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Michael R. Zile - One of the best experts on this subject based on the ideXlab platform.

  • renin angiotensin inhibition in Diastolic Heart Failure and chronic kidney disease
    The American Journal of Medicine, 2013
    Co-Authors: Ali Ahmed, Michael R. Zile, Gregg C Fonarow, Inmaculada Aban, Kanan Patel, Michael W Rich, Paul W Sanders, Yan Zhang, Thomas E Love, Wilbert S Aronow
    Abstract:

    Abstract Background The role of renin-angiotensin inhibition in older patients with Diastolic Heart Failure and chronic kidney disease remains unclear. Methods Of the 1340 patients (age≥65 years) with Diastolic Heart Failure (ejection fraction≥45%) and chronic kidney disease (estimated glomerular filtration rate 2 ), 717 received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Propensity scores for the use of these drugs, estimated for each of the 1340 patients, were used to assemble a cohort of 421 pairs of patients, receiving and not receiving these drugs, who were balanced on 56 baseline characteristics. Results During more than 8 years of follow-up, all-cause mortality occurred in 63% and 69% of matched patients with chronic kidney disease receiving and not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, respectively (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.70-0.97; P = .021). There was no association with Heart Failure hospitalization (HR, 0.98; 95% CI, 0.82-1.18; P = .816). Similar mortality reduction (HR, 0.81; 95% CI, 0.66-0.995; P = .045) occurred in a subgroup of matched patients with an estimated glomerular filtration rate less than 45 mL/min/1.73 m 2 . Among 207 pairs of propensity-matched patients without chronic kidney disease, the use of these drugs was not associated with mortality (HR, 1.03; 95% CI, 0.80-1.33; P = .826) or Heart Failure hospitalization (HR, 0.99; 95% CI, 0.76-1.30; P = .946). Conclusions A discharge prescription for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant reduction in all-cause mortality in older patients with Diastolic Heart Failure and chronic kidney disease, including those with more advanced chronic kidney disease.

  • plasma biomarkers that reflect determinants of matrix composition identify the presence of left ventricular hypertrophy and Diastolic Heart Failure
    Circulation-heart Failure, 2011
    Co-Authors: Michael R. Zile, Catalin F Baicu, Stacia M Desantis, Robert E Stroud, Sheila B Thompson, Catherine D Mcclure, Shannon M Mehurg, Francis G Spinale
    Abstract:

    Background—Chronic pressure overload (such as arterial hypertension) may cause left ventricular (LV) remodeling, alterations in cardiac function, and the development of Diastolic Heart Failure. Changes in the composition of the myocardial extracellular matrix may contribute to the development of pressure-overload–induced LV remodeling. We hypothesized that a specific pattern of plasma biomarker expression that reflected changes in these pathophysiological mechanisms would have diagnostic application to identify (1) patients who have development of LV hypertrophy (LVH) and (2) patients with LVH who have development of Diastolic Heart Failure. Methods and Results—Plasma concentration of 17 biomarkers (matrix metalloproteinase [MMP]-1, -2, -3, -7, -8, and -9; tissue inhibitors -1, -2, -3, and -4; N-terminal propeptide of brain natriuretic peptide (NT-proBNP); cardiotrophin; osteopontin; soluble receptor for advanced glycation end products; collagen I teleopeptide; collagen I NT-proBNP; and collagen III N-ter...

  • application of implantable hemodynamic monitoring in the management of patients with Diastolic Heart Failure a subgroup analysis of the compass hf trial
    Journal of Cardiac Failure, 2008
    Co-Authors: Michael R. Zile, Robert C Bourge, Tom D Bennett, Lynne W Stevenson, Yong K Cho, Philip B Adamson, Mark F Aaron, Juan M Aranda, William T Abraham, Frank W Smart
    Abstract:

