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The Non-Ischemic HEART FAILURE Patient
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Maria-Anna Bazmpani, Theodoros D. Karamitsos
Upon initial assessment of a patient with HF and suspected NICM, a detailed clinical and family history should be obtained. Clinical history should include potential causes of systolic dysfunction, e.g., hypertension, known VHD, exposure to toxins, drugs, or alcohol, prior myocarditis, or arrhythmias. A detailed family history aims to identify other family members with known or suspected myocardial disease. Questions should include history of sudden cardiac death, HF, skeletal muscle disease, or stroke at a young age.29 A family pedigree facilitates determination of genetic transmission mode of several cardiomyopathies.
Cardiovascular Disease in Women
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Stephen T. Sinatra, Sara Gottfried
Similar findings were seen in a post hoc subgroup in the PEACE trial in which ACE inhibitors resulted in a benefit in patients with ischemic cardiomyopathy and a midrange LVEF of 40%–50%.67 In another analysis of TOPCAT, mineralocorticoid receptor antagonists can be considered to reduce the risk of heart failure hospitalization in selected patients with preserved ejection fraction (HFpEF).68 Although these recent trials suggest some benefit from pharmaceutical therapies on patient outcomes, clearly a more suitable alternative metabolic approach is needed to treat any patient with DD and/or systolic dysfunction.
Hypertrophic Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Once progression to the end-stage and systolic dysfunction has occurred, pharmacological management includes angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, betablockers, spironolactone, and digoxin. These drugs benefit patients with conventional CHF, but they have uncertain efficacy and do not reverse the clinical course or transplant recommendation in HCM [2, 3]. There are limited pharmacological options in this subgroup, similar in this respect to patients with preserved EF.
Intraventricular vector flow mapping 3-D by triplane Doppler echocardiography
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
F. Vixege, P. Y. Courand, P. Blanc-Benon, S. Mendez, F. Nicoud, D. Vray, D. Garcia
Heart failure affects the heart’s ability to meet the oxygen needs of the organs. It concerns more than one million people in France. It can be defined by the reduced capacity of the heart to be filled with blood (diastolic dysfunction) and/or emptied (systolic dysfunction). Although systolic dysfunction is relatively easy to diagnose, the diagnosis of diastolic dysfunction is more challenging. The accessibility of echocardiography, and its ability to provide information non-invasively and in real time, makes ultrasound the preferred technique for evaluating left ventricular diastolic function. However, the diagnosis of diastolic dysfunction often remains uncertain, as the recommended ultrasound indices may lead to conflicting conclusions. Since intracardiac blood flow is very sensitive to changes in the myocardium, we hypothesized that a thorough examination of intraventricular blood flow by color Doppler echocardiography could improve the assessment of diastolic function in patients with heart failure.
Obesity related changes in cardiac structure and function: role of blood pressure and metabolic abnormalities
Published in Acta Cardiologica, 2020
Tiziana Di Chiara, Antonino Tuttolomondo, Gaspare Parrinello, Daniela Colomba, Antonio Pinto, Rosario Scaglione
In addition, left ventricular dysfunction found in the present study in obese patients with LVH has been reported by us previously in healthy young obese subjects [33,34]. Factors contributing to LV systolic dysfunction in obesity include adverse LV loading conditions, duration of obesity, increased LV mass, and perhaps most importantly, co-morbidities such as CAD, hypertension and diabetes mellitus. In addition, it is well known that adiponectin and other ADKs may influence the relation between obesity and LV systolic function [8,11,14,26,27]. Recent data by Wu et al. [35] further support our results clearly indicating that obesity is able to predict a greater longitudinal increase in LVMI and decrease in LVEF in diabetic patients compared with overweight or normal weight subjects. Other studies utilising tissue Doppler and strain imaging technology have shown respectively a negative correlation between systolic parameters and severity of obesity and a reduced global longitudinal LV strain and strain rate in obese subjects [36,37]. These studies were performed in asymptomatic patients and this suggests that load-independent sub-clinical LV systolic dysfunction may be more common in obese subjects than was previously realised [35–37].
Lumen narrowing and increased wall to lumen ratio of retinal microcirculation are valuable biomarkers of hypertension-mediated cardiac damage
Published in Blood Pressure, 2020
Edyta Dąbrowska, Joanna M. Harazny, Eliza Miszkowska-Nagórna, Adrian Stefański, Beata Graff, Katarzyna Kunicka, Ewa Świerblewska, Agnieszka Rojek, Anna Szyndler, Jacek Wolf, Marcin Gruchała, Roland E. Schmieder, Krzysztof Narkiewicz
Adding indirect and direct impact of microvascular remodelling and increased total vascular resistance on the myocardial function, we can estimate the following adaptive changes in the heart: hypertrophy of cardiomyocytes in response to pressure overload, atrial and ventricular enlargement as a consequence of augmented filling pressures, ischemia as the result of microvascular vasoconstriction, reduced vasodilatory reserve and decreased density of arterioles in hypertrophied myocardium. Altogether, finally, lead to diastolic and systolic dysfunction and subsequently to heart failure. These associations were observed in our study in inverse and independent relationship between lumen diameter and IVSD, LVM and LAV. Since this close relation between morphology of retinal arterioles and geometric patterns of the heart is observed, our findings may have significant clinical implications.