International journal of heart failure最新文献

Background and objectives: Few data have examined cardiac function correlates of hyponatremia in heart failure (HF) patients. We examined the association between hyponatremia and echocardiographic parameters with outcomes among HF patients in the cardiac intensive care unit (CICU).

Methods: Retrospective analysis of 3,372 Mayo Clinic CICU patients with HF from 2007 to 2018 grouped according to admission serum sodium: severe hyponatremia (sodium <130 mEq/L, 6%), mild hyponatremia (sodium 130-134 mEq/L, 16%), normal (sodium 135-144 mEq/L, 78%). Echocardiographic findings and mortality were compared across groups.

Results: The median age was 71.8 years old, and 39% were females. Patients with hyponatremia had worse echocardiographic parameters reflecting left ventricular (LV) systolic function and forward flow, particularly stroke volume index and LV systolic work index, with higher right atrial pressure and worse right ventricular-pulmonary artery coupling. In-hospital mortality occurred in 12.4% and increased with more severe hyponatremia: ≥135 mEq/L, 10.8%; 130-134 mEq/L, 16.7%; <130 mEq/L, 21.6% (p<0.001). One-year mortality occurred in 32.1% and was higher in patients with hyponatremia: ≥135 mEq/L, 29.6%; 130-134 mEq/L, 40.7%; <130 mEq/L, 40.7% (p<0.001). Patients with hyponatremia had significantly higher in-hospital (adjusted odds ratio, 1.80; 95% confidence interval [CI], 1.44-2.25; p<0.001) and one-year (adjusted hazard ratio, 1.51; 95% CI, 1.32-1.72; p<0.001) mortality, both overall and when stratified by echocardiographic measures. Additive increases in mortality were seen in patients with hyponatremia and poor echocardiographic hemodynamics.

Conclusions: CICU patients with HF and hyponatremia have worse hemodynamics reflected by echocardiographic parameters of LV systolic and diastolic function and forward flow, plus worse right ventricular function, with resultant worse clinical outcomes.

Speckle-tracking echocardiography (STE) has emerged as a valuable noninvasive tool for assessing myocardial deformation in patients with heart failure (HF). This review summarizes the principles, clinical applications, and prognostic implications of strain echocardiography across the spectrum of HF phenotypes, including heart failure with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF). Global longitudinal strain (GLS) provides a more sensitive and reproducible measure of left ventricular (LV) systolic function than traditional echocardiographic parameter like LV ejection fraction (EF), enabling early detection of subclinical dysfunction in stage A and B HF. In HFrEF, LVGLS adds incremental prognostic value beyond LVEF and identifies patients at risk for adverse outcomes. In HFmrEF, it helps characterize disease trajectory, guide therapy, and predict LVEF deterioration. In HFpEF, LVGLS uncovers subtle systolic impairment and stratifies risk. Additionally, left atrial (LA) and right ventricular (RV) strain measurements are increasingly recognized as important indicators of chamber-specific dysfunction and predictors of mortality, HF hospitalization, and atrial fibrillation. Despite vendor variability and the lack of universally accepted cut-offs, STE is becoming integral to HF evaluation. Pattern recognition of myocardial strains, such as apical sparing in amyloidosis, adds diagnostic value in cardiomyopathies. The integration of strain parameters enhances risk stratification, facilitates early diagnosis, and aids therapeutic monitoring in HF. Further standardization and broader clinical adoption of STE are needed to fully harness its prognostic and diagnostic capabilities in HF management.

Background and objectives: Pericoronary adipose tissue (PCAT) is linked to coronary artery disease (CAD) progression through compositional changes that disrupt adipose homeostasis and affect vascular biology. This study explores how PCAT characteristics - volume and fat attenuation index (FAI)-relate to CAD severity and left ventricular (LV) function.

Methods: This study included 100 patients with suspected CAD who underwent coronary computed tomography angiography (CCTA) and echocardiography between September 2023 and July 2024. PCAT volume, FAI and thickness were measured along coronary arteries (right coronary artery [RCA], left anterior descending [LAD], and left circumflex [LCX]). CAD severity was assessed using the Gensini score, while LV structural and functional metrics, including diastolic function, were obtained via echocardiography. Correlations between PCAT parameters, CAD burden, and LV function were analyzed using Spearman's correlation and p value <0.05 was considered significant.

Results: RCA FAI exhibited the strongest association with CAD severity (Gensini score: r=0.416, p=0.026) and diastolic dysfunction (r=0.536, p<0.001), with progressively less negative values from Grade 1 to Grade 3 dysfunction. LAD and LCX (r=0.278, p=0.03) FAI displayed moderate associations. RCA volume correlated with LV mass index, fractional shortening and diastolic parameters. Hypertension was associated with elevated RCA FAI and volume (p<0.05), while diabetes showed no significant impact on PCAT metrics.

Conclusions: PCAT FAI is a sensitive marker of CAD severity and diastolic dysfunction, especially in the RCA, highlighting its value for detection, risk stratification, and personalized CAD management. Integration of PCAT metrics into routine CCTA analysis could enhance cardiovascular risk assessment and treatment planning.

Background and objectives: Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure hospitalizations and disproportionately affects women, who present with distinct risk profiles and pathophysiologies compared to men. Prior studies exploring sex differences have been limited by small sample sizes and have often focused on index hospitalizations. We aimed to examine sex differences in risk factors, causes of readmission, and mortality following HFpEF hospitalization using a large, nationally representative cohort.

Methods: We performed a retrospective cohort study using the 2016-2019 National Readmissions Database. Adults hospitalized with a primary diagnosis of HFpEF were included. Patients were followed for 90-day readmissions, and multivariable logistic regression was used to identify predictors of readmission and readmission-related mortality, stratified by sex. The final sample included 353,536 patients (217,354 women and 136,182 men).

Results: Women were older at admission, more likely to live in lower-income areas, and more often presented with uncomplicated hypertension, while men had a higher burden of ischemic heart disease. Advancing age was associated with increased risk of readmission in women. Women were more frequently readmitted with respiratory failure, diastolic heart failure, and atrial fibrillation, suggesting a greater burden of vascular stiffness and symptom severity. Chronic kidney disease and diabetes were key predictors of readmission and mortality in both sexes.

Conclusions: HFpEF manifests with distinct sex-specific risk factors, clinical trajectories, and outcomes. These findings underscore the need for sex-informed, individualized treatment strategies and equitable resource allocation to reduce disparities and improve outcomes in HFpEF care.