H.P. Brunner-La Rocca

Circulating biomarkers of distinct pathophysiological pathways in heart failure with preserved vs. reduced left ventricular ejection fraction

The aim of this study was to evaluate whether biomarkers reflecting pathophysiological pathways are different between heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) and whether the prognostic value of biomarkers is different in HFpEF vs. HFrEF.

Short-term cardiorespiratory adaptation to high altitude in children compared with adults.

As short‐term cardiorespiratory adaptation to high altitude (HA) exposure has not yet been studied in children, we assessed acute mountain sickness (AMS), hypoxic ventilatory response (HVR) at rest and maximal exercise capacity (CPET) at low altitude (LA) and HA in pre‐pubertal children and their fathers. Twenty father–child pairs (11u2009±u20091 years and 44u2009±u20094 years) were tested at LA (450u2009m) and HA (3450u2009m) at days 1, 2, and 3 after fast ascent (HA1/2/3). HVR was measured at rest and CPET was performed on a cycle ergometer. AMS severity was mild to moderate with no differences between generations. HVR was higher in children than adults at LA and increased at HA similarly in both groups. Peak oxygen uptake (VO2peak) relative to body weight was similar in children and adults at LA and decreased significantly by 20% in both groups at HA; maximal heart rate did not change at HA in children while it decreased by 16% in adults (Pu2009<u20090.001). Changes in HVR and VO2peak from LA to HA were correlated among the biological child–father pairs. In conclusion, cardiorespiratory adaptation to altitude seems to be at least partly hereditary. Even though children and their fathers lose similar fractions of aerobic capacity going to high altitude, the mechanisms might be different.

Prevalence of asymptomatic heart failure in formerly pre-eclamptic women: a cohort study

After pre‐eclampsia (PE), the prevalence of structural heart disease without symptoms, i.e. heart failure Stage B (HF‐B), may be as high as one in four women in the first year postpartum. We hypothesize that a significant number of formerly pre‐eclamptic women with HF‐B postpartum are still in their resolving period and will not have HF‐B during follow‐up.

Biomarkers in outpatient heart failure management; Are they correlated to and do they influence clinical judgment?

AimsHeart failure (HF) management is complicated by difficulties in clinical assessment. Biomarkers may help guide HF management, but the correspondence between clinical evaluation and biomarker serum levels has hardly been studied. We investigated the correlation between biomarkers and clinical signs and symptoms, the influence of patient characteristics and comorbidities on New York Heart Association (NYHA) classification and the effect of using biomarkers on clinical evaluation.Methods and resultsThis post-hoc analysis comprised 622 patients (77u2009±u20098xa0years, 76xa0% NYHA class ≥3, 80xa0% LVEF ≤45xa0%) participating in TIME-CHF, randomising patients to either NT-proBNP-guided or symptom-guided therapy. Biomarker measurements and clinical evaluation were performed at baseline and after 1, 3, 6, 12 and 18xa0months. NT-proBNP, GDF-15, hs-TnT and to a lesser extent hs-CRP and cystatin-C were weakly correlated to NYHA, oedema, jugular vein distension and orthopnoea (ρ-range: 0.12–0.33; pu2009<u20090.01). NT-proBNP correlated more strongly to NYHA class in the NT-proBNP-guided group compared with the symptom-guided group. NYHA class was significantly influenced by age, body mass index, anaemia, and the presence of two or more comorbidities.ConclusionIn HF, biomarkers correlate only weakly with clinical signs and symptoms. NYHA classification is influenced by several comorbidities and patient characteristics. Clinical judgement seems to be influenced by a clinician’s awareness of NT-proBNP concentrations.

Decreased endothelial function and increased subclinical heart failure in women several years after pre‐eclampsia

Pre‐eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure Stage B (HF‐B). In this study, we assessed the relationship between endothelial function, measured by flow‐mediated dilation (FMD), and HF‐B in women with a history of PE.

Impact of airflow limitation in chronic heart failure

BackgroundComorbidities are common in chronic heart failure (HF) patients, but diagnoses are often not based on objective testing. Chronic obstructive pulmonary disease (COPD) is an important comorbidity and often neglected because of shared symptoms and risk factors. Precise prevalence and consequences are not well known. Therefore, we investigated prevalence, pulmonary treatment, symptoms andxa0quality of life (QOL)xa0of COPD in patients with chronic HF.Methods205 patients with stable HF for at least 1xa0month, aged above 50xa0years, were included from our outpatient cardiology clinic, irrespective of left ventricular ejection fraction. Patients performed post-bronchodilator spirometry, axa0six-minute walk test (6-MWT) and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). COPD was diagnosed according to GOLD criteria. Restrictive lung function was defined as FEV1/FVC ≥0.70 and FVC <80% of predicted value. The BODE and ADO index, risk scores in COPD patients, were calculated.ResultsAlmost 40% fulfilled the criteria of COPD and 7% had restrictive lung disease, the latter being excluded from further analysis. Noteworthy, 63% of the COPD patients were undiagnosed and 8% of those without COPD used inhalation therapy. Patients with COPD had more shortness of breath despite little difference in HF severity and similar other comorbidities. KCCQ was significantly worse in COPD patients. The ADO and BODE indices were significantly different.ConclusionCOPD is very common in unselected HF patients. It was often not diagnosed and many patients received treatment without being diagnosed with COPD. Presence of COPD worsens symptoms and negatively effects cardiac specific QOL.

Real-world heart failure management in 10,910 patients with chronic heart failure in the Netherlands

AimsData from patient registries give insight into the management of patients with heart failure (HF), but actual data from unselected real-world HF patients are scarce. Therefore, we performed axa0cross sectional study of current HF care in the period 2013–2016 among more than 10,000 unselected HF patients at HF outpatient clinics in the Netherlands.MethodsIn 34xa0participating centres, all 10,910 patients with chronic HF treated at cardiology centres were included in the CHECK-HF registry. Of these, most (96%) were managed at axa0specific HF outpatient clinic. Heart failure was typically diagnosed according to the ESC guidelines 2012, based on signs, symptoms and structural and/or functional cardiac abnormalities. Information on diagnostics, treatment and co-morbidities were recorded, with specific focus on drug therapy and devices. In our cohort, the mean age was 73xa0years (SDxa012) and 60% were male. Frequent co-morbidities reported in the patient records were diabetes mellitus 30%, hypertension 43%, COPD 19%, and renal insufficiency 58%. In 47% of the patients, ischaemia was the origin of HF. In our registry, the prevalence of HF with preserved ejection fraction was 21%.ConclusionThe CHECK-HF registry will provide insight into the current, real world management of patient with chronic HF, including HF with reduced ejection fraction, preserved ejection fraction and mid-range ejection fraction, that will help define ways to improve quality of care. Drug and device therapy and guideline adherence as well as interactions with age, gender and co-morbidities will receive specific attention.

Elderly primary care hypertension patients–who to refer for echocardiography?

Heart failure (HF) is a complex clinical syndrome resulting from impaired diastolic and/or systolic function and clinically manifested by numerous, rather unspecific symptoms such as dyspnoea (at rest or exertion), orthopnoea, wheezing, chronic fatigue and lower extremity oedema. The prevalence of HF increases steeply with age, causing high mortality and morbidity, substantial loss in quality of life, and high health care costs [1]. For the diagnosis of HF, guidelines require, in addition to symptoms, objective evidence of cardiac dysfunction that is most commonly assessed by echocardiography. While many conditions may cause HF, the most common aetiologies are coronary artery disease (CAD) and hypertension.