Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proporti...Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF （HFrEF）, and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfimction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this dis- ease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF.展开更多
Background:Patients with unrepaired Ebstein’s anomaly experience exercise intolerance,heart failure and premature mortality.Volumetric assessment of right ventricular function is difffcult due to the complex anatomy ...Background:Patients with unrepaired Ebstein’s anomaly experience exercise intolerance,heart failure and premature mortality.Volumetric assessment of right ventricular function is difffcult due to the complex anatomy of the right ventricle and tricuspid valve.Myocardial deformation indices are an early marker in other cardiac pathologies of ventricular dysfunction.Objectives:1.Assess myocardial deformation in unrepaired Ebstein’s compared to healthy controls.2.Investigate the relationships between myocardial deformation and exercise capacity.Methods:Myocardial deformation parameters(strain)were calculated using feature tracking from standard cardiac magnetic resonance cine images.Cardiopulmonary exercise results were included where available.Results:36 patients with unrepaired Ebstein’s and 36 matched controls were included.Right ventricular,right atrial,and left ventricular global longitudinal,as well as left ventricular circumferential strain were impaired in Ebstein’s patients compared to controls(p<0.05).In Ebstein’s patients right atrial peak strain correlated with their percentage predicted VO_(2) max(r=−0.448,p=0.022)and VE/VCO_(2) slope(r=0.435,p=0.026).There were no correlations between right ventricular ejection fraction and exercise parameters.When Ebstein’s patients were divided by severity into mild or severe according to the median total right/left index,those with severe demonstrated signiffcantly impaired right ventricular global longitudinal strain compared to those in the mild category(−17.5±5.4%vs.−21.4±4.4%,p=0.0017).Conclusions:Myocardial deformation parameters for both the right and left ventricle are impaired in patients with unrepaired Ebstein’s compared to healthy controls.Right atrial peak strain is related to impaired exercise capacity and warrants further investigation as an early prognostic marker in this patient cohort.展开更多
Cardiac injury and sustained cardiovascular abnormalities in long-COVID syndrome,i.e.post-acute sequelae of coronavirus disease 2019(COVID-19)have emerged as a debilitating health burden that has posed challenges for ...Cardiac injury and sustained cardiovascular abnormalities in long-COVID syndrome,i.e.post-acute sequelae of coronavirus disease 2019(COVID-19)have emerged as a debilitating health burden that has posed challenges for management of pre-existing cardiovascular conditions and other associated chronic comorbidities in the most vulnerable group of patients recovered from acute COVID-19.A clear and evidence-based guideline for treating cardiac issues of long-COVID syndrome is still lacking.In this review,we have summarized the common cardiac symptoms reported in the months after acute COVID-19 illness and further evaluated the possible pathogenic factors underlying the pathophysiology process of long-COVID.The mechanistic understanding of how Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)damages the heart and vasculatures is critical in developing targeted therapy and preventive measures for limiting the viral attacks.Despite the currently available therapeutic interventions,a considerable portion of patients recovered from severe COVID-19 have reported a reduced functional reserve due to deconditioning.Therefore,a rigorous and comprehensive cardiac rehabilitation program with individualized exercise protocols would be instrumental for the patients with long-COVID to regain the physicalfitness levels comparable to their pre-illness baseline.展开更多
文摘Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF （HFrEF）, and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfimction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this dis- ease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF.
基金This observational retrospective study was approved by the local Clinical Governance Committee(RRK6237)conformed to the principles of Good Clinical Practice guidelines.Additionally,healthy controls were identiffed from a national ethics board approved observational CMR study(NCT01028703).
文摘Background:Patients with unrepaired Ebstein’s anomaly experience exercise intolerance,heart failure and premature mortality.Volumetric assessment of right ventricular function is difffcult due to the complex anatomy of the right ventricle and tricuspid valve.Myocardial deformation indices are an early marker in other cardiac pathologies of ventricular dysfunction.Objectives:1.Assess myocardial deformation in unrepaired Ebstein’s compared to healthy controls.2.Investigate the relationships between myocardial deformation and exercise capacity.Methods:Myocardial deformation parameters(strain)were calculated using feature tracking from standard cardiac magnetic resonance cine images.Cardiopulmonary exercise results were included where available.Results:36 patients with unrepaired Ebstein’s and 36 matched controls were included.Right ventricular,right atrial,and left ventricular global longitudinal,as well as left ventricular circumferential strain were impaired in Ebstein’s patients compared to controls(p<0.05).In Ebstein’s patients right atrial peak strain correlated with their percentage predicted VO_(2) max(r=−0.448,p=0.022)and VE/VCO_(2) slope(r=0.435,p=0.026).There were no correlations between right ventricular ejection fraction and exercise parameters.When Ebstein’s patients were divided by severity into mild or severe according to the median total right/left index,those with severe demonstrated signiffcantly impaired right ventricular global longitudinal strain compared to those in the mild category(−17.5±5.4%vs.−21.4±4.4%,p=0.0017).Conclusions:Myocardial deformation parameters for both the right and left ventricle are impaired in patients with unrepaired Ebstein’s compared to healthy controls.Right atrial peak strain is related to impaired exercise capacity and warrants further investigation as an early prognostic marker in this patient cohort.
文摘Cardiac injury and sustained cardiovascular abnormalities in long-COVID syndrome,i.e.post-acute sequelae of coronavirus disease 2019(COVID-19)have emerged as a debilitating health burden that has posed challenges for management of pre-existing cardiovascular conditions and other associated chronic comorbidities in the most vulnerable group of patients recovered from acute COVID-19.A clear and evidence-based guideline for treating cardiac issues of long-COVID syndrome is still lacking.In this review,we have summarized the common cardiac symptoms reported in the months after acute COVID-19 illness and further evaluated the possible pathogenic factors underlying the pathophysiology process of long-COVID.The mechanistic understanding of how Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2)damages the heart and vasculatures is critical in developing targeted therapy and preventive measures for limiting the viral attacks.Despite the currently available therapeutic interventions,a considerable portion of patients recovered from severe COVID-19 have reported a reduced functional reserve due to deconditioning.Therefore,a rigorous and comprehensive cardiac rehabilitation program with individualized exercise protocols would be instrumental for the patients with long-COVID to regain the physicalfitness levels comparable to their pre-illness baseline.
