The prognostic role of vascular function indices in patients with acute heart failure with reduced ejection fraction

Introduction – Aim of the study: Although impaired arterial function has been associated with adverse prognosis in chronic heart failure, its role in acute heart failure syndromes has been little studied. The aim of this study was to prospectively investigate the prognostic role of arterial function indices on mortality and heart failure hospitalizations in patients admitted for an acute heart failure syndrome.Materials and Methods: We studied patients hospitalized for an acute heart failure syndrome (with reduced and preserved ejection fraction) who consented to participate in the study. The patients were examined at 24-48 hours before discharge and followed for 6 months for prespecified clinical events (all-cause death and heart failure hospitalizations). An echocardiographic study and a thorough assessment of arterial function by measurement of brachial artery flow-mediated dilation (bFMD), carotid-femoral (aortic) pulse wave velocity (cf-PWV), central aortic pressures (cPP), arterial elasticity indices and ankle-brachial index (ABI) were performed. Moreover, basic clinical and biochemical indices were studied as well as important heart failure biomarkers, such as the natriuretic peptide BNP and Galectin - 3. Results: One hundred patients were studied; aged 70±11 years, 78% males, 61% had left ventricular ejection fraction (LVEF) ≤40% and 24% LVEF ≥50%. Mean aortic cf- PWV was 11.2±3.4 m/s and median bFMD was 3.14%. At 6-month follow up, 9 patients died (all deaths were cardiac) and 23 patients had at least one heart failure hospitalization. Higher aortic cf-PWV was independently associated with all-cause mortality (HR 1.59 per 1m/s, P14 (indicating high left ventricular filling pressures), increased Left Ventricular Mass index and increased Left Atrial Volume Index as well as metabolic parameters, i.e. low serum HDL cholesterol and low albumin values), were also independently associated with all-cause mortality or heart failure hospitalizations in the total population (P 14, αυξημένη μάζα αριστερής κοιλίας και αυξημένος όγκος αριστερού κόλπου) και μεταβολικές (χαμηλή HDL- χοληστερόλη και χαμηλή αλβουμίνη) επίσης σχετίστηκαν ανεξάρτητα με την ολική θνητότητα και τις νοσηλείες για καρδιακή ανεπάρκεια σε όλο τον πληθυσμό (P<0.05 για όλες τις συσχετίσεις).Συμπεράσματα: Σε ασθενείς μετά από νοσηλεία για οξεία καρδιακή ανεπάρκεια, δείκτες περιφερικής κυκλοφορίας βρέθηκε να παίζουν σημαντικό ρόλο στην πρόγνωση των ασθενών και να σχετίζονται ανεξάρτητα με μείζονα καρδιαγγειακά συμβάντα στους 6 μήνες παρακολούθησης. Η αυξημένη αρτηριακή σκληρία όπως αυτή μπορεί να εκτιμηθεί με την καρωτιδομηριαία ταχύτητα σφυγμικού κύματος (cf-PWV) και η κεντρική πίεση παλμού (cPP) σχετίστηκαν ανεξάρτητα με τη θνητότητα και τις νοσηλείες για καρδιακή ανεπάρκεια, αντίστοιχα.Ηχωκαρδιογραφικοί δείκτες επηρεασμένης διαστολικής λειτουργίας, αυξημένης μάζας αριστερής κοιλίας και συμφόρησης, καθώς και μεταβολικές διαταραχές βρέθηκαν ακόμη να είναι ανεξάρτητοι προγνωστικοί δείκτες μειζόνων καρδιαγγειακών συμβάντων.Περαιτέρω έρευνα απαιτείται για να αποδειχθεί αν η αναλυτική διαχείριση των ασθενών με οξεία καρδιακή ανεπάρκεια (ενδεχομένως ξεχωριστά για κάθε υποκατηγορία HFrEF και HFpEF) με στόχο τη βελτίωση της καρδιακής και αγγειακής λειτουργίας και του μεταβολικού προφίλ, ίσως βελτιώσει την πρόγνωση μετά από νοσηλεία για οξεία καρδιακή ανεπάρκεια

Endothelial dysfunction and heart failure: A review of the existing bibliography with emphasis on flow mediated dilation

Heart failure affects 1–2% of the population worldwide, and it is characterized by episodes of decompensation often requiring hospitalization. Although targeted treatment has reduced the prevalence of rehospitalizations to 30–50%, mortality rates remain high. A complex blend of structural and functional alterations accounts for the genesis and progression of heart failure, but the exact underlying pathophysiology remains poorly understood. The aim of this review is to summarize endothelial dysfunction and its role in the pathogenesis and progression of heart failure. Moreover, it sums up all the appropriate methods of assessing endothelial dysfunction emphasizing on flow-mediated dilation and introduces endothelium as a potential target for new therapeutic development and research in the wide spectrum of the syndrome called heart failure

[Case Report] Stress induced (Takotsubo) cardiomyopathy triggered by the COVID-19 pandemic

Stress induced (Takotsubo) cardiomyopathy (TC) represents an acute heart failure syndrome triggered by physical or emotional stressors. COVID-19 pandemic has caused an unprecedented health crisis resulting in fear, distress and anxiety, with emerging cardiovascular implications. COVID-19 related stress can act as potential trigger for TC. We present a case of an elderly female who developed TC due to stress surrounding COVID-19