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1. Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy: A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology

Author

Guazzi, Marco, Wilhelm, Matthias, Halle, Martin, Van Craenenbroeck, Emeline, Kemps, Hareld, de Boer, Rudolph A., Coats, Andrew J.S., Lund, Lars, Mancini, Donna, Borlaug, Barry, Filippatos, Gerasimos, Pieske, Burkert, Guazzi, Marco, Wilhelm, Matthias, Halle, Martin, Van Craenenbroeck, Emeline, Kemps, Hareld, de Boer, Rudolph A., Coats, Andrew J.S., Lund, Lars, Mancini, Donna, Borlaug, Barry, Filippatos, Gerasimos, and Pieske, Burkert

Abstract

Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as well as extracardiac components play a role for the limited exercise capacity, including an impaired cardiac and peripheral vascular reserve, a limitation in mechanical ventilation and/or gas exchange with reduced pulmonary vascular reserve, skeletal muscle dysfunction and iron deficiency/anaemia. Although most of these components can be differentiated and quantified through gas exchange analysis by cardiopulmonary exercise testing (CPET), the information provided by objective measures of exercise performance has not been systematically considered in the recent algorithms/scores for HFpEF diagnosis, by neither European nor US groups. The current clinical consensus statement by the Heart Failure Association (HFA) and European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC) aims at outlining the role of exercise testing and its pathophysiological, clinical and prognostic insights, addressing the implications of a thorough functional evaluation from the diagnostic algorithm to the pathophysiology and treatment perspectives of HFpEF. Along with these goals, we provide a specific analysis of the evidence that CPET is the standard for assessing, quantifying, and differentiating the origin of dyspnoea and exercise impairment and even more so when combined with echocardiography and/or invasive haemodynamic evaluation. This will lead to improved quality of diagnosis when applying the proposed scores and may also help to implement the progressive characterization of the specific HFpEF phenotypes, a critical step toward the delivery of phenotype-specific treatments.

Published
2022

2. Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II):a randomised, multicentre, blinded, sham-controlled trial

Author

Shah, Sanjiv J., Borlaug, Barry A., Chung, Eugene, Cutlip, Donald E., Debonnaire, Philippe, Fail, Peter, Gao, Qi, Hasenfuß, Gerd, Kahwash, Rami, Kaye, David M., Litwin, Sheldon E., Lurz, Philipp, Massaro, Joseph M., Mohan, Rajeev C., Ricciardi, Mark J., Solomon, Scott D., Sverdlov, Aaron L., Swarup, Vijendra, van Veldhuisen, Dirk J., Winkler, Sebastian, Leon, Martin B., Akar, Joseph, Ando, Jiro, Anzai, Toshihisa, Asakura, Masanori, Bailey, Steven, Basuray, Anupam, Bauer, Fabrice, Bergmann, Martin, Blair, John, Cavendish, Jeffrey, Cikes, Maja, Dauber, Ira, Donal, Erwan, Eicher, Jean Christophe, Flaherty, James, Freixa, Xavier, Gafoor, Sameer, Gertz, Zachary, Gordon, Robert, Guazzi, Marco, Guerrero-Miranda, Cesar, Gupta, Deepak, Gustafsson, Finn, Hadadi, Cyrus, Hakemi, Emad, Handoko, Louis, Hass, Moritz, Shah, Sanjiv J., Borlaug, Barry A., Chung, Eugene, Cutlip, Donald E., Debonnaire, Philippe, Fail, Peter, Gao, Qi, Hasenfuß, Gerd, Kahwash, Rami, Kaye, David M., Litwin, Sheldon E., Lurz, Philipp, Massaro, Joseph M., Mohan, Rajeev C., Ricciardi, Mark J., Solomon, Scott D., Sverdlov, Aaron L., Swarup, Vijendra, van Veldhuisen, Dirk J., Winkler, Sebastian, Leon, Martin B., Akar, Joseph, Ando, Jiro, Anzai, Toshihisa, Asakura, Masanori, Bailey, Steven, Basuray, Anupam, Bauer, Fabrice, Bergmann, Martin, Blair, John, Cavendish, Jeffrey, Cikes, Maja, Dauber, Ira, Donal, Erwan, Eicher, Jean Christophe, Flaherty, James, Freixa, Xavier, Gafoor, Sameer, Gertz, Zachary, Gordon, Robert, Guazzi, Marco, Guerrero-Miranda, Cesar, Gupta, Deepak, Gustafsson, Finn, Hadadi, Cyrus, Hakemi, Emad, Handoko, Louis, and Hass, Moritz

Abstract

Background: Placement of an interatrial shunt device reduces pulmonary capillary wedge pressure during exercise in patients with heart failure and preserved or mildly reduced ejection fraction. We aimed to investigate whether an interatrial shunt can reduce heart failure events or improve health status in these patients. Methods: In this randomised, international, blinded, sham-controlled trial performed at 89 health-care centres, we included patients (aged ≥40 years) with symptomatic heart failure, an ejection fraction of at least 40%, and pulmonary capillary wedge pressure during exercise of at least 25 mm Hg while exceeding right atrial pressure by at least 5 mm Hg. Patients were randomly assigned (1:1) to receive either a shunt device or sham procedure. Patients and outcome assessors were masked to randomisation. The primary endpoint was a hierarchical composite of cardiovascular death or non-fatal ischemic stroke at 12 months, rate of total heart failure events up to 24 months, and change in Kansas City Cardiomyopathy Questionnaire overall summary score at 12 months. Pre-specified subgroup analyses were conducted for the heart failure event endpoint. Analysis of the primary endpoint, all other efficacy endpoints, and safety endpoints was conducted in the modified intention-to-treat population, defined as all patients randomly allocated to receive treatment, excluding those found to be ineligible after randomisation and therefore not treated. This study is registered with ClinicalTrials.gov, NCT03088033. Findings: Between May 25, 2017, and July 24, 2020, 1072 participants were enrolled, of whom 626 were randomly assigned to either the atrial shunt device (n=314) or sham procedure (n=312). There were no differences between groups in the primary composite endpoint (win ratio 1·0 [95% CI 0·8–1·2]; p=0·85) or in the individual components of the primary endpoint. The prespecified subgroups demonstrating a differential effect of atrial shunt device treatment on hea

Published
2022

3. Right Heart Phenotype in Heart Failure with Preserved Ejection Fraction

Author

Guazzi, Marco, Naeije, Robert, Guazzi, Marco, and Naeije, Robert

Abstract

The health burden of heart failure with preserved ejection fraction is increasingly recognized. Despite improvements in diagnostic algorithms and established knowledge on the clinical trajectory, effective treatment options for heart failure with preserved ejection fraction remain limited, mainly because of the high mechanistic heterogeneity. Diagnostic scores, big data, and phenomapping categorization are proposed as key steps needed for progress. In the meantime, advancements in imaging techniques combined to high-fidelity pressure signaling analysis have uncovered right ventricular dysfunction as a mediator of heart failure with preserved ejection fraction progression and as major independent determinant of poor outcome. This review summarizes the current understanding of the pathophysiology of right ventricular dysfunction in heart failure with preserved ejection fraction covering the different right heart phenotypes and offering perspectives on new treatments targeting the right ventricle in its function and geometry., SCOPUS: ar.j, DecretOANoAutActif, info:eu-repo/semantics/published

Published
2021

4. Cardiopulmonary Exercise Test Parameters in Athletic Population: A Review

Author

Mazaheri, Reza; https://orcid.org/0000-0003-0140-5184, Schmied, Christian, Niederseer, David; https://orcid.org/0000-0003-3089-1222, Guazzi, Marco, Mazaheri, Reza; https://orcid.org/0000-0003-0140-5184, Schmied, Christian, Niederseer, David; https://orcid.org/0000-0003-3089-1222, and Guazzi, Marco

Abstract

Although still underutilized, cardiopulmonary exercise testing (CPET) allows the most accurate and reproducible measurement of cardiorespiratory fitness and performance in athletes. It provides functional physiologic indices which are key variables in the assessment of athletes in different disciplines. CPET is valuable in clinical and physiological investigation of individuals with loss of performance or minor symptoms that might indicate subclinical cardiovascular, pulmonary or musculoskeletal disorders. Highly trained athletes have improved CPET values, so having just normal values may hide a medical disorder. In the present review, applications of CPET in athletes with special attention on physiological parameters such as VO$_{2}$max, ventilatory thresholds, oxygen pulse, and ventilatory equivalent for oxygen and exercise economy in the assessment of athletic performance are discussed. The role of CPET in the evaluation of possible latent diseases and overtraining syndrome, as well as CPET-based exercise prescription, are outlined.

