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  1. Article: Heart Failure with Mid-Range Ejection Fraction - a New Category of Heart Failure or Still a Gray Zone.

    Andronic, Anca Andreea / Mihaila, Sorina / Cinteza, Mircea

    Maedica

    2017  Volume 11, Issue 4, Page(s) 320–324

    Abstract: Heart failure with midrange ejection fraction (HFmrEF) is a new category of heart failure (HF), inbetween HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Previous studies were mainly conducted in HFrEF patients ... ...

    Abstract Heart failure with midrange ejection fraction (HFmrEF) is a new category of heart failure (HF), inbetween HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Previous studies were mainly conducted in HFrEF patients having a left ventricle ejection fraction (LVEF) lower than 35-40%. Later on, HFpEF captured the spot-light of the research field, and studies focused on patients with HF symptoms, but with a LVEF exceeding 50%. Consequently, a gap of knowledge comprising the LVEF between 40 and 49% has arisen. Current studies focusing on patients with HFmrEF are arguing the same conclusions or even having contradictory findings. HFmrEF has a prevalence of 10-20% of HF patients. HFmrEF has distinct, but intermediate clinical, structural and functional characteristics, as well as intermediate outcomes in comparison with HFrEF and HFpEF. However, there is still a large gap in evidence regarding detailed hemodynamic characteristics, long-term follow-up and optimal therapeutic options for these patients. Extensive research was recommended in order to improve knowledge about this "gray area" of patients with HF. Therefore, we aimed to provide an over-view of the existing and lacking data regarding patients with HFmrEF.
    Language English
    Publishing date 2017-08-18
    Publishing country Romania
    Document type Journal Article
    ZDB-ID 2399972-X
    ISSN 2069-6116 ; 1841-9038
    ISSN (online) 2069-6116
    ISSN 1841-9038
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: New insights into the potential utility of the left atrial function analysis in heart failure with preserved ejection fraction diagnosis.

    Rimbas, Roxana Cristina / Visoiu, Ionela Simona / Magda, Stefania Lucia / Mihaila-Baldea, Sorina / Luchian, Maria Luiza / Chitroceanu, Alexandra Maria / Hayat, Memis / Mihalcea, Diana Janina / Dragoi-Galrinho-Antunes-Guerra, Ruxandra / Stefan, Miruna / Velcea, Andreea / Andronic, Anca Andreea / Lungeanu-Juravle, Laura / Nicula, Alina Ioana / Vinereanu, Dragos

    PloS one

    2022  Volume 17, Issue 5, Page(s) e0267962

    Abstract: Aims: None of the conventional echocardiographic parameters alone predict increased NTproBNP level and symptoms, making diagnosis of heart failure with preserved ejection fraction (HFpEF) very difficult in some cases, in resting condition. We evaluated ... ...

    Abstract Aims: None of the conventional echocardiographic parameters alone predict increased NTproBNP level and symptoms, making diagnosis of heart failure with preserved ejection fraction (HFpEF) very difficult in some cases, in resting condition. We evaluated LA functions by 2D speckle tracking echocardiography (STE) on top of conventional parameters in HFpEF and preHF patients with diastolic dysfunction (DD), in order to establish the added value of the LA deformation parameters in the diagnosis of HFpEF.
    Methods: We prospectively enrolled 125 patients, 88 with HFpEF (68±9 yrs), and 37 asymptomatic with similar risk factors with DD (preHF) (61±8 yrs). We evaluated them by NTproBNP, conventional DD parameters, and STE. Global longitudinal strain (GS) was added. LA reservoir (R), conduit (C), and pump function (CT) were assessed both by volumetric and STE. 2 reservoir strain (S) derived indices were also measured, stiffness (SI) and distensibility index (DI).
    Results: LA R and CT functions were significantly reduced in HFpEF compared to preHF group (all p<0.001), whereas conduit was similarly in both groups. SI was increased, whereas DI was reduced in HFpEF group (p<0.001). By adding LA strain analysis, from all echocardiographic parameters, SR_CT<-1.66/s and DI<0.57 (AUC = 0.76, p<0.001) demonstrated the highest accuracy to identify HFpEF diagnosis. However, by multivariate logistic regression, the model that best identifies HFpEF included only SR_CT, GS and sPAP (R2 = 0.506, p<0.001). Moreover, SR_CT, DI, and sPAP registered significant correlation with NTproBNP level.
    Conclusions: By adding LA functional analysis, we might improve the HFpEF diagnosis accuracy, compared to present guidelines. LA pump function is the only one able to differentiates preHF from HFpEF patients at rest. A value of SR_CT < -1.66/s outperformed conventional parameters from the scoring system, reservoir strain, and LA overload indices in HFpEF diagnosis. We suggest that LA function by STE could be incorporated in the current protocol for HFpEF diagnosis at rest as a major functional criterion, in order to improve diagnostic algorithm, and also in the follow-up of patients with risk factors and DD, as a prognostic marker. Future studies are needed to validate our findings.
    MeSH term(s) Atrial Function, Left ; Echocardiography/methods ; Heart Atria/diagnostic imaging ; Heart Failure/diagnostic imaging ; Humans ; Risk Factors ; Stroke Volume ; Ventricular Function, Left
    Language English
    Publishing date 2022-05-04
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0267962
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: 3-D Echocardiography Is Feasible and More Reproducible than 2-D Echocardiography for In-Training Echocardiographers in Follow-up of Patients with Heart Failure with Reduced Ejection Fraction.