    Abstract Background Nearly half of all patients with chronic Heart Failure (HF) have a normal ejection fraction (EF), and abnormal Diastolic function (ie, Diastolic Heart Failure [DHF]). However, appropriate management of DHF patients remains a difficult and uncertain challenge. Methods and Results The Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure (COMPASS-HF) trial was designed to evaluate whether an implantable hemodynamic monitor (IHM) was safe and effective in reducing the number of Heart Failure–related events (HFRE) in patients with chronic HF. The current study presents data on a prespecified and planned subgroup analysis from the COMPASS-HF trial: 70 patients with an EF ≥50% (ie, DHF). As such, this represents a subgroup analysis of the COMPASS-HF Trial. DHF patients were randomized to IHM-guided care (treatment) vs. standard care (control) for 6 months. All 70 patients received optimal medical therapy, but the hemodynamic information from the IHM was used to guide patient management only in the treatment group. The HFRE rate in DHF patients randomized to treatment was 0.58 events/6 months compared with DHF patients randomized to control, which was 0.73 events/6 months; this represented a 20% nonsignificant reduction in the overall HFRE rate in the treatment group (95% CI = –46, 56, P = .66). There was a 29% nonsignificant reduction in the relative risk of a HF hospitalization in the DHF patients randomized to treatment compared with DHF patients randomized to control (95% CI = –69, 70, P = .43). Conclusions The IHM was shown to be safe and was associated with a very low system-related and procedure-related complication rate in DHF patients. However, in this subgroup analysis limited to 70 DHF patients, the addition IHM-guided care did not significantly lower the rate of HFR events. The results of this subgroup analysis in DHF patients, for whom there are currently no proven, effective management strategies, will be used to design future studies defining the effects of IHM-guided care in patients with DHF.

  • effects of digoxin on morbidity and mortality in Diastolic Heart Failure the ancillary digitalis investigation group trial
    Circulation, 2006
    Co-Authors: Ali Ahmed, Michael R. Zile, Dalane W Kitzman, Jerome L Fleg, Michael W Rich, Thomas E Love, Wilbert S Aronow, James B Young, Kirkwood F Adams, Mihai Gheorghiade
    Abstract:

    Background— About half of the 5 million Heart Failure patients in the United States have Diastolic Heart Failure (clinical Heart Failure with normal or near-normal ejection fraction). Except for candesartan, no drugs have been tested in randomized clinical trials in these patients. Although digoxin was tested in an appreciable number of Diastolic Heart Failure patients in the Digitalis Investigation Group ancillary trial, detailed findings from this important study have not previously been published. Methods and Results— Ambulatory chronic Heart Failure patients (n=988) with normal sinus rhythm and ejection fraction >45% (median, 53%) from the United States and Canada (1991 to 1993) were randomly assigned to digoxin (n=492) or placebo (n=496). During follow-up with a mean length of 37 months, 102 patients (21%) in the digoxin group and 119 patients (24%) in the placebo group (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.63 to 1.07; P=0.136) experienced the primary combined outcome of Heart fai...

  • response to letter regarding article contractile behavior of the left ventricle in Diastolic Heart Failure with emphasis on regional systolic function
    Circulation, 2006
    Co-Authors: Gerard P Aurigemma, Michael R. Zile, William H. Gaasch
    Abstract:

    We appreciate Dr Sanderson’s interest and support of our efforts to better understand cardiac function in patients with Diastolic Heart Failure (DHF) and welcome the opportunity to respond. We have previously reported normal left ventricular systolic performance, function, and contractility in patients with DHF and have concluded that the pumping ability of the whole ventricle is normal in the basal state.1 To our knowledge, there are no published data that refute this …

William H. Gaasch - One of the best experts on this subject based on the ideXlab platform.

  • response to letter regarding article contractile behavior of the left ventricle in Diastolic Heart Failure with emphasis on regional systolic function
    Circulation, 2006
    Co-Authors: Gerard P Aurigemma, Michael R. Zile, William H. Gaasch
    Abstract:

    We appreciate Dr Sanderson’s interest and support of our efforts to better understand cardiac function in patients with Diastolic Heart Failure (DHF) and welcome the opportunity to respond. We have previously reported normal left ventricular systolic performance, function, and contractility in patients with DHF and have concluded that the pumping ability of the whole ventricle is normal in the basal state.1 To our knowledge, there are no published data that refute this …

  • contractile behavior of the left ventricle in Diastolic Heart Failure with emphasis on regional systolic function
    Circulation, 2006
    Co-Authors: Gerard P Aurigemma, Michael R. Zile, William H. Gaasch
    Abstract:

    Received March 31, 2005; revision received July 15, 2005; accepted July 21, 2005. In Diastolic Heart Failure, the left ventricular (LV) ejection fraction (EF) is normal and there is increased passive stiffness with impaired relaxation of the ventricle, resulting in disturbances in the pattern of filling and elevated Diastolic pressure.1–3 The mechanism underlying such Failure has been thought to be principally Diastolic because LV Diastolic function is universally abnormal and systolic performance, function, and contractility are normal.4 However, several reports suggest that abnormalities in regional shortening are present in Diastolic Heart Failure.5–9 The significance of these findings, especially their relation to the syndrome of Heart Failure, remains uncertain. Accordingly, we will review some of the structural and functional differences between systolic and Diastolic Heart Failure, and, emphasizing the systolic or contractile behavior of the left ventricle, we will attempt to reconcile what appear to be disparate conclusions about LV systolic function in patients with Diastolic Heart Failure. The Hearts of patients with systolic Heart Failure differ dramatically from those of patients with Diastolic Heart Failure in regard to both gross and microscopic anatomic features. As will be seen, these anatomic differences tend to parallel physiological and functional differences in systolic and Diastolic Heart Failure10,11 (Table 1). View this table: TABLE 1. LV Structure and Function in Chronic Heart Failure ### LV Chamber Remodeling Patients with Diastolic Heart Failure generally exhibit a concentric pattern of LV remodeling and a hypertrophic process that is characterized by a normal or near-normal end-Diastolic volume, increased wall thickness, and a high ratio of mass to volume with a high ratio of wall thickness to chamber radius.12 By contrast, patients with systolic Heart Failure exhibit a pattern of eccentric remodeling with an increase in end-Diastolic volume, little increase in wall thickness, and a substantial decrease in the ratio …

  • left ventricular systolic performance function and contractility in patients with Diastolic Heart Failure
    Circulation, 2005
    Co-Authors: Catalin F Baicu, Michael R. Zile, Gerard P Aurigemma, William H. Gaasch
    Abstract:

    Background— Patients with Diastolic Heart Failure (DHF) have significant abnormalities in left ventricular (LV) Diastolic function, including slow and delayed relaxation and increased chamber stiffness. Whether and to what extent these abnormalities in Diastolic function occur in association with abnormalities in LV systolic performance, function, and contractility has not been investigated thoroughly. Methods and Results— The systolic properties of the LV were examined in 75 patients with Heart Failure and a normal ejection fraction (ie, DHF) and 75 normal control subjects with no evidence of cardiovascular disease. LV systolic properties were assessed with echocardiographic and cardiac catheterization data. Stroke work (an index of LV systolic performance), preload recruitable stroke work and ejection fraction (indices of LV systolic function), systolic stress-shortening relationship, end-systolic pressure-volume relationship, and peak (+)dP/dt (indices of LV contractility) were examined. The systolic p...

  • lack of relationship between doppler indices of Diastolic function and left ventricular pressure transients in patients with definite Diastolic Heart Failure
    American Heart Journal, 2004
    Co-Authors: Gerard P Aurigemma, Michael R. Zile, William H. Gaasch
    Abstract:

    Abstract Objectives The purpose of this study was to compare invasive with noninvasive indices of Diastolic function in a well-defined group of patients with Diastolic dysfunction and a history of Diastolic Heart Failure. Background Patients with Heart Failure and a normal left ventricular (LV) ejection fraction comprise a very large portion of the Heart Failure population and most are thought to have Diastolic Heart Failure. While clinical and Doppler criteria for Diastolic dysfunction and Diastolic Heart Failure have been developed, there remains some controversy about the need for invasive cardiac catheterization and/or echo-Doppler evaluation of LV Diastolic function. To date, there is no consensus as to the utility of these 2 methods in the diagnosis of Diastolic Heart Failure. Methods Forty-seven patients (mean age 58 ± 11 years) with a history of congestive Heart Failure and preserved ejection fraction (≥50%) by echocardiography underwent a combined hemodynamic/echo-Doppler study. Patients with coronary disease were excluded. Invasive parameters of LV Diastolic function (tau, LV Diastolic pressures) and Doppler parameters (peak E, peak A, E/A ratio, isovolumic relaxation time, and E deceleration time) were measured using standard techniques. Results There was a close correlation between invasively-determined parameters (tau vs end Diastolic pressure: r = 0.62, P Conclusions Standard echo-Doppler indices of Diastolic function correlate poorly with LV Diastolic pressure transients. The diagnosis of Diastolic Heart Failure cannot be made on the basis of a single echo-Doppler parameter but, rather, all parameters must be examined in concert and used in combination with clinical observations.

  • Diastolic Heart Failure abnormalities in active relaxation and passive stiffness of the left ventricle
    The New England Journal of Medicine, 2004
    Co-Authors: Michael R. Zile, Catalin F Baicu, William H. Gaasch
    Abstract:

    Background Patients with signs and symptoms of Heart Failure and a normal left ventricular ejection fraction are said to have Diastolic Heart Failure. It has traditionally been thought that the pathophysiological cause of Heart Failure in these patients is an abnormality in the Diastolic properties of the left ventricle; however, this hypothesis remains largely unproven. Methods We prospectively identified 47 patients who met the diagnostic criteria for definite Diastolic Heart Failure; all the patients had signs and symptoms of Heart Failure, a normal ejection fraction, and an increased left ventricular end-Diastolic pressure. Ten patients who had no evidence of cardiovascular disease served as controls. Left ventricular Diastolic function was assessed by means of cardiac catheterization and echocardiography. Results The patients with Diastolic Heart Failure had abnormal left ventricular relaxation and increased left ventricular chamber stiffness. The mean (±SD) time constant for the isovolumic-pressure ...