Published
2021

5. N-Terminal-pro-Brain natriuretic peptide dynamics during effort phenotypes ischemic heart failure and determines prognosis regardless of ejection fraction

Author

Popović, Dejana, Popović, Dejana, Đorđević, Tea, Jakovljević, Đorđe, Ristić, Arsen, Lasica, Ratko, Arena, Ross, Guazzi, Marco, Popović, Dejana, Popović, Dejana, Đorđević, Tea, Jakovljević, Đorđe, Ristić, Arsen, Lasica, Ratko, Arena, Ross, and Guazzi, Marco

Abstract

Ischemic heart disease leading to heart failure (HF) portends a high overall morbidity and mortality. A higher N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) at rest reflects HF severity and impaired cardiac output, most often secondary to reduced ejection fraction (EF). As an insufficient increase in cardiac output during exertion is common in all HF phenotypes, we examined the value of NT-pro-BNP during exercise testing as a risk stratification index for ischemic HF secondary to either reduced (HFrEF) or mid-ranged/preserved EF (HFmrEF/HFpEF). 213 patients (123 HFrEF; 90 HFmrEF/HFpEF) underwent cardiopulmonary exercise testing (CPET). NT-pro-BNP was determined at rest and peak exercise. The distribution of HFrEF and HFmrEF/HFpEF etiology in subjects with and without oxygen consumption trajectory flattening during CPET was similar (p > 0.05). Patients with HFrEF had higher plasma levels of NT-pro-BNP at rest and peak exercise than those with HFmrEF/HFpEF (984 vs. 780; 1012 vs. 845 pg/mL, p < 0.01, respectively), whereas ΔNT-pro-BNPpeak/rest was similar (60 vs. 50 pg/mL, p > 0.05). During the tracking period (22.4 ± 20.3 months) 34 patients died, and there were 2 cardiac transplantations and 3 LVAD implantations. In a multivariate regression model only the NT-pro-BNPpeak and ΔNT-pro-BNPpeak/rest were retained in the regression for the prediction of adverse events (Chi-square:8.97, p = 0.003). ROC analysis demonstrated that NT-pro-BNPpeak ≥1506 pg/mL and ΔNT-pro-BNPpeak/rest ≥108 pg/mL were optimal for identifying patients with a risk (Sn = 76.9, 74.4 %; Sp = 84.7, 80.9 %, respectively). NT-pro-BNP changes during effort and absolute peak values reached provide novel insights emerging as new and strong predictors of adverse events in HF of any EF.

Published
2020

6. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Author

HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Pieske, Burkert, Tschöpe, Carsten, de Boer, Rudolf A, Fraser, Alan G, Anker, Stefan D, Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S P, Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A, Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D, Vasan, Ramachandran S, Rutten, Frans H, Voors, Adriaan A, Ruschitzka, Frank, Paulus, Walter J, Seferovic, Petar, Filippatos, Gerasimos, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Pieske, Burkert, Tschöpe, Carsten, de Boer, Rudolf A, Fraser, Alan G, Anker, Stefan D, Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S P, Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A, Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D, Vasan, Ramachandran S, Rutten, Frans H, Voors, Adriaan A, Ruschitzka, Frank, Paulus, Walter J, Seferovic, Petar, and Filippatos, Gerasimos

Published
2020

7. How to diagnose heart failure with preserved ejection fraction : The HFA-PEFF diagnostic algorithm: A consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Author

Pieske, Burkert, Tschöpe, Carsten, De Boer, Rudolf A., Fraser, Alan G., Anker, Stefan D., Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S.P., Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A., Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D., Vasan, Ramachandran S., Rutten, Frans H., Voors, Adriaan A., Ruschitzka, Frank, Paulus, Walter J., Seferovic, Petar, Filippatos, Gerasimos, Pieske, Burkert, Tschöpe, Carsten, De Boer, Rudolf A., Fraser, Alan G., Anker, Stefan D., Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S.P., Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A., Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D., Vasan, Ramachandran S., Rutten, Frans H., Voors, Adriaan A., Ruschitzka, Frank, Paulus, Walter J., Seferovic, Petar, and Filippatos, Gerasimos

Published
2019

8. How to diagnose heart failure with preserved ejection fraction : The HFA-PEFF diagnostic algorithm: A consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Author

Pieske, Burkert, Tschöpe, Carsten, De Boer, Rudolf A., Fraser, Alan G., Anker, Stefan D., Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S.P., Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A., Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D., Vasan, Ramachandran S., Rutten, Frans H., Voors, Adriaan A., Ruschitzka, Frank, Paulus, Walter J., Seferovic, Petar, Filippatos, Gerasimos, Pieske, Burkert, Tschöpe, Carsten, De Boer, Rudolf A., Fraser, Alan G., Anker, Stefan D., Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S.P., Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A., Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D., Vasan, Ramachandran S., Rutten, Frans H., Voors, Adriaan A., Ruschitzka, Frank, Paulus, Walter J., Seferovic, Petar, and Filippatos, Gerasimos

Published
2019

9. Pulmonary hypertension due to left heart disease

Author

Vachiery, Jean-Luc, Tedford, Ryan J., Rosenkranz, Stephan, Palazzini, Massimiliano, Lang, Irene, Guazzi, Marco, Coghlan, Gerry, Chazova, Irina, De Marco, Teresa, Vachiery, Jean-Luc, Tedford, Ryan J., Rosenkranz, Stephan, Palazzini, Massimiliano, Lang, Irene, Guazzi, Marco, Coghlan, Gerry, Chazova, Irina, and De Marco, Teresa

Abstract

Pulmonary hypertension (PH) is frequent in left heart disease (LHD), as a consequence of the underlying condition. Significant advances have occurred over the past 5 years since the 5th World Symposium on Pulmonary Hypertension in 2013, leading to a better understanding of PH-LHD, challenges and gaps in evidence. PH in heart failure with preserved ejection fraction represents the most complex situation, as it may be misdiagnosed with group 1 PH. Based on the latest evidence, we propose a new haemodynamic definition for PH due to LHD and a three-step pragmatic approach to differential diagnosis. This includes the identification of a specific left heart phenotype and a non-invasive probability of PH-LHD. Invasive confirmation of PH-LHD is based on the accurate measurement of pulmonary arterial wedge pressure and, in patients with high probability, provocative testing to clarify the diagnosis. Finally, recent clinical trials did not demonstrate a benefit in treating PH due to LHD with pulmonary arterial hypertension-approved therapies.