    Baldea, Sorina Mihaila / Velcea, Andreea Elena / Rimbas, Roxana Cristina / Andronic, Anca / Matei, Lavinia / Calin, Simona Ionela / Muraru, Denisa / Badano, Luigi Paolo / Vinereanu, Dragos

    Ultrasound in medicine & biology

    2020  Volume 47, Issue 3, Page(s) 499–510

    Abstract: Left ventricular volumes (LVVs) and ejection fraction (LVEF) are key elements in the evaluation and follow-up of patients with heart failure with reduced ejection fraction (HFrEF). Therefore, a feasible and reproducible imaging method to be used by both ... ...

    Abstract Left ventricular volumes (LVVs) and ejection fraction (LVEF) are key elements in the evaluation and follow-up of patients with heart failure with reduced ejection fraction (HFrEF). Therefore, a feasible and reproducible imaging method to be used by both experienced and in-training echocardiographers is mandatory. Our aim was to establish if, in a large echo lab, echocardiographers in-training provide feasible and more reproducible results for the evaluation of patients with HFrEF when using 3-dimensional echocardiography (3-DE) versus 2-dimensional echocardiography (2-DE). Sixty patients with HFrEF (46 males, age: 58 ± 17 y) underwent standard transthoracic 2-D acquisitions and 3-D multibeat full volumes of the left ventricle. One expert user in echocardiography (expert) and three echocardiographers with different levels of training in 2-DE (beginner, medium and advanced) measured the 2-D LVVs and LVEFs on the same consecutive images of patients with HFrEF. Afterward, the expert performed a 1-mo training in 3-DE analysis of the users, and both the expert and trainees measured the 3-D LVVs and LVEF of the same patients. Measurements provided by the expert and all trainees in echo were compared. Six patients were excluded from the study because of poor image quality. The mean end-diastolic LVV of the remaining 54 patients was 214 ± 75 mL with 2-DE and 233 ± 77 mL with 3-DE. Mean LVEF was 35 ± 10% with 2-DE and 33 ± 10% with 3-DE. Our analysis revealed that, compared with the expert user, the trainees had acceptable reproducibility for the 2-DE measurements, according to their level of expertise in 2-DE (intra-class coefficients [ICCs] ranging from 0.75 to 0.94). However, after the short training in 3-DE, they provided feasible and more reproducible measurements of the 3-D LVVs and LVEF (ICCs ranging from 0.89-0.97) than they had with 2-DE. 3-DE is a feasible, rapidly learned and more reproducible method for the assessment of LVVs and LVEF than 2-DE, regardless of the basic level of expertise in 2-DE of the trainees in echocardiography. In echo labs with a wide range of staff experience, 3-DE might be a more accurate method for the follow-up of patients with HFrEF.
    MeSH term(s) Echocardiography ; Echocardiography, Three-Dimensional ; Feasibility Studies ; Female ; Heart Failure/diagnosis ; Heart Failure/diagnostic imaging ; Humans ; Learning Curve ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; Stroke Volume
    Language English
    Publishing date 2020-11-29
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 186150-5
    ISSN 1879-291X ; 0301-5629
    ISSN (online) 1879-291X
    ISSN 0301-5629
    DOI 10.1016/j.ultrasmedbio.2020.10.022
    Database MEDical Literature Analysis and Retrieval System OnLINE

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