Characterization of heart failure with preserved ejection fraction in the outpatient setting: improvement in prognosis assessment and applicability of new echocardiographic techniques
[eng] Heart failure with preserved left ventricular ejection fraction (HFPEF) is the most prevalent type of heart failure (HF) in the outpatient setting. Left ventricular ejection fraction values (considered as a surrogate of systolic function measured by standard echocardiography) are normal in HFP...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2016 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/109226 |
| Acceso en línea: | https://hdl.handle.net/2445/109226 http://hdl.handle.net/10803/401866 |
| Access Level: | acceso abierto |
| Palabra clave: | Insuficiència cardíaca Miocardiopaties Heart failure Myocardiopathies |
| Sumario: | [eng] Heart failure with preserved left ventricular ejection fraction (HFPEF) is the most prevalent type of heart failure (HF) in the outpatient setting. Left ventricular ejection fraction values (considered as a surrogate of systolic function measured by standard echocardiography) are normal in HFPEF, making its diagnosis more challenging. In the present project, the underlying mechanisms involved in the early stages of HFPEF were analysed in outpatients with new onset HF and healthy controls. We observed that left atrial dysfunction was similar in HF patients with preserved or reduced left ventricular ejection fraction, but left ventricular function of HFPEF patients showed normal left ventricular ejection fraction and strain analysis similar values to that observed in a control group of patients without HF. Interatrial dyssynchrony was also observed in patients with new HFPEF onset. Both mechanisms seem to be present at the moment of symptoms onset, before ventricular dysfunction occurs. The study of these earliest alterations may be useful to achieve an early diagnosis and develop specific treatments, such as stepwise intensive management of atrial fibrillation or electrostimulation to resynchronizing the atria. On the other hand, previous studies in patients diagnosed with HF as the cause of a hospital admission indicated a similar prognosis for patients with HFPEF and those with reduced ejection fraction (HFREF). In our study, outpatients with new-onset HFPEF and HFREF also showed similar midterm cardiovascular prognosis. We performed a discriminant analysis to identify the best combination of clinical, echocadiographic and analytical variables to determine the cardiovascular outcome of our cohort. Several biomarkers showed prognostic value, including high-sensitivity troponine I, matrix metalloprotease type 2, tissue inhibitor of metalloprotease-1, haemoglobin, left atrial volume and brain natriuretic peptide type B. The status of atrial function, analysed by the mean left atrial deformation, was also identified as an important prognostic marker. The present project demonstrates that the presence of underlying abnormalities such as atrial contractile dysfunction and dyssynchrony may contribute to the common clinical presentation of HF in patients with preserved left ventricular ejection fraction. These findings suggest the potential for alternative treatments in this syndrome. Additionally, the prognostic implications of several biomarkers and atrial dysfunction were demonstrated, allowing for the early identification of high-risk patients who should receive close follow-up and intensive treatment. |
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