Published
2019

10. Quantification of coronary artery disease using different modalities of cardiopulmonary exercise testing

Author

Popović, Dejana, Popović, Dejana, Guazzi, Marco, Jakovljević, Đorđe G., Lasica, Ratko, Banović, Marko, Ostojić, Miodrag, Arena, Ross, Popović, Dejana, Popović, Dejana, Guazzi, Marco, Jakovljević, Đorđe G., Lasica, Ratko, Banović, Marko, Ostojić, Miodrag, and Arena, Ross

Abstract

Background: This study examined the accuracy of cardiopulmonary exercise testing (CPET) on a treadmill (TM) and recumbent ergometry (RE) in the predicting coronary artery disease (CAD) severity and prognosis. Methods: Forty Caucasian subjects, mean age 63.5 +/- 7.6, with significant coronary artery lesions (>= 50%) were included. Within two months of coronary angiography, TM and RE CPET were performed on two visits 2-4 days apart and subsequently followed up to 32 +/- 10 months. Results: Mean left ventricular ejection fraction was 56.7 +/- 9.6%. TM CPET exhibited a higher occurrence of ST segment depression >= 1 mm (71.05% vs 28.95%, p = 0.04). Subjects with 1-2 stenotic coronary arteries (SCA) demonstrated a better CPET response compared to those with 3-SCA. ROC analysis revealed a high predictive value for the ventilation/carbon dioxide production (VE/VCO2) slope obtained on TM (area 0.84, p = 0.003, Sn 88.9%, Sp 72%) in distinguishing between 1 and 2-SCA and 3-SCA. Among all CPET parameters, work efficiency (Delta VO2/Delta WR) during RE predicted cumulative cardiac events (p lt 0.01). Conclusions: CPET parameters hold predictive value for CAD severity and prognosis. CPET on a TM appears to be more reliable in the quantification of CAD compared to RE.

Published
2019

11. How to diagnose heart failure with preserved ejection fraction : The HFA-PEFF diagnostic algorithm: A consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Author

Pieske, Burkert, Tschöpe, Carsten, De Boer, Rudolf A., Fraser, Alan G., Anker, Stefan D., Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S.P., Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A., Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D., Vasan, Ramachandran S., Rutten, Frans H., Voors, Adriaan A., Ruschitzka, Frank, Paulus, Walter J., Seferovic, Petar, Filippatos, Gerasimos, Pieske, Burkert, Tschöpe, Carsten, De Boer, Rudolf A., Fraser, Alan G., Anker, Stefan D., Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S.P., Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A., Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D., Vasan, Ramachandran S., Rutten, Frans H., Voors, Adriaan A., Ruschitzka, Frank, Paulus, Walter J., Seferovic, Petar, and Filippatos, Gerasimos

Published
2019

12. How to diagnose heart failure with preserved ejection fraction: The HFA-PEFF diagnostic algorithm: A consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Author

HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Pieske, Burkert, Tschöpe, Carsten, De Boer, Rudolf A., Fraser, Alan G., Anker, Stefan D., Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S.P., Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A., Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D., Vasan, Ramachandran S., Rutten, Frans H., Voors, Adriaan A., Ruschitzka, Frank, Paulus, Walter J., Seferovic, Petar, Filippatos, Gerasimos, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Pieske, Burkert, Tschöpe, Carsten, De Boer, Rudolf A., Fraser, Alan G., Anker, Stefan D., Donal, Erwan, Edelmann, Frank, Fu, Michael, Guazzi, Marco, Lam, Carolyn S.P., Lancellotti, Patrizio, Melenovsky, Vojtech, Morris, Daniel A., Nagel, Eike, Pieske-Kraigher, Elisabeth, Ponikowski, Piotr, Solomon, Scott D., Vasan, Ramachandran S., Rutten, Frans H., Voors, Adriaan A., Ruschitzka, Frank, Paulus, Walter J., Seferovic, Petar, and Filippatos, Gerasimos

Published
2019

13. Predictors of Clinical Evolution in Prehypertrophic Fabry Disease

Author

Camporeale, Antonia, Pieroni, Maurizio, Pieruzzi, Federico, Lusardi, Paola, Pica, Silvia, Spada, Marco, Mignani, Renzo, Burlina, Alessandro, Bandera, Francesco, Guazzi, Marco, Graziani, Francesca, Crea, Filippo, Greiser, Adrea, Boveri, Sara, Ambrogi, Federico, Lombardi, Massimo, Antonia Camporeale, Francesca Graziani (ORCID:0000-0002-4520-5689), Filippo Crea (ORCID:0000-0001-9404-8846), Camporeale, Antonia, Pieroni, Maurizio, Pieruzzi, Federico, Lusardi, Paola, Pica, Silvia, Spada, Marco, Mignani, Renzo, Burlina, Alessandro, Bandera, Francesco, Guazzi, Marco, Graziani, Francesca, Crea, Filippo, Greiser, Adrea, Boveri, Sara, Ambrogi, Federico, Lombardi, Massimo, Antonia Camporeale, Francesca Graziani (ORCID:0000-0002-4520-5689), and Filippo Crea (ORCID:0000-0001-9404-8846)

Abstract

Background: In prehypertrophic Fabry disease, low myocardial T1 values, reflecting sphingolipid storage, are associated with early structural and ECG changes. The correlations between T1 values and functional parameters have not been explored. Furthermore, the potential prognostic role of T1 in predicting disease worsening is still unknown. Methods: ECG, 2D echocardiography, cardiopulmonary test, and cardiac magnetic resonance were performed in 44 Fabry patients without left ventricular hypertrophy (35.7±14.5 years, 68.2% females). After a 12-month follow-up, clinical stability was evaluated using Fabry Stabilization Index. Results: At baseline, T1 values showed a negative correlation with left ventricular mass ( r=-0.79; P<0.0001), maximum wall thickness ( r=-0.79; P<0.0001), Sokolow-Lyon Index ( r=-0.54; P<0.0001), left atrial volume ( r=-0.49; P<0.0002), and Mainz Severity Score Index ( r=-0.61; P<0.0001). No significant differences in systo-diastolic function and exercise capacity were observed comparing normal and low T1 Fabry patients. Arrhythmias were reported in 2 females with low T1 and late gadolinium enhancement. Five patients (40.0±12.4 years, 2 females) showed clinical worsening (Fabry Stabilization Index >20%) at follow-up. Higher left ventricular wall thickness (odds ratio, 2.61; CI, 1.04-6.57; P=0.04), left atrial volume (odds ratio, 1.24; CI, 1.02-1.51; P=0.03), and lower T1 values (odds ratio, 0.98; CI, 0.96-0.99; P=0.03) at baseline were independently associated with clinical worsening at follow-up. Conclusions: In prehypertrophic Fabry disease, low T1 values correlate with early electrocardiographic, morphological cardiac changes, and worsening of global disease severity but are not associated with functional abnormalities. The presence of low T1 values is a risk factor for disease worsening, thus representing a potential new tool in prognostic stratification and therapeutic approach.

Published
2019

14. Pulmonary hypertension due to left heart disease

Author

Vachiery, Jean-Luc, Tedford, Ryan J., Rosenkranz, Stephan, Palazzini, Massimiliano, Lang, Irene, Guazzi, Marco, Coghlan, Gerry, Chazova, Irina, De Marco, Teresa, Vachiery, Jean-Luc, Tedford, Ryan J., Rosenkranz, Stephan, Palazzini, Massimiliano, Lang, Irene, Guazzi, Marco, Coghlan, Gerry, Chazova, Irina, and De Marco, Teresa

Abstract

Pulmonary hypertension (PH) is frequent in left heart disease (LHD), as a consequence of the underlying condition. Significant advances have occurred over the past 5 years since the 5th World Symposium on Pulmonary Hypertension in 2013, leading to a better understanding of PH-LHD, challenges and gaps in evidence. PH in heart failure with preserved ejection fraction represents the most complex situation, as it may be misdiagnosed with group 1 PH. Based on the latest evidence, we propose a new haemodynamic definition for PH due to LHD and a three-step pragmatic approach to differential diagnosis. This includes the identification of a specific left heart phenotype and a non-invasive probability of PH-LHD. Invasive confirmation of PH-LHD is based on the accurate measurement of pulmonary arterial wedge pressure and, in patients with high probability, provocative testing to clarify the diagnosis. Finally, recent clinical trials did not demonstrate a benefit in treating PH due to LHD with pulmonary arterial hypertension-approved therapies.