Gerard P Aurigemma - One of the best experts on this subject based on the ideXlab platform.

  • Diastolic Heart Failure a common and lethal condition by any name
    The New England Journal of Medicine, 2006
    Co-Authors: Gerard P Aurigemma
    Abstract:

    This issue of the Journal contains two provocative contributions to the literature on Heart Failure. Owan et al.1 describe the epidemiologic outcomes and survival rates among patients with Heart fa...

  • response to letter regarding article contractile behavior of the left ventricle in Diastolic Heart Failure with emphasis on regional systolic function
    Circulation, 2006
    Co-Authors: Gerard P Aurigemma, Michael R. Zile, William H. Gaasch
    Abstract:

    We appreciate Dr Sanderson’s interest and support of our efforts to better understand cardiac function in patients with Diastolic Heart Failure (DHF) and welcome the opportunity to respond. We have previously reported normal left ventricular systolic performance, function, and contractility in patients with DHF and have concluded that the pumping ability of the whole ventricle is normal in the basal state.1 To our knowledge, there are no published data that refute this …

  • contractile behavior of the left ventricle in Diastolic Heart Failure with emphasis on regional systolic function
    Circulation, 2006
    Co-Authors: Gerard P Aurigemma, Michael R. Zile, William H. Gaasch
    Abstract:

    Received March 31, 2005; revision received July 15, 2005; accepted July 21, 2005. In Diastolic Heart Failure, the left ventricular (LV) ejection fraction (EF) is normal and there is increased passive stiffness with impaired relaxation of the ventricle, resulting in disturbances in the pattern of filling and elevated Diastolic pressure.1–3 The mechanism underlying such Failure has been thought to be principally Diastolic because LV Diastolic function is universally abnormal and systolic performance, function, and contractility are normal.4 However, several reports suggest that abnormalities in regional shortening are present in Diastolic Heart Failure.5–9 The significance of these findings, especially their relation to the syndrome of Heart Failure, remains uncertain. Accordingly, we will review some of the structural and functional differences between systolic and Diastolic Heart Failure, and, emphasizing the systolic or contractile behavior of the left ventricle, we will attempt to reconcile what appear to be disparate conclusions about LV systolic function in patients with Diastolic Heart Failure. The Hearts of patients with systolic Heart Failure differ dramatically from those of patients with Diastolic Heart Failure in regard to both gross and microscopic anatomic features. As will be seen, these anatomic differences tend to parallel physiological and functional differences in systolic and Diastolic Heart Failure10,11 (Table 1). View this table: TABLE 1. LV Structure and Function in Chronic Heart Failure ### LV Chamber Remodeling Patients with Diastolic Heart Failure generally exhibit a concentric pattern of LV remodeling and a hypertrophic process that is characterized by a normal or near-normal end-Diastolic volume, increased wall thickness, and a high ratio of mass to volume with a high ratio of wall thickness to chamber radius.12 By contrast, patients with systolic Heart Failure exhibit a pattern of eccentric remodeling with an increase in end-Diastolic volume, little increase in wall thickness, and a substantial decrease in the ratio …

  • left ventricular systolic performance function and contractility in patients with Diastolic Heart Failure
    Circulation, 2005
    Co-Authors: Catalin F Baicu, Michael R. Zile, Gerard P Aurigemma, William H. Gaasch
    Abstract:

    Background— Patients with Diastolic Heart Failure (DHF) have significant abnormalities in left ventricular (LV) Diastolic function, including slow and delayed relaxation and increased chamber stiffness. Whether and to what extent these abnormalities in Diastolic function occur in association with abnormalities in LV systolic performance, function, and contractility has not been investigated thoroughly. Methods and Results— The systolic properties of the LV were examined in 75 patients with Heart Failure and a normal ejection fraction (ie, DHF) and 75 normal control subjects with no evidence of cardiovascular disease. LV systolic properties were assessed with echocardiographic and cardiac catheterization data. Stroke work (an index of LV systolic performance), preload recruitable stroke work and ejection fraction (indices of LV systolic function), systolic stress-shortening relationship, end-systolic pressure-volume relationship, and peak (+)dP/dt (indices of LV contractility) were examined. The systolic p...

