International Journal of Heart Failure最新文献

Patients with heart failure with preserved ejection fraction (HFpEF) constitutes a considerable sized population like that of subjects with heart failure with reduced ejection fraction. The symptoms include exercise induced dyspnoea and fatigue besides an increased mortality rate when compared to the general population. There is limited evidence of benefit from pharmacological therapy. A main pathophysiological mechanism is a left ventricular filling pressure that might be near to normal during resting conditions but increases during exercise leading to pulmonary congestion. Based on observations like the apparent lesser symptomatology in patients with combined mitral valve stenosis and atrial septal defect (Lutembacher syndrome) when compared to patients with isolated mitral valve stenosis, several Inter-Atrial Shunt Devices (IASD) have been developed with the intent to unload the pressure in the left atrium by creating a shunt into the right atrium. Smaller studies have found that the IASDs reduce the left ventricular filling pressure during exercise and increase the functional status of patients both subjectively and objectively with reported low rates of complications. These devices are undergoing further investigations and might prove to be a new paradigm in the treatment of patients with HFpEF.

The presence and severity of functional mitral regurgitation (FMR) is associated with worse outcomes in patients with heart failure and reduced ejection fraction. Prior to the availability of percutaneous mitral valve repair, management for FMR has been limited to medical therapy, cardiac resynchronization therapy for a specific subset of patients and surgery which has yet to demonstrate mortality benefits. Transcatheter edge-to-edge repair (TEER) of the mitral valve has emerged in the past decade as an invaluable member of the armamentarium against FMR with the 2 landmark randomized controlled trials providing deep insights on patient selection. In addition, TEER has spurred the rapid advancement in our understanding of FMR. This article seeks to provide an overview as well as our current understanding on the role of TEER in FMR.

Background and objectives: Heart failure (HF) is a complex syndrome with multiple etiologies resulting in impaired ventricular filling or pumping of blood. HF is as a major public health concern that leads to significant morbidity and mortality resulting in an enormous financial burden on the healthcare system. The study objectives were to assess the 30-day hospital readmission rates and its financial impact on the hospital.

Methods: The study was a retrospective single-center analysis of decoded data of all HF patients admitted to an outpatient diuretic infusion program. Adult patients who were readmitted to the hospital within 30 days despite guideline derive medical therapy were included if they were enrolled in the outpatient diuretic infusion clinic. Adult patients who were included in this study received a furosemide dose of 40 mg intravenously (infusion over 3 hours) at the clinic visit. Patients whose clinical signs/symptoms improved and remained stable in consequent visits were eventually discharged from the clinic. Financial impact was assessed using data obtained from the hospital administration on cost of HF readmissions.

Results: The results show a 30-day hospital readmission rate at 6-9% in the years analyzed (n=56) with a net savings of $562,815 to $736,560 per year.

Conclusions: This treatment strategy has no detrimental effects in addition to generating substantial financial savings. It appears to be a useful addition to the existing medical treatment regimens chronic HF patients.

Dilated cardiomyopathy (DCM) is one of the important causes of heart failure (HF). With the rapidly evolving technologies for gene analysis and tremendous advances in knowledge of HF genetics, the importance of genetic testing in DCM is currently highlighted. Several genetic variants causing DCM have been identified and this information is used for diagnosis, risk stratification and family screening of DCM patients. However, there are still several challenges in applying genetic testing to real clinical practice. In this review, we will summarize recent understandings in DCM genetics and provide an evidence-based practical guide to the use of genetic testing for DCM patients.

Coronary microvascular dysfunction (CMD) is one of the mechanisms of myocardial ischemia and left ventricular (LV) diastolic dysfunction, which is closely related to heart failure with preserved ejection fraction (HFpEF). Frailty, associated with sarcopenia, is often accompanied by HFpEF. In the present study, we aim to evaluate the relationship between CMD, body composition, and cardiopulmonary exercise capacity in patients with suspected HFpEF. We will enroll patients experiencing chest symptoms (chest pain or dyspnea) with an indication of non-obstructive coronary artery disease (<50% stenosis) on coronary angiography and preserved LV ejection fraction (≥50%) on echocardiography. All patients will undergo body composition analysis and adenosine stress echocardiography with the evaluation of coronary artery blood flow and maximal oxygen consumption by cardiopulmonary exercise test. LV end-diastolic pressure will be assessed using coronary angiography. Coronary flow reserve (CFR) is defined as the ratio of the peak to the baseline mean diastolic velocity of coronary blood flow. A CFR <2.3 is defined as coronary microvascular dysfunction. The correlation of CFR and body composition with LV diastolic function and cardiopulmonary exercise capacity will be assessed. This trial will suggest the specific phenotypes of HFpEF according to body composition and CMD and the specific management of the different phenotypes of HFpEF.

Trial registration: ClinicalTrials.gov Identifier: NCT04822649.

Background and objectives: Heart failure (HF) is a disease with high morbidity and mortality. With ageing society and increasing prevalence of risk factors of HF, the prevalence of HF is expected to increase, as well. In this official report of the Korean Society of Heart Failure the epidemiology of HF in Korea is presented.

Methods: The data of Korean National Health Insurance big data, the Korean Heart Failure (KorHF) and the Korean Acute Heart Failure (KorAHF) registries have been used.

Results: In 2018, the prevalence, incidence, mortality of HF patients, and mortality due to HF were 2,261, 579, 245, and 10.4 per 100.000 persons, respectively. Regarding the temporal trend, there was a continuous increase in HF prevalence (0.77% in 2002, 1.48% in 2013, and 2.24% in 2018) and HF related deaths. The most common etiology for HF was ischemic origin, and the dominant subtype was HF with reduced ejection fraction (EF), defined as EF ≤40%. Of these, 77.6%, 58.0%, and 55.1% received renin-angiotensin-system inhibitors (angiotensin-converting-enzyme inhibitors or angiotensin-receptor-blockers), beta-blockers, and aldosterone-antagonists, respectively. In 2018, 1,542 implantable cardiac defibrillators and 272 cardiac resynchronization therapy devices were implanted, and 176 patients received heart transplantation. With improvement of pharmacologic and non-pharmacological therapy, the survival time of HF has been improving in the last 2 decades; nonetheless, it is associated with enormous increase in medical costs.

Conclusions: The prevalence of HF has been increasing in Korea. With improvement of therapy, the prognosis of HF has been improving, too. Nonetheless, appropriate interventions are necessary to prevent HF.