Published
2019

15. Right heart dysfunction and failure in heart failure with preserved ejection fraction : mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Author

Gorter, Thomas M, van Veldhuisen, Dirk J., Bauersachs, Johann, Borlaug, Barry A, Celutkiene, Jelena, Coats, Andrew J S, Crespo-Leiro, Marisa G, Guazzi, Marco, Harjola, Veli-Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S P, Lund, Lars H, Lyon, Alexander R, Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J., Pieske, Burkert, Piepoli, Massimo F., Ruschitzka, Frank, Rutten, Frans H, Seferovic, Petar M., Solomon, Scott D, Shah, Sanjiv J, Triposkiadis, Filippos, Wachter, Rolf, Tschöpe, Carsten, de Boer, Rudolf A., Gorter, Thomas M, van Veldhuisen, Dirk J., Bauersachs, Johann, Borlaug, Barry A, Celutkiene, Jelena, Coats, Andrew J S, Crespo-Leiro, Marisa G, Guazzi, Marco, Harjola, Veli-Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S P, Lund, Lars H, Lyon, Alexander R, Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J., Pieske, Burkert, Piepoli, Massimo F., Ruschitzka, Frank, Rutten, Frans H, Seferovic, Petar M., Solomon, Scott D, Shah, Sanjiv J, Triposkiadis, Filippos, Wachter, Rolf, Tschöpe, Carsten, and de Boer, Rudolf A.

Published
2018

16. Right heart dysfunction and failure in heart failure with preserved ejection fraction : mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Author

Gorter, Thomas M, van Veldhuisen, Dirk J., Bauersachs, Johann, Borlaug, Barry A, Celutkiene, Jelena, Coats, Andrew J S, Crespo-Leiro, Marisa G, Guazzi, Marco, Harjola, Veli-Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S P, Lund, Lars H, Lyon, Alexander R, Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J., Pieske, Burkert, Piepoli, Massimo F., Ruschitzka, Frank, Rutten, Frans H, Seferovic, Petar M., Solomon, Scott D, Shah, Sanjiv J, Triposkiadis, Filippos, Wachter, Rolf, Tschöpe, Carsten, de Boer, Rudolf A., Gorter, Thomas M, van Veldhuisen, Dirk J., Bauersachs, Johann, Borlaug, Barry A, Celutkiene, Jelena, Coats, Andrew J S, Crespo-Leiro, Marisa G, Guazzi, Marco, Harjola, Veli-Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S P, Lund, Lars H, Lyon, Alexander R, Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J., Pieske, Burkert, Piepoli, Massimo F., Ruschitzka, Frank, Rutten, Frans H, Seferovic, Petar M., Solomon, Scott D, Shah, Sanjiv J, Triposkiadis, Filippos, Wachter, Rolf, Tschöpe, Carsten, and de Boer, Rudolf A.

Published
2018

17. Right heart dysfunction and failure in heart failure with preserved ejection fraction : mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Author

Gorter, Thomas M, van Veldhuisen, Dirk J., Bauersachs, Johann, Borlaug, Barry A, Celutkiene, Jelena, Coats, Andrew J S, Crespo-Leiro, Marisa G, Guazzi, Marco, Harjola, Veli-Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S P, Lund, Lars H, Lyon, Alexander R, Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J., Pieske, Burkert, Piepoli, Massimo F., Ruschitzka, Frank, Rutten, Frans H, Seferovic, Petar M., Solomon, Scott D, Shah, Sanjiv J, Triposkiadis, Filippos, Wachter, Rolf, Tschöpe, Carsten, de Boer, Rudolf A., Gorter, Thomas M, van Veldhuisen, Dirk J., Bauersachs, Johann, Borlaug, Barry A, Celutkiene, Jelena, Coats, Andrew J S, Crespo-Leiro, Marisa G, Guazzi, Marco, Harjola, Veli-Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S P, Lund, Lars H, Lyon, Alexander R, Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J., Pieske, Burkert, Piepoli, Massimo F., Ruschitzka, Frank, Rutten, Frans H, Seferovic, Petar M., Solomon, Scott D, Shah, Sanjiv J, Triposkiadis, Filippos, Wachter, Rolf, Tschöpe, Carsten, and de Boer, Rudolf A.

Published
2018

18. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Author

HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Gorter, Thomas M, van Veldhuisen, Dirk J., Bauersachs, Johann, Borlaug, Barry A, Celutkiene, Jelena, Coats, Andrew J S, Crespo-Leiro, Marisa G, Guazzi, Marco, Harjola, Veli-Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S P, Lund, Lars H, Lyon, Alexander R, Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J., Pieske, Burkert, Piepoli, Massimo F., Ruschitzka, Frank, Rutten, Frans H, Seferovic, Petar M., Solomon, Scott D, Shah, Sanjiv J, Triposkiadis, Filippos, Wachter, Rolf, Tschöpe, Carsten, de Boer, Rudolf A., HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Gorter, Thomas M, van Veldhuisen, Dirk J., Bauersachs, Johann, Borlaug, Barry A, Celutkiene, Jelena, Coats, Andrew J S, Crespo-Leiro, Marisa G, Guazzi, Marco, Harjola, Veli-Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S P, Lund, Lars H, Lyon, Alexander R, Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J., Pieske, Burkert, Piepoli, Massimo F., Ruschitzka, Frank, Rutten, Frans H, Seferovic, Petar M., Solomon, Scott D, Shah, Sanjiv J, Triposkiadis, Filippos, Wachter, Rolf, Tschöpe, Carsten, and de Boer, Rudolf A.

Published
2018

19. Mineralocorticoid receptor antagonists for heart failure: a real-life observational study

Author

Bruno, N, Sinagra, G, Paolillo, S, Bonomi, A, Corrà, U, Piepoli, M, Veglia, F, Salvioni, E, Lagioia, R, Metra, M, Limongelli, G, Cattadori, G, Scardovi, A, Carubelli, V, Scrutino, D, Badagliacca, R, Guazzi, M, Raimondo, R, Gentile, P, Magrì, D, Correale, M, Parati, G, Re, F, Cicoira, M, Frigerio, M, Bussotti, M, Vignati, C, Oliva, F, Mezzani, A, Vergaro, G, Di Lenarda, A, Passino, C, Sciomer, S, Pacileo, G, Ricci, R, Contini, M, Apostolo, A, Palermo, P, Mapelli, M, Carriere, C, Clemenza, F, Binno, S, Belardinelli, R, Lombardi, C, Perrone Filardi, P, Emdin, M, Agostoni, P, Bruno, Noemi, Sinagra, Gianfranco, Paolillo, Stefania, Bonomi, Alice, Corrà, Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Cattadori, Gaia, Scardovi, Angela B, Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Guazzi, Marco, Raimondo, Rosa, Gentile, Piero, Magrì, Damiano, Correale, Michele, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Vignati, Carlo, Oliva, Fabrizio, Mezzani, Alessandro, Vergaro, Giuseppe, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Mapelli, Massimo, Carriere, Cosimo, Clemenza, Francesco, Binno, Simone, Belardinelli, Romualdo, Lombardi, Carlo, Perrone Filardi, Pasquale, Emdin, Michele, Agostoni, Piergiuseppe, Bruno, N, Sinagra, G, Paolillo, S, Bonomi, A, Corrà, U, Piepoli, M, Veglia, F, Salvioni, E, Lagioia, R, Metra, M, Limongelli, G, Cattadori, G, Scardovi, A, Carubelli, V, Scrutino, D, Badagliacca, R, Guazzi, M, Raimondo, R, Gentile, P, Magrì, D, Correale, M, Parati, G, Re, F, Cicoira, M, Frigerio, M, Bussotti, M, Vignati, C, Oliva, F, Mezzani, A, Vergaro, G, Di Lenarda, A, Passino, C, Sciomer, S, Pacileo, G, Ricci, R, Contini, M, Apostolo, A, Palermo, P, Mapelli, M, Carriere, C, Clemenza, F, Binno, S, Belardinelli, R, Lombardi, C, Perrone Filardi, P, Emdin, M, Agostoni, P, Bruno, Noemi, Sinagra, Gianfranco, Paolillo, Stefania, Bonomi, Alice, Corrà, Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Cattadori, Gaia, Scardovi, Angela B, Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Guazzi, Marco, Raimondo, Rosa, Gentile, Piero, Magrì, Damiano, Correale, Michele, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Vignati, Carlo, Oliva, Fabrizio, Mezzani, Alessandro, Vergaro, Giuseppe, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Mapelli, Massimo, Carriere, Cosimo, Clemenza, Francesco, Binno, Simone, Belardinelli, Romualdo, Lombardi, Carlo, Perrone Filardi, Pasquale, Emdin, Michele, and Agostoni, Piergiuseppe