  • lack of relationship between doppler indices of Diastolic function and left ventricular pressure transients in patients with definite Diastolic Heart Failure
    American Heart Journal, 2004
    Co-Authors: Gerard P Aurigemma, Michael R. Zile, William H. Gaasch
    Abstract:

    Abstract Objectives The purpose of this study was to compare invasive with noninvasive indices of Diastolic function in a well-defined group of patients with Diastolic dysfunction and a history of Diastolic Heart Failure. Background Patients with Heart Failure and a normal left ventricular (LV) ejection fraction comprise a very large portion of the Heart Failure population and most are thought to have Diastolic Heart Failure. While clinical and Doppler criteria for Diastolic dysfunction and Diastolic Heart Failure have been developed, there remains some controversy about the need for invasive cardiac catheterization and/or echo-Doppler evaluation of LV Diastolic function. To date, there is no consensus as to the utility of these 2 methods in the diagnosis of Diastolic Heart Failure. Methods Forty-seven patients (mean age 58 ± 11 years) with a history of congestive Heart Failure and preserved ejection fraction (≥50%) by echocardiography underwent a combined hemodynamic/echo-Doppler study. Patients with coronary disease were excluded. Invasive parameters of LV Diastolic function (tau, LV Diastolic pressures) and Doppler parameters (peak E, peak A, E/A ratio, isovolumic relaxation time, and E deceleration time) were measured using standard techniques. Results There was a close correlation between invasively-determined parameters (tau vs end Diastolic pressure: r = 0.62, P Conclusions Standard echo-Doppler indices of Diastolic function correlate poorly with LV Diastolic pressure transients. The diagnosis of Diastolic Heart Failure cannot be made on the basis of a single echo-Doppler parameter but, rather, all parameters must be examined in concert and used in combination with clinical observations.

John E Sanderson - One of the best experts on this subject based on the ideXlab platform.

  • the hong kong Diastolic Heart Failure study a randomised controlled trial of diuretics irbesartan and ramipril on quality of life exercise capacity left ventricular global and regional function in Heart Failure with a normal ejection fraction
    Heart, 2008
    Co-Authors: Mei Wang, Jeffrey Winghong Fung, Tian Wang, Skiva Chan, Leata Yeung, Man O Tang, Chuk M Yu, John E Sanderson
    Abstract:

    Background: Although Heart Failure with a preserved or normal ejection fraction (HFNEF or Diastolic Heart Failure) is common, treatment outcomes on quality of life and cardiac function are lacking. The effect of renin–angiotensin blockade by irbesartan or ramipril in combination with diuretics on quality of life (QoL), regional and global systolic and Diastolic function was assessed in HFNEF patients. Methods: 150 patients with HFNEF (LVEF >45%) were randomised to (1) diuretics alone, (2) diuretics plus irbesartan, or (3) diuretics plus ramipril. QoL, 6-minute walk test (6MWT) and Doppler echocardiography were performed at baseline, 12, 24 and 52 weeks. Results: The QoL score improved similarly in all three groups by 52 weeks (−46%, 51%, and 50% respectively, all p Conclusions: In this typically elderly group of HF patients with normal LVEF, diuretic therapy significantly improved symptoms and neither irbesartan nor ramipril had a significant additional effect. However, diuretics in combination with irbesartan or ramipril marginally improved LV systolic and Diastolic longitudinal LV function, and lowered NT-proBNP over 1 year.

  • how to diagnose Diastolic Heart Failure a consensus statement on the diagnosis of Heart Failure with normal left ventricular ejection fraction by the Heart Failure and echocardiography associations of the european society of cardiology
    European Heart Journal, 2007
    Co-Authors: Walter Paulus, Carsten Tschope, John E Sanderson, Cesare Rusconi, Frank A Flachskampf, Frank Rademakers, Paolo Marino, Otto A Smiseth, Gilles W De Keulenaer, Adelino F Leitemoreira
    Abstract:

    Diastolic Heart Failure (DHF) currently accounts for more than 50% of all Heart Failure patients. DHF is also referred to as Heart Failure with normal left ventricular (LV) ejection fraction (HFNEF) to indicate that HFNEF could be a precursor of Heart Failure with reduced LVEF. Because of improved cardiac imaging and because of widespread clinical use of plasma levels of natriuretic peptides, diagnostic criteria for HFNEF needed to be updated. The diagnosis of HFNEF requires the following conditions to be satisfied: (i) signs or symptoms of Heart Failure; (ii) normal or mildly abnormal systolic LV function; (iii) evidence of Diastolic LV dysfunction. Normal or mildly abnormal systolic LV function implies both an LVEF > 50% and an LV end-Diastolic volume index (LVEDVI) 16 mmHg or mean pulmonary capillary wedge pressure >12 mmHg) or non-invasively by tissue Doppler (TD) (E/E' > 15). If TD yields an E/E' ratio suggestive of Diastolic LV dysfunction (15 > E/E' > 8), additional non-invasive investigations are required for diagnostic evidence of Diastolic LV dysfunction. These can consist of blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, electrocardiographic evidence of atrial fibrillation, or plasma levels of natriuretic peptides. If plasma levels of natriuretic peptides are elevated, diagnostic evidence of Diastolic LV dysfunction also requires additional non-invasive investigations such as TD, blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, or electrocardiographic evidence of atrial fibrillation. A similar strategy with focus on a high negative predictive value of successive investigations is proposed for the exclusion of HFNEF in patients with breathlessness and no signs of congestion. The updated strategies for the diagnosis and exclusion of HFNEF are useful not only for individual patient management but also for patient recruitment in future clinical trials exploring therapies for HFNEF.

