Aims: Assessment of N- terminal brain natriuretic peptide(NTBNP) as a screening tool for heart failure in patients with a permanent pacemaker. Methods and results: Consecutive patients undergoing a routine permanent p...Aims: Assessment of N- terminal brain natriuretic peptide(NTBNP) as a screening tool for heart failure in patients with a permanent pacemaker. Methods and results: Consecutive patients undergoing a routine permanent pacemaker assessment were enrolled. Patients underwent medical history and examination, echocardiography and blood sampling for NT- BNP. Analysis was performed on 261 patients(132 DDD, 121 VVI, eight others), mean age 73± 12 years, range 34- 99 years. Seventy two subjects(27% ) had heart failure as defined by left ventricular ejection fraction(LVEF) ≤ 40% and symptoms of heart failure(NYHA class II, III, or IV). Screening with NT- BNP gave a sensitivity of 73% and specificity of 72% for detecting heart failure in all patients [area under the curve(AUC) 0.76, P< 0.001, 95% CI 0.69- 0.83]. This increased in subjects with a DDD type pacemaker(sensitivity 80% , specificity 66% , AUC=0.8, CI 0.7- 0.90) and reduced in subjects with a VVI type pacemaker(sensitivity 66% , specificity 61% , AUC 0.68 CI 0.57- 0.78). Conclusion: Symptoms of heart failure are common in patients with pacemakers. Screening with NT- BNP is feasible and assists in the detection of important cardiac co- morbidity, particularly in patients with a DDD type pacemaker.展开更多
Aims: The 6-min walk test(6-MWT) is used to estimate functional capacity. However, in elderly patients with chronic heart failure(CHF):(i) 1 year reproducibility of the 6-MWT;(ii) sensitivity of the 6-MWT to self-perc...Aims: The 6-min walk test(6-MWT) is used to estimate functional capacity. However, in elderly patients with chronic heart failure(CHF):(i) 1 year reproducibility of the 6-MWT;(ii) sensitivity of the 6-MWT to self-perceived changes in symptoms of heart failure; and(iii) implications for patient numbers required for studies using the 6-MWT as an endpoint have not been described. Methods and results: One thousand and seventy-seven patients with CHF, aged >60, with NYHA Class ≥II were recruited. Heart failure symptom assessment was determined using a questionnaire related to aspects of physical function, and patients performed a baseline 6-MWT, with follow-up 1 year later. Seventy-four patients with unchanged symptoms had an unchanged 6-MWT distance, with an overall intraclass correlation coefficient of 0.80(95%CI=0.69-0.87). Four hundred and twenty-three patients reported an improvement in symptoms during follow-up. There was a negative correlation(r=-0.55; P=0.0001) between Δsymptoms and Δ6-MWT(i.e. a reduced 6-MWT distance is associated with reduced symptom severity at follow-up). Five hundred and sixteen patients reported worsening symptoms of heart failure, a moderate inverse correlation(r=-0.53; P=0.0001) was displayed between Δsymptoms and Δ6-MWT. For all patients, irrespective of symptom status, a high inverse correlation(r=-0.75; P=0.0001) was evident. On the basis of the data for patients with unchanged symptoms, it is calculated that to detect an increase in 6-MWT of 50 m, with 90%power, a study size of approximately 120 is required. Conclusion: In elderly patients with CHF, the 6-MWT shows satisfactory agreement when repeated 1 year later. Change in 6-MWT distance is sensitive to change in self-perceived symptoms of heart failure.展开更多
Objective: To examine the relation between longitudinal left ventricular funct ion assessed by tissue Doppler imaging (TDi) and exercise capacity in heart fail ure. Subjects: 153 patients with chronic heart failure fr...Objective: To examine the relation between longitudinal left ventricular funct ion assessed by tissue Doppler imaging (TDi) and exercise capacity in heart fail ure. Subjects: 153 patients with chronic heart failure from left ventricular sys tolic dysfunction (ejection fraction< 45%) and 87 age and sex matched controls. Methods: Echocardiography was used to measure conventional indices of left vent ricular systolic function. TDi was used to assess left and right ventricular lon gitudinal function by measuring mitral and lateral tricuspid annular velocities during the cardiac cycle. Velocities measured at each point were the systolic pe ak (Sm) and the diastolic troughs(Em and Am), corresponding to passive and activ e (atrial) left ventricular filling. Each patient also underwent treadmill exerc ise testing with metabolic gas exchange measurements. Results: Left and right ve ntricular TDi velocities were greater in controls than in patients. Left ventric ular ejection fraction (LVEF) correlated with