Abstract

AIMS: Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population-based analysis, the long-term effects of MRA treatment in HFrEF patients. METHODS AND RESULTS: We analysed data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset. Analysis was performed in patients treated (n = 3163) and not treated (n = 2883) with MRA. The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Ten years' survival was analysed through Kaplan-Meier, compared by log-rank test and propensity score matching. At 10 years' follow-up, the MRA-untreated group had a significantly lower number of events than the MRA-treated group (P < 0.001). MRA-treated patients had more severe heart failure (higher New York Heart Association class and lower left ventricular ejection fraction, kidney function, and peak VO2 ). At a propensity-score-matching analysis performed on 1587 patients, MRA-treated and MRA-untreated patients showed similar study endpoint values. CONCLUSIONS: In conclusion, MRA treatment does not affect the composite of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation in a real-life setting. A meticulous patient follow-up, as performed in trials, is likely needed to match the positive MRA-related benefits observed in clinical trials

Published
2018

20. The Right Heart International Network (RIGHT-NET): Rationale, Objectives, Methodology, and Clinical Implications

Author

Ferrara, F., Gargani, Luna, Armstrong, W.F., Agoston, Gergely, Cittadini, Antonio, Citro, Rodolfo, D'Alto, M., D'Andrea, A., Dellegrottaglie, Santo, De Luca, Nicola, Di Salvo, Giovanni, Ghio, S., Grünig, Ekkehard, Guazzi, Marco, Kasprzak, Joanna J.M., Kolias, Theodore John, Kovacs, Gabor, Lancellotti, Patrizio, La Gerche, André, Limongelli, Giuseppe, Marra, A.M., Moreo, Antonella, Ostenfeld, Ellen, Pieri, Francesco, Pratali, Lorenza, Rudski, Lawrence Glenn, Saggar, R., Scalese, Marco, Selton-Suty, Christine, Serra, Walter, Stanziola, Anna Agnese, Voilliot, Damien, Vriz, Olga, Naeije, Robert, Bossone, E., Ferrara, F., Gargani, Luna, Armstrong, W.F., Agoston, Gergely, Cittadini, Antonio, Citro, Rodolfo, D'Alto, M., D'Andrea, A., Dellegrottaglie, Santo, De Luca, Nicola, Di Salvo, Giovanni, Ghio, S., Grünig, Ekkehard, Guazzi, Marco, Kasprzak, Joanna J.M., Kolias, Theodore John, Kovacs, Gabor, Lancellotti, Patrizio, La Gerche, André, Limongelli, Giuseppe, Marra, A.M., Moreo, Antonella, Ostenfeld, Ellen, Pieri, Francesco, Pratali, Lorenza, Rudski, Lawrence Glenn, Saggar, R., Scalese, Marco, Selton-Suty, Christine, Serra, Walter, Stanziola, Anna Agnese, Voilliot, Damien, Vriz, Olga, Naeije, Robert, and Bossone, E.

Abstract

The Right Heart International Network is a multicenter international study aiming to prospectively collect exercise Doppler echocardiography tests of the right heart pulmonary circulation unit (RHPCU) in large cohorts of healthy subjects, elite athletes, and individuals at risk of or with overt pulmonary hypertension. It is going to provide standardization of exercise stress echocardiography of RHPCU and explore the full physiopathologic response., SCOPUS: re.j, info:eu-repo/semantics/published

Published
2018

21. Pulmonary hypertension in heart failure with preserved ejection fraction: a plea for proper phenotyping and further research

Author

Hoeper, Marius M., Lam, Carolyn S. P., Vachiery, Jean-Luc, Bauersachs, Johann, Gerges, Christian, Lang, Irene M., Bonderman, Diana, Olsson, Karen M., Gibbs, J. Simon R., Dorfmuller, Peter, Guazzi, Marco, Galie, Nazzareno, Manes, Alessandra, Handoko, M. Louis, Vonk-Noordegraaf, Anton, Lankeit, Mareike, Konstantinides, Stavros, Wachter, Rolf, Opitz, Christian, Rosenkranz, Stephan, Hoeper, Marius M., Lam, Carolyn S. P., Vachiery, Jean-Luc, Bauersachs, Johann, Gerges, Christian, Lang, Irene M., Bonderman, Diana, Olsson, Karen M., Gibbs, J. Simon R., Dorfmuller, Peter, Guazzi, Marco, Galie, Nazzareno, Manes, Alessandra, Handoko, M. Louis, Vonk-Noordegraaf, Anton, Lankeit, Mareike, Konstantinides, Stavros, Wachter, Rolf, Opitz, Christian, and Rosenkranz, Stephan

Published
2017

22. Oxygen consumption and carbon-dioxide recovery kinetics in the prediction of coronary artery disease severity and outcome

Author

Popović, Dejana, Popović, Dejana, Martić, Dejana, Đorđević, Tea, Pešić, Vesna, Guazzi, Marco, Myers, Jonathan, Mohebi, Reza, Arena, Ross, Popović, Dejana, Popović, Dejana, Martić, Dejana, Đorđević, Tea, Pešić, Vesna, Guazzi, Marco, Myers, Jonathan, Mohebi, Reza, and Arena, Ross

Abstract

Background: Revascularization appears to be beneficial only in patients with high levels of ischemia. This study examined the utility of gas analysis during the recovery phase of cardiopulmonary exercise testing (CPET) in predicting coronary artery disease (CAD) severity and prognosis. Methods: 40 Caucasian patients (21.2% females), mean age 63.5 +/- 7.6 with significant coronary artery lesions (>= 50%) were studied. Within two months of coronary angiography, CPET on a treadmill (TM) and recumbent ergometer (RE) were performed on two visits 2-4 days apart; subjects were subsequently followed 32 +/- 10 months. Myocardial wall motion was recorded by echocardiography at rest and peak exercise. Ischemia was quantified by the wall motion score index (WMSI). Results: Mean ejection fraction was 56.7 +/- 9.6%. Patients with 1-2 stenotic coronary arteries (SCA) showed a poorer CPET response during the recovery phase than patients with 3-SCA. ROC analysis revealed the change of carbon-dioxide output (Delta VCO2) recovery/peak (area under ROC curve 0.77, p = 0.02, Sn = 87.5%, Sp = 70.4%) and oxygen uptake (Delta VO2) recovery/peak during TM CPET (area under ROC curve 0.76, p = 0.03, Sn 75.0%, Sp 77.8%) were significant in distinguishing between 1-2-SCA and 3-SCA. The same variables predicted.WMSI peak/rest on univariate analysis (p lt 0.05). Multivariate Cox analysis revealed a high predictive value of Delta VO2 recovery/peak obtained during TM CPET for composite endpoint of cumulative cardiac events (HR = 1.27, CI = 1.07-1.51, p = 0.008). Conclusions: The current study suggests CPET parameters in recovery hold predictive value for CAD severity and prognosis. TM testing seems to be a better approach in the assessment of CAD severity and prognosis.