  • letter by sanderson regarding article contractile behavior of the left ventricle in Diastolic Heart Failure with emphasis on regional systolic function
    Circulation, 2006
    Co-Authors: John E Sanderson
    Abstract:

    To the Editor: Aurigemma et al1 have attempted to reconcile the recent findings that ventricular long-axis function in systole is reduced in Diastolic Heart Failure (DHF) with the standard concept that systolic function is entirely normal in this condition. They question the relevance of long-axis function mainly because annular velocities are within normal limits in some patients. However, DHF is episodic and often requires a triggering factor, such as an ischemic episode, arrhythmia, etc. No study to date has measured regional ventricular function …

  • left ventricular long axis function in Diastolic Heart Failure is reduced in both diastole and systole time for a redefinition
    Heart, 2002
    Co-Authors: M Wang, Y Zhang, J W H Fung, P Y Ho, John E Sanderson
    Abstract:

    Objective: To test the hypothesis that, when measured in the long axis, left ventricular systolic function is abnormal in patients with Diastolic Heart Failure. Design: A case–control study. Setting: University teaching hospital (tertiary referral centre). Patients: 68 patients with Heart Failure, 29 with a left ventricular ejection fraction (LVEF) of > 0.45 and Diastolic dysfunction (Diastolic Heart Failure), 39 with an LVEF of ≤ 0.45 (systolic Heart Failure), and 105 normal subjects, including 33 age matched controls. Methods: LVEF was measured by cross sectional Simpson's method, and mitral annular amplitudes and velocities by M mode and tissue Doppler echocardiography, respectively, along with mitral Doppler inflow velocities. Results were compared between the three groups. Main outcome measures: Peak systolic mitral annular velocity and amplitude between the different groups. Results: The mitral annular peak mean velocity and amplitude in systole were lower in the patients with Diastolic Heart Failure (mean (SEM), 4.8 (0.2) cm/s) than in the age matched normal controls (6.1 (0.14) cm/s), but higher than those with systolic Heart Failure (2.8 (0.13) cm/s) (all p < 0.001). Similar changes were seen the mitral annular amplitude during systole. Peak early Diastolic velocity and amplitude were also significantly reduced in the group with Diastolic Heart Failure. Left ventricular hypertrophy was evident in over 95% patients in both Diastolic and systolic Heart Failure groups, with a comparable left ventricular mass index. Conclusions: In patients with Diastolic Heart Failure and evidence of left ventricular hypertrophy, there is systolic left ventricular impairment as measured by myocardial Doppler imaging of the longitudinal axis. Thus subtle abnormalities of systolic function are present in patients with Heart Failure and a normal left ventricular ejection fraction, and there appears to be a continuum of systolic function between those with truly normal, mildly impaired (labelled Diastolic Heart Failure), and obviously abnormal left ventricular systolic function. Isolated Diastolic dysfunction is uncommon.

Masatsugu Hori - One of the best experts on this subject based on the ideXlab platform.

  • left atrial dilatation as a predictive factor of beneficial response to carvedilol in patients with hfpef a finding from the japanese Diastolic Heart Failure study j dhf
    European Heart Journal, 2013
    Co-Authors: Kazuhiro Yamamoto, Hideki Origasa, Masatsugu Hori
    Abstract:

