Donna Vizi

The transcardiac gradient of cardio-microRNAs in the failing heart

Differential microRNA expression in peripheral blood has been observed in patients with heart failure, suggesting their value as potential biomarkers and likely contributors to disease mechanisms. In the present study, we aimed to evaluate the transcardiac gradient of 84 cardio‐microRNAs in healthy and failing hearts to determine which microRNAs are released or absorbed by the myocardium in heart failure.

Effects of Milrinone on Rest and Exercise Hemodynamics in Heart Failure With Preserved Ejection Fraction

Heart failure with preserved ejection fraction (HFPEF) accounts for a substantial proportion of the population of patients with heart failure, and the prevalence is rising [(1)][1]. The pathophysiology of HFPEF is complex [(2)][2]; a rapid rise in left ventricular diastolic and pulmonary pressures

Hemodynamic Profile of Patients With Heart Failure and Preserved Ejection Fraction Vary by Age

Background Patients with heart failure with preserved ejection fraction (HFpEF) exhibit a range of cardiovascular phenotypic profiles modified by several common comorbidities. In particular, patients with HFpEF tend to be older; however, it is unclear whether the effects of cardiovascular aging per se modify the expression of HFpEF. We therefore sought to investigate the interaction between age and physiologic profile in patients with HFpEF. Methods and Results We assessed the hemodynamic and metabolic profile of 40 patients with HFpEF. Patients underwent right heart catheterization at rest and during supine cycle ergometry, and were segregated into 2 groups by the median age of the cohort. Older patients with HFpEF demonstrated reduced resting cardiac output (4.8±1.2 L/min versus 5.7±1.1 L/min). With exercise, older patients demonstrated a marked rise in arteriovenous oxygen content difference (10.8±1.8 versus 7.9±2.4 mL, P≤0.001), driven by enhanced oxygen extraction. There was no significant difference in peak pulmonary capillary wedge pressure (30±7 mm Hg versus 27±6, P=0.135), including when indexed to workload (pulmonary capillary wedge pressure/W, 0.88 mm Hg/W versus 0.92; P=0.83). Conclusions Older patients with HFpEF display a different physiological phenotype compared with younger patients, with enhanced oxygen extraction and lower increment in cardiac output to increase oxygen consumption from rest to peak supine exercise. This finding highlights the importance in considering age when considering therapeutic options in patients with HFpEF.

AGE SPECIFIC HEMODYNAMIC FEATURES IN HFPEF: IMPLICATIONS FOR THERAPY

Background: Heart failure is a clinical diagnosis in which a stratification based on left ventricular ejection fraction (LVEF) has been applied to identify more homogeneous groups for the purpose of diagnosis and treatment. Within the group with HF with preserved ejection fraction (HFpEF), a range

Exercise Hemodynamics as a Predictor of Myocardial Recovery in LVAD Patients

Mechanical circulatory support using left ventricular assist devices (LVADs) has been demonstrated to improve survival in patients with advanced heart failure. Left ventricular assist device therapy also promotes reverse ventricular remodeling, which in some cases has led to sufficient myocardial recovery to allow LVAD removal. Identification of suitable patients for LVAD removal however remains challenging. We investigated the hypothesis that invasive assessment of exercise hemodynamics may provide additional information in relation to the assessment of contractile reserve in potential candidates for LVAD explant.