Published
2017

23. Stress hormones at rest and following exercise testing predict coronary artery disease severity and outcome

Author

Popović, Dejana, Popović, Dejana, Damjanović, Svetozar S., Đorđević, Tea, Martić, Dejana, Ignjatović, Svetlana, Milinković, Neda, Banović, Marko, Lasica, Ratko, Petrović, Milan, Guazzi, Marco, Arena, Ross, Popović, Dejana, Popović, Dejana, Damjanović, Svetozar S., Đorđević, Tea, Martić, Dejana, Ignjatović, Svetlana, Milinković, Neda, Banović, Marko, Lasica, Ratko, Petrović, Milan, Guazzi, Marco, and Arena, Ross

Abstract

Objectives: Despite considerable knowledge regarding the importance of stress in coronary artery disease (CAD) pathogenesis, its underestimation persists in routine clinical practice, in part attributable to lack of a standardized, objective assessment. The current study examined the ability of stress hormones to predict CAD severity and prognosis at basal conditions as well as during and following an exertional stimulus.Materials and methods: Forty Caucasian subjects with significant coronary artery lesions (50%) were included. Within 2 months of coronary angiography, cardiopulmonary exercise testing (CPET) on a recumbent ergometer was performed in conjunction with stress echocardiography (SE). At rest, peak and after 3min of recovery following CPET, plasma levels of cortisol, adrenocorticotropic hormone (ACTH) and NT-pro-brain natriuretic peptide (NT-pro-BNP) were measured by immunoassay sandwich technique, radioimmunoassay, and radioimmunometric technique, respectively. Subjects were subsequently followed a mean of 3210months.Results and discussion: Mean ejection fraction was 56.7 +/- 9.6%. Subjects with 1-2 stenotic coronary arteries (SCA) demonstrated a significantly lower plasma cortisol levels during CPET compared to those with 3-SCA (p lt .05), whereas ACTH and NT-pro-BNP were not significantly different (p>.05). Among CPET, SE, and hormonal parameters, cortisol at rest and during CPET recovery demonstrated the best predictive value in distinguishing between 1-, 2-, and 3-SCA [area under ROC curve 0.75 and 0.77 (SE=0.11, 0.10; p=.043, .04) for rest and recovery, respectively]. Cortisol peak/rest predicted cumulative cardiac events (area under ROC curve 0.75, SE=0.10, p=.049).Conclusions: Cortisol at rest and following an exercise test holds predictive value for CAD severity and prognosis, further demonstrating a link between stress and unwanted cardiac events.

Published
2017

24. Pulmonary hypertension in heart failure with preserved ejection fraction: a plea for proper phenotyping and further research

Author

Hoeper, Marius M., Lam, Carolyn S. P., Vachiery, Jean-Luc, Bauersachs, Johann, Gerges, Christian, Lang, Irene M., Bonderman, Diana, Olsson, Karen M., Gibbs, J. Simon R., Dorfmuller, Peter, Guazzi, Marco, Galie, Nazzareno, Manes, Alessandra, Handoko, M. Louis, Vonk-Noordegraaf, Anton, Lankeit, Mareike, Konstantinides, Stavros, Wachter, Rolf, Opitz, Christian, Rosenkranz, Stephan, Hoeper, Marius M., Lam, Carolyn S. P., Vachiery, Jean-Luc, Bauersachs, Johann, Gerges, Christian, Lang, Irene M., Bonderman, Diana, Olsson, Karen M., Gibbs, J. Simon R., Dorfmuller, Peter, Guazzi, Marco, Galie, Nazzareno, Manes, Alessandra, Handoko, M. Louis, Vonk-Noordegraaf, Anton, Lankeit, Mareike, Konstantinides, Stavros, Wachter, Rolf, Opitz, Christian, and Rosenkranz, Stephan

Published
2017

25. Pulmonary Hypertension in Heart Failure: Pathophysiology, Pathobiology, and Emerging Clinical Perspectives

Author

Guazzi, Marco, Naeije, Robert, Guazzi, Marco, and Naeije, Robert

Abstract

Pulmonary hypertension is a common hemodynamic complication of heart failure. Interest in left-sided pulmonary hypertension has increased remarkably in recent years because its development and consequences for the right heart are now seen as mainstay abnormalities that begin in the early stages of the disease and bear unfavorable prognostic insights. However, some knowledge gaps limit our ability to influence this complex condition. Accordingly, attention is now focused on: 1) establishing a definitive consensus for a hemodynamic definition, perhaps incorporating exercise and fluid challenge; 2) implementing the limited data available on the pathobiology of lung capillaries and small arteries; 3) developing standard methods for assessing right ventricular function and, hopefully, its coupling to pulmonary circulation; and 4) searching for effective therapies that may benefit lung vessels and the remodeled right ventricle. The authors review the pathophysiology, pathobiology, and emerging clinical perspectives on pulmonary hypertension across the broad spectrum of heart failure stages., SCOPUS: re.j, info:eu-repo/semantics/published

Published
2017

26. Pulmonary hypertension in heart failure with preserved ejection fraction: A plea for proper phenotyping and further research

Author

Hoeper, Marius M., Dorfmuller, Peter, Guazzi, Marco, Galie, Nazzareno, Manes, Alessandra, Handoko, Martin Louis, Vonk-Noordegraaf, Anton, Lankeit, Mareike, Konstantinides, Stavros, Wachter, Rolf, Opitz, Christian, Lam, Carolyn C.S.P., Rosenkranz, Stephan, Vachiery, Jean-Luc, Bauersachs, Johann, Gerges, Christian, Lang, Istvan, Bonderman, Diana, Olsson, Karen K.M., Gibbs, John Simon Russell J.S., Hoeper, Marius M., Dorfmuller, Peter, Guazzi, Marco, Galie, Nazzareno, Manes, Alessandra, Handoko, Martin Louis, Vonk-Noordegraaf, Anton, Lankeit, Mareike, Konstantinides, Stavros, Wachter, Rolf, Opitz, Christian, Lam, Carolyn C.S.P., Rosenkranz, Stephan, Vachiery, Jean-Luc, Bauersachs, Johann, Gerges, Christian, Lang, Istvan, Bonderman, Diana, Olsson, Karen K.M., and Gibbs, John Simon Russell J.S.

Abstract

Heart failure (HF) with preserved ejection fraction (HFpEF) is a common disease affecting the elderly in particular. Up to 80% of these patients develop pulmonary hypertension (PH), which is associated with worse symptoms and increased mortality.1 It is a matter of concern that drugs approved for pulmonary arterial hypertension (PAH) are sometimes used in such patients despite insufficient data for their safety and efficacy. On the other hand, the impact of PH and right ventricular (RV) dysfunction on morbidity and mortality in HFpEF call for proper attention both at the clinical and scientific level. Here we discuss the clinical problem, pathophysiology, diagnostic shortfalls, gaps in evidence, and future strategies for PH-HFpEF., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2017

27. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure : The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC

Author

Ponikowski, Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G F, Coats, Andrew J S, Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M C, Ruilope, Luis M., Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Gerasimos, McMurray, John J V, Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, Atherton, John James, Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin, Fernández-Golfín, Covadonga, Fitzsimons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y H, Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, Zamorano, Jose Luis, Ponikowski, Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G F, Coats, Andrew J S, Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M C, Ruilope, Luis M., Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Gerasimos, McMurray, John J V, Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, Atherton, John James, Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin, Fernández-Golfín, Covadonga, Fitzsimons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y H, Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, and Zamorano, Jose Luis