    Purpose: Therapeutic strategy for Heart Failure with Preserved Ejection Fraction (HFPEF) has not been established. Recently, the Japanese Diastolic Heart Failure Study (J-DHF), a multicenter, prospective, randomized, open, blinded endpoint (PROBE) trial to assess the effects of β-blocker, carvedilol, in HFPEF patients in Japan, has suggested beneficial effects of the standard-dose, not the low-dose, prescription of carvedilol in HFPEF patients. However, it is unclear whether any factor could predict the effects of the standard-dose carvedilol in HFPEF. Methods: Data from 245 HFPEF patients in J-DHF were evaluated to clarify demographic, clinical, echocardiographic and biological variables that are related to the primary outcome (a composite of cardiovascular death and unplanned hospitalization for Heart Failure) and another major outcome (a composite of cardiovascular death and unplanned hospitalization for any cardiovascular causes). We also analyzed the interaction between these clinically relevant factors and the response to standard-dose carvedilol in the proportional hazard model. Results: Aging, decreased body mass index, diabetes mellitus, history of hospitalization for Heart Failure, anemia, renal dysfunction, increased plasma B-type natriuretic peptide, left ventricular (LV) hypertrophy, and left atrial (LA) dilatation were prognostic factors for both clinical outcomes. In the patients with LA diameter ≥ 43.2mm (the median value), standard-dose carvedilol was associated with hazard ratio (HR) 0.263 (95% confidence interval (CI):0.080 to 0.859) for the primary outcome, but in those with LA diameter < 43.2mm, HR was 1.123 (95% CI:0.501 to 2.514). A p value for the interaction was 0.0462. For another major outcome, HR was 0.257 (95% CI:0.092 to 0.715) in the patients with LA diameter ≥ 43.2mm and 0.783 (95% CI:0.393 to 1.561) in those with LA diameter < 43.2mm, and a p value for the interaction was 0.0764. The other prognostic factors did not influence the response to standard-dose carvedilol. Conclusions: As LA dilatation is a sign of LV Diastolic dysfunction, the current results suggest that the beneficial effects of standard-dose carvedilol are provided in HFPEF patients with advanced rather than modest Diastolic dysfunction.

  • effects of carvedilol on Heart Failure with preserved ejection fraction the japanese Diastolic Heart Failure study j dhf
    European Journal of Heart Failure, 2013
    Co-Authors: Kazuhiro Yamamoto, Hideki Origasa, Masatsugu Hori
    Abstract:

    Aims The therapeutic strategy for Heart Failure with preserved ejection fraction (HFPEF) has not been established. The Japanese Diastolic Heart Failure Study (J-DHF) is a multicentre, prospective, randomized, open, blinded-endpoint trial, designed to assess the effects of carvedilol in HFPEF patients. Methods and results A total of 245 patients with Heart Failure and ejection fraction >40% were randomly assigned into those treated with (carvedilol group, n = 120) and without carvedilol (control group, n = 125). The primary outcome is a composite of cardiovascular death and unplanned hospitalization for Heart Failure. During a median follow-up of 3.2 years, the primary endpoint occurred in 29 patients in the carvedilol group and in 34 patients in the control group [adjusted hazard ratio (HR) 0.902, 95% confidence interval (CI) 0.546–1.488, P = 0.6854]. Another major composite endpoint, cardiovascular death and unplanned hospitalization for any cardiovascular causes, occurred in 38 patients of the carvedilol group and 52 patients of the control group (HR 0.768, 95% CI 0.504–1.169; P = 0.2178). The target dose of carvedilol was 20 mg/day, but the median prescribed dose was 7.5 mg/day. In the patients treated with standard doses (carvedilol >7.5 mg/day, n = 58), this composite outcome was significantly less than in the controls (HR 0.539, 95% CI 0.303–0.959; P = 0.0356), whereas it was comparable with the controls in the patients treated with carvedilol ≤7.5 mg/day (n = 62, HR 1.070, 95% CI 0.650–1.763; P = 0.7893). Conclusions Carvedilol did not improve prognosis of HFPEF patients overall; however, the standard dose, not the low dose, prescription might be effective. This may facilitate further investigation. UMIN number: C000000318.

  • beneficial effects of bisoprolol on the survival of hypertensive Diastolic Heart Failure model rats
    European Journal of Heart Failure, 2008
    Co-Authors: Mayu Nishio, Tohru Masuyama, Masatsugu Hori, Yasushi Sakata, Toshiaki Mano, Tomohito Ohtani, Yasuharu Takeda, Takeshi Miwa, Takashi Kondo, Kazuhiro Yamamoto
    Abstract:

    Background: β-blocker therapy is an established therapeutic strategy for systolic Heart Failure. However, its benefits in Diastolic Heart Failure (DHF) are controversial. Aims: This study was designed to investigate the effects of bisoprolol on DHF. Methods and results: Dahl salt-sensitive rats fed on 8% NaCl diet from age 6weeks, DHF model rats, were divided into three groups at age 13 weeks. One group was treated with bisoprolol 12.5 mg/kg/day (Low dose group, n=18), one group was treated with bisoprolol 250 mg/kg/day (High dose group, n=18), and there was also an untreated group (Untreated group, n=18). The survival rate was best in the High dose group. Left ventricular hypertrophy and the expression of proinflammatory cytokines in the myocardium were significantly attenuated in the High dose group, but not in the Low dose group, and oxidative stress was most suppressed in the High dose group. Measurement with electron spin resonance revealed that bisoprolol had a potent scavenging ability, and bisoprolol attenuated the down-regulation of peroxisome proliferation-activated receptor coactivator-1α, an important element in the mitochondrial reactive oxygen species detoxification system. Conclusion: β-blocker administration, particularly at high dose, improved the survival rate of the DHF model, at least partly through the attenuation of inflammatory changes and oxidative stress.

