemic etiology (%) 39 (n=7) 58 (n=7) 0.457
Prolonged QRS (%) 28 (n=5) 0 0.0657
Left bundle branch block (%) 16 (n=3) 0 0.252
ACEI (%) 44 (n=8) 50 (n=6) 1
ARNI (%) 33 (n=6) 17 (n=2) 0.419
BB (%) 83 (n=15) 66 (n=8) 0.3915
Pulse pressure (mean) 42+/−16 58+/−11 0.0054

Comparison of basic echocardiographic parameters of the studied groups

Variable advanced HF patients (n=18) ‘pre-HF’ patients (n=12) p value
EDV End-diastolic diameter 67+/−6.8 49+/−7.7 0.0001
ESV End-systolic diameter 62+/−5.9 35+/−8.3 0.0001
LVMi Indexed left ventricular mass 130+/−40 83+/−21 0.0017
LAVi Indexed left atrial volume 51+/−17 24+/−6 0.0130
EDVi Indexed end-diastolic volume 117+/−43 43+/−11 0.0001
ESV End-systolic volume 183+/−74 36+/−18 0.0001
ESVi Indexed end-systolic volume 93+/−38 18+/−8 0.0001
Mitral E/A 1.89+/−1 1.26+/−0.1 0.2411
EDT E wave deceleration time 146+/−69 184+/−36 0.32
E/septalE’ 22+/−13 10+/−3.5 0.0697

Comparison of hemodynamic parameters between stage D HF patients and asymptomatic stage B patients

Variable (mean value +/−SD) advanced HF patients (n=18) ‘pre-HF’ patients (n=12) p value
PP Pulse pressure 42+/−16 58+/−11 0.0054
LVEF left ventricular ejection fraction 25+/−7.7 57+/−7 0.0001
TVI-LVOT Time velocity integral in the LVOT 12.2+/−3.9 18.1+/−4 0.0004
max lvot velocity 72.5+/−13.6 95.8+/−19.2 0.0006
SV stroke volume 58.5+/−14 68.3+/−11.4 0.0534
CI cardiac index 1.96+/−0.34 2.35+/−0.52 0.0189
PEP preejection time 102+/−23 65+/−27 0.0004
LVET LV ejection time 261+/−43 322+/−27 0.0002
PEP/LVET 0.406+/−0.122 0.200+/−0.078 0.0001
Ea effective arterial elastance (median) 1.865+/−0.607 1.749+/−0.476 0.5806
Ees ventricular elastance 1.127+/−0.303 2.299+/−1.092 0.0002
VAC ventriculo-arterial coupling 1.745+/−0.353 0.895+/−0.340 0.0007
CPO cardiac power output 0.762+/−0.207 0.932+/−0.230 0.0440
LVF left ventricular ejection force 7.9+/−3.3 12.3+/−4.1 0.0041
eISSN:
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Sprache:
Englisch
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Fachgebiete der Zeitschrift:
Medizin, Klinische Medizin, Allgemeinmedizin, Innere Medizin, Kardiologie, Kinder- und Jugendmedizin, Kinderkardiologie, Chirurgie, Herzchirurgie
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