Published
2016

28. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure : The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC

Author

Ponikowski, Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G F, Coats, Andrew J S, Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M C, Ruilope, Luis M., Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Gerasimos, McMurray, John J V, Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, Atherton, John James, Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin, Fernández-Golfín, Covadonga, Fitzsimons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y H, Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, Zamorano, Jose Luis, Ponikowski, Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G F, Coats, Andrew J S, Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M C, Ruilope, Luis M., Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Gerasimos, McMurray, John J V, Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, Atherton, John James, Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin, Fernández-Golfín, Covadonga, Fitzsimons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y H, Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, and Zamorano, Jose Luis

Published
2016

29. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure : The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC

Author

Ponikowski, Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G F, Coats, Andrew J S, Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M C, Ruilope, Luis M., Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Gerasimos, McMurray, John J V, Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, Atherton, John James, Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin, Fernández-Golfín, Covadonga, Fitzsimons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y H, Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, Zamorano, Jose Luis, Ponikowski, Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G F, Coats, Andrew J S, Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M C, Ruilope, Luis M., Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Gerasimos, McMurray, John J V, Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, Atherton, John James, Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin, Fernández-Golfín, Covadonga, Fitzsimons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y H, Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, and Zamorano, Jose Luis

Published
2016

30. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC

Author

HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Epidemiology & Health Economics, Brain, Ponikowski, Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G F, Coats, Andrew J S, Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M C, Ruilope, Luis M., Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Gerasimos, McMurray, John J V, Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, Atherton, John James, Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin, Fernández-Golfín, Covadonga, Fitzsimons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y H, Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, Zamorano, Jose Luis, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Epidemiology & Health Economics, Brain, Ponikowski, Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G F, Coats, Andrew J S, Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M C, Ruilope, Luis M., Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Gerasimos, McMurray, John J V, Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, Atherton, John James, Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin, Fernández-Golfín, Covadonga, Fitzsimons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y H, Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, and Zamorano, Jose Luis

Published
2016

31. Impact of pharmacologic interventions-treating endothelial dysfunction and group 2 pulmonary hypertension

Author

Guazzi, Marco, Gomberg-Maitland, Mardi, Naeije, Robert, Guazzi, Marco, Gomberg-Maitland, Mardi, and Naeije, Robert

Abstract

Pulmonary hypertension (PH) secondary to left heart disease (LHD) is a largely underappreciated therapeutic target. Except for a specific focus on PH consequences in patients with advanced heart failure (HF) receiving a left ventricular assist device or candidates for heart transplant, prevention and treatment of initial subclinical forms of PH are not considered a priority in the management of this chronic disease population. Nonetheless, there is recent growing evidence supporting a clinical and prognostic role of PH in the elderly populations and in HF with preserved ejection fraction (pEF). Although the prevalence of PH in these populations still remains largely unknown, there is a large potential for effective pharmacological approaches that might impact the natural history of HFpEF by targeting earlier stages. However, pharmacological studies performed to date with traditional pulmonary vasodilators (i.e. prostanoids and endothelin receptor blockers) in cohorts with HF and left-sided PH have not been positive, primarily because of concomitant systemic hypotension and hepatic toxicity. The encouraging preliminary data with more selective well-tolerated pulmonary vasodilators, such as phosphodiesterase type 5 inhibitors and guanylate cyclase stimulators/activators, however, suggest the need for new targets of pulmonary microvascular dysfunction and for treating PH-LHD at both early and later stages of the disease process., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2015

32. Waiting with a failing right heart

Author

Naeije, Robert, Guazzi, Marco, Naeije, Robert, and Guazzi, Marco

Abstract

SCOPUS: no.j, info:eu-repo/semantics/published

Published
2015

33. Waiting with a failing right heart

Author

Naeije, Robert, Guazzi, Marco, Naeije, Robert, and Guazzi, Marco

Abstract

SCOPUS: no.j, info:eu-repo/semantics/published

Published
2015

34. Impact of pharmacologic interventions-treating endothelial dysfunction and group 2 pulmonary hypertension

Author

Guazzi, Marco, Gomberg-Maitland, Mardi, Naeije, Robert, Guazzi, Marco, Gomberg-Maitland, Mardi, and Naeije, Robert

Abstract

Pulmonary hypertension (PH) secondary to left heart disease (LHD) is a largely underappreciated therapeutic target. Except for a specific focus on PH consequences in patients with advanced heart failure (HF) receiving a left ventricular assist device or candidates for heart transplant, prevention and treatment of initial subclinical forms of PH are not considered a priority in the management of this chronic disease population. Nonetheless, there is recent growing evidence supporting a clinical and prognostic role of PH in the elderly populations and in HF with preserved ejection fraction (pEF). Although the prevalence of PH in these populations still remains largely unknown, there is a large potential for effective pharmacological approaches that might impact the natural history of HFpEF by targeting earlier stages. However, pharmacological studies performed to date with traditional pulmonary vasodilators (i.e. prostanoids and endothelin receptor blockers) in cohorts with HF and left-sided PH have not been positive, primarily because of concomitant systemic hypotension and hepatic toxicity. The encouraging preliminary data with more selective well-tolerated pulmonary vasodilators, such as phosphodiesterase type 5 inhibitors and guanylate cyclase stimulators/activators, however, suggest the need for new targets of pulmonary microvascular dysfunction and for treating PH-LHD at both early and later stages of the disease process., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2015

35. Echocardiography of right ventriculoarterial coupling combined with cardiopulmonary exercise testing to predict outcome in heart failure

Author

Guazzi, Marco, Temporelli, Pierluigi, Naeije, Robert, Arena, Ross, Corrà, Ugo, Ghio, Stefano, Forfia, Paul P.R., Rossi, Andrea, Cahalin, Lawrence L.P., Bandera, Francesco, Guazzi, Marco, Temporelli, Pierluigi, Naeije, Robert, Arena, Ross, Corrà, Ugo, Ghio, Stefano, Forfia, Paul P.R., Rossi, Andrea, Cahalin, Lawrence L.P., and Bandera, Francesco

Abstract

BACKGROUND: Pulmonary hypertension, which is related to right ventricular (RV) failure, indicates a poor prognosis in heart failure (HF). Increased ventilatory response and exercise oscillatory ventilation (EOV) also have a negative impact. We hypothesized that the severity classification of HF and risk prediction could be improved by combining functional capacity with cardiopulmonary exercise testing (CPET) and RV-pulmonary circulation coupling, as evaluated by the tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) relationship. METHODS: Four hundred fifty-nine patients with HF were assessed with Doppler echocardiography and CPET and were tracked for outcome. The subjects were followed for major cardiac events (cardiac mortality, left ventricular assist device implant, or heart transplant). Cox regression and Kaplan-Meier analyses were performed with TAPSE and PASP as individual measures that were then combined into a ratio form. RESULTS: The TAPSE/PASP ratio (TAPSE/PASP) was the strongest predictor, whereas the New York Heart Association classification and EOV added predictive value. A four-quadrant group prediction risk was created based on TAPSE (< 16 mm or ≥ 16 mm) vs PASP (< 40 mm Hg or ≥ 40 mm Hg) thresholds and the CPET variables distribution as follows: group A (TAPSE > 16 mm and PASP < 40 mm Hg) presented the lowest risk (hazard ratio, 0.17) and best ventilation; group B exhibited a low risk (hazard ratio, 0.88) with depressed TAPSE (< 16 mm) and normal PASP, a preserved peak oxygen consumption (Vo2), but high ventilation. Group C had an increased risk (hazard ratio, 1.3; TAPSE ≥ 16 mm, PASP ≥ 40 mm Hg), a reduced peak Vo2, and a high EOV prevalence. Group D had the highest risk (hazard ratio, 5.6), the worse RV-pulmonary pressure coupling (TAPSE < 16 and PASP ≥ 40 mm Hg), the lowest peak Vo2, and the highest EOV rate. CONCLUSIONS: TAPSE/PASP, combined with exercise ventilation, pro, SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2015