  • at1 receptor blocker added to ace inhibitor provides benefits at advanced stage of hypertensive Diastolic Heart Failure
    Hypertension, 2004
    Co-Authors: Junichi Yoshida, Kazuhiro Yamamoto, Masatsugu Hori, Mayu Nishio, Yasushi Sakata, Toshiaki Mano, Tomohito Ohtani, Takeshi Miwa, Nagahiro Nishikawa, Tohru Masuyama
    Abstract:

    Diastolic Heart Failure (DHF) has become a social burden; however, evidences leading to its therapeutic strategy are lacking. This study investigated effects of addition of angiotensin II type 1 receptor blocker (ARB) to angiotensin-converting enzyme inhibitor (ACEI) at advanced stage of DHF in hypertensive rats. Dahl salt-sensitive rats fed 8% NaCl diet from age 7 weeks served as DHF model, and those fed a normal chow served as control. The DHF model rats were arbitrarily assigned to 3 treatment regimens at age 17 weeks: ACEI (temocapril 0.4 mg/kg per day), combination of ACEI (temocapril 0.2 mg/kg per day) with ARB (olmesartan 0.3 mg/kg per day), or placebo. At age 17 weeks, this model represents progressive ventricular hypertrophy and fibrosis, relaxation abnormality, and myocardial stiffening. Data were collected at age 20 weeks. As compared with the monotherapy with ACEI, the addition of ARB induced more prominent suppression of ventricular hypertrophy and fibrosis, leading to suppression of myocardial stiffening, improvement of relaxation, and inhibition of hemodynamic deterioration. Such benefits were associated with greater decreases in reactive oxygen species (ROS) generation, macrophage infiltration, and gene expression of transforming growth factor (TGF)-beta(1) and interleukin (IL)-1beta, but not with changes in gene expression of monocyte chemoattractant protein (MCP)-1 and tumor necrosis factor (TNF)-alpha. Thus, ARB added to ACEI provides more benefits as compared with ACEI alone in DHF when initiated at an advanced stage. The additive effects are likely provided through more prominent suppression of ROS generation and inflammatory changes without effects on expression of MCP-1 and TNF-alpha.

  • elevation of plasma brain natriuretic peptide is a hallmark of Diastolic Heart Failure independent of ventricular hypertrophy
    Journal of the American College of Cardiology, 2004
    Co-Authors: Hitoshi Yamaguchi, Masayoshi Mishima, Kazuhiro Yamamoto, Masatsugu Hori, Yasushi Sakata, Toshiaki Mano, Junichi Yoshida, Noriyuki Akehi, Youngjae Lim, Tohru Masuyama
    Abstract:

    Abstract Objectives We tested a hypothesis that elevation of the plasma level of brain natriuretic peptide (BNP) is one of the characteristics of patients with Diastolic Heart Failure (DHF) independent of left ventricular (LV) hypertrophy. Background The clinical characteristics of DHF are not well acknowledged, although DHF has become a great social burden. Such a lack of clinical information leads to inaccuracy in the diagnosis of DHF. We have demonstrated enhancement of ventricular production of BNP with progression of maladaptive ventricular hypertrophy, but not with development of compensatory hypertrophy in an animal DHF model. Methods Of 372 patients who presented to the emergency department because of acute pulmonary congestion without acute coronary syndrome between January 1996 and May 2002, those with an ejection fraction ≥45% upon admission, who were stably controlled at least for a year in our outpatient clinics, comprised the DHF group (n = 19). A control group consisted of 22 hypertensive patients with a LV mass index greater than or equal to its minimum value of the DHF group and an ejection fraction ≥45%, in whom cardiac symptoms had not occurred. Results Despite a similar distribution of LV mass index, the BNP level was higher in the DHF group than in the control group (149 ± 38 vs. 31 ± 5 pg/ml, p Conclusions An elevation of BNP may be a hallmark of patients with or at risk of DHF among subjects with preserved systolic function independent of LV hypertrophy.