36. Nonrespiratory determinants of respiratory impairment in elderly patients: heart failure and diabetes.

Author

Guazzi, Marco, Fuso, Leonello, Fuso, Leonello (ORCID:0000-0002-1198-6712), Guazzi, Marco, Fuso, Leonello, and Fuso, Leonello (ORCID:0000-0002-1198-6712)

Abstract

Heart failure (HF) and diabetes mellitus (DM) promote a plethora of abnormalities in lung function and, in both conditions, the lung is considered the ‘‘target organ’’ for therapeutic interventions. HF is associated with changes in lung mechanics and gas diffusion, which are the direct consequence of haemodynamic perturbations and congestion. Changes in lung mechanics may vary according to the acute or chronic manifestations of HF, with a predominant obstructive lung pattern in acute HF and a restrictive one in chronic conditions. Specific relevance has recently been given to the anatomical and functional consequence of a pressure and/or a volume overload on the lung microcirculation of HF patients. This challenges the alveolar–capillary integrity, causes an increase in capillary permeability to water and ions, and impairs local mechanisms for gas diffusion. Remarkably, an impairment in alveolar gas conductance properties reflects underlying lung tissue damage, is involved in the pathogenesis of exercise limitation and is an independent prognostic marker. Diabetes mellitus elicits an angiopathy process of the lung microvessels that leads to the development of pulmonary dysfunction and to an accelerated organ ageing process. An increasing prevalence of type 2 diabetes mellitus with age indicates that elderly subjects are more exposed to the pulmonary complications of the disease. Diabetes mellitus could also contribute to an increase in the incidence of respiratory infections both by itself and by worsening the age-related abnormalities of the respiratory system. Epidemiological and clinical studies show that diabetes mellitusrelated pulmonary involvement has important clinical and prognostic implications contributing to increased morbidity and mortality of older subjects.

Published
2009

37. Contribution to the study of sympathetic dysregulation in pulmonary arterial hypertension and after heart transplantation

Author

Naeije, Robert, Van De Borne, Philippe, Gevenois, Pierre-Alain, Guazzi, Marco M., Fagard, Robert, Detroyer, André, Van der Linden, P, Motte, Serge, Boeynaems, Jean-Marie, Ciarka, Agnieszka, Naeije, Robert, Van De Borne, Philippe, Gevenois, Pierre-Alain, Guazzi, Marco M., Fagard, Robert, Detroyer, André, Van der Linden, P, Motte, Serge, Boeynaems, Jean-Marie, and Ciarka, Agnieszka

Abstract

A. INTRODUCTIONA.1. The sympathetic nervous system.A.1.1. General considerations and historical perspective.A.1.1.1. Historical perspectiveA.1.1.2. Reflex regulation of the autonomic nervous systemA.1.1.3. Central control of the autonomic nervous systemA.1.1.4. Sympathetic and parasympathetic components of the autonomicnervous systemA.1.1.5. Organisation of the sympathetic nervous systemA.1.1.6. Functions of the sympathetic nervous systemA.1.1.7. Neurotransmitters of the sympathetic nervous systemA.1.1.8. Neurotransmitter secretion at effectors organ synapseA.1.1.9. AdrenoreceptorsA.1.2. Control mechanismsA.1.2.1. Aortic arch and carotid baroreceptorsA.1.2.2. Low pressure baroreceptorsA.1.2.3. ChemoreceptorsA.1.2.4. Effects of exercise on sympathetic nervous system activationA.1.2.5. Effects of left ventricular dysfunction on sympathetic nervoussystem activationA.1.2.6. Effects of right ventricular dysfunction and hearttransplantation on sympathetic nervous system activityA.2. Methodological considerations.A.2.1. Assessment of sympathetic activity in humansA.2.2. Circulating catecholaminesA.2.3. MicroneurographyA.3. ErgospirometryA.3.1. Several aspects of physiology of exerciseA.3.2. Principles of exercise testingA.3.3. Exercise ventilationA.4. Assessment of chemoreceptor regulation in humansA.4.1. Peripheral chemoreceptor inhibitionA.4.2. Peripheral and central chemoreceptor activationA.5. Brief summary of still unresolved questionsA.5.1. Pulmonary arterial hypertensionA.5.2. Heart transplantationB. SYMPATHETIC CONTROL IN PULMONARY ARTERIAL HYPERTENSIONB.1. Hypothesis testedB.2. Study populationsB.2.1. Study investigating sympathetic activity in PAH patientsB.2.2. Study investigating the effects of atrial septostomy on MSNA in PAHpatientsB.3. Material, methods and study protocolsB.3.1. Particular measurements in the study investigating sy, Doctorat en Sciences médicales, info:eu-repo/semantics/nonPublished

Published
2008

38. Contribution to the study of sympathetic dysregulation in pulmonary arterial hypertension and after heart transplantation

Author

Naeije, Robert, Van De Borne, Philippe, Gevenois, Pierre-Alain, Guazzi, Marco M., Fagard, Robert, Detroyer, André, Van der Linden, P, Motte, Serge, Boeynaems, Jean-Marie, Ciarka, Agnieszka, Naeije, Robert, Van De Borne, Philippe, Gevenois, Pierre-Alain, Guazzi, Marco M., Fagard, Robert, Detroyer, André, Van der Linden, P, Motte, Serge, Boeynaems, Jean-Marie, and Ciarka, Agnieszka

Abstract

A. INTRODUCTIONA.1. The sympathetic nervous system.A.1.1. General considerations and historical perspective.A.1.1.1. Historical perspectiveA.1.1.2. Reflex regulation of the autonomic nervous systemA.1.1.3. Central control of the autonomic nervous systemA.1.1.4. Sympathetic and parasympathetic components of the autonomicnervous systemA.1.1.5. Organisation of the sympathetic nervous systemA.1.1.6. Functions of the sympathetic nervous systemA.1.1.7. Neurotransmitters of the sympathetic nervous systemA.1.1.8. Neurotransmitter secretion at effectors organ synapseA.1.1.9. AdrenoreceptorsA.1.2. Control mechanismsA.1.2.1. Aortic arch and carotid baroreceptorsA.1.2.2. Low pressure baroreceptorsA.1.2.3. ChemoreceptorsA.1.2.4. Effects of exercise on sympathetic nervous system activationA.1.2.5. Effects of left ventricular dysfunction on sympathetic nervoussystem activationA.1.2.6. Effects of right ventricular dysfunction and hearttransplantation on sympathetic nervous system activityA.2. Methodological considerations.A.2.1. Assessment of sympathetic activity in humansA.2.2. Circulating catecholaminesA.2.3. MicroneurographyA.3. ErgospirometryA.3.1. Several aspects of physiology of exerciseA.3.2. Principles of exercise testingA.3.3. Exercise ventilationA.4. Assessment of chemoreceptor regulation in humansA.4.1. Peripheral chemoreceptor inhibitionA.4.2. Peripheral and central chemoreceptor activationA.5. Brief summary of still unresolved questionsA.5.1. Pulmonary arterial hypertensionA.5.2. Heart transplantationB. SYMPATHETIC CONTROL IN PULMONARY ARTERIAL HYPERTENSIONB.1. Hypothesis testedB.2. Study populationsB.2.1. Study investigating sympathetic activity in PAH patientsB.2.2. Study investigating the effects of atrial septostomy on MSNA in PAHpatientsB.3. Material, methods and study protocolsB.3.1. Particular measurements in the study investigating sy, Doctorat en Sciences médicales, info:eu-repo/semantics/nonPublished

Published
2008

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