Sm(r=0.30, p=0.0005), but not with Em, Am, or the Em/Am ratio. There were no significant differences between New Y ork Heart Association (NYHA) functional class for any of the TDi variables. Righ t ventricular indices were not related to exercise capacity. Systolic myocardial motion measured by TDi correlated more closely with peak oxygen consumption (p VO2) (r=0.35, p< 0.0001) than LVEF (r=0.21,< 0.02). The Em/Am ratio was not corr elated with P VO2. In multiple regression, Sm was the only left ventricular TDi variable to predict exercise capacity independently(p< 0.05). Conclusions: Exerc ise capacity and symptoms are poorly related to conventional measures of cardiac function and more closely correlated with indices of longitudinal left ventricu lar function as assessed by TDi.展开更多
Anemia and renal dysfunction(RD) are frequent complications seen in chronic heart failure(HF). However, the prevalence and interaction of these co-morbidities in a representative population of outpatients with chronic...Anemia and renal dysfunction(RD) are frequent complications seen in chronic heart failure(HF). However, the prevalence and interaction of these co-morbidities in a representative population of outpatients with chronic HF is poorly described. In this study, it was sought to determine the association between RD and anemia in patients with HF enrolled in a community-based HF program. Nine hundred fifty-five patients with HF due to left ventricular systolic dysfunction were investigated for the prevalence of anemia and its cause and followed for a median of 531 days. Anemia was defined as hemoglobin< 12.0 g/dl in women and< 13.0 g/dl in men. RD was defined as a calculated glomerular filtration rate of< 60 ml/min. The prevalence of anemia was 32%. Fifty-three percent of patients with and 27%of those without anemia had ≥1 test suggesting hematinic deficiency. The prevalence of RD was 54%. Forty-one percent of patients with and 22%of patients without RD had anemia, with similar proportions associated with iron deficiency in the presence or absence of RD. Anemia and RD independently predicted a worse outcome, and this effect was additive. In conclusion, in outpatients with chronic HF, anemia and RD are common and co-exist but confer independent prognostic information. A deficiency of conventional hematinic factors may cause about 1/3 of anemia in this clinical setting.展开更多
文摘Aims: Assessment of N- terminal brain natriuretic peptide(NTBNP) as a screening tool for heart failure in patients with a permanent pacemaker. Methods and results: Consecutive patients undergoing a routine permanent pacemaker assessment were enrolled. Patients underwent medical history and examination, echocardiography and blood sampling for NT- BNP. Analysis was performed on 261 patients(132 DDD, 121 VVI, eight others), mean age 73± 12 years, range 34- 99 years. Seventy two subjects(27% ) had heart failure as defined by left ventricular ejection fraction(LVEF) ≤ 40% and symptoms of heart failure(NYHA class II, III, or IV). Screening with NT- BNP gave a sensitivity of 73% and specificity of 72% for detecting heart failure in all patients [area under the curve(AUC) 0.76, P< 0.001, 95% CI 0.69- 0.83]. This increased in subjects with a DDD type pacemaker(sensitivity 80% , specificity 66% , AUC=0.8, CI 0.7- 0.90) and reduced in subjects with a VVI type pacemaker(sensitivity 66% , specificity 61% , AUC 0.68 CI 0.57- 0.78). Conclusion: Symptoms of heart failure are common in patients with pacemakers. Screening with NT- BNP is feasible and assists in the detection of important cardiac co- morbidity, particularly in patients with a DDD type pacemaker.
文摘Aims: The 6-min walk test(6-MWT) is used to estimate functional capacity. However, in elderly patients with chronic heart failure(CHF):(i) 1 year reproducibility of the 6-MWT;(ii) sensitivity of the 6-MWT to self-perceived changes in symptoms of heart failure; and(iii) implications for patient numbers required for studies using the 6-MWT as an endpoint have not been described. Methods and results: One thousand and seventy-seven patients with CHF, aged >60, with NYHA Class ≥II were recruited. Heart failure symptom assessment was determined using a questionnaire related to aspects of physical function, and patients performed a baseline 6-MWT, with follow-up 1 year later. Seventy-four patients with unchanged symptoms had an unchanged 6-MWT distance, with an overall intraclass correlation coefficient of 0.80(95%CI=0.69-0.87). Four hundred and twenty-three patients reported an improvement in symptoms during follow-up. There was a negative correlation(r=-0.55; P=0.0001) between Δsymptoms and Δ6-MWT(i.e. a reduced 6-MWT distance is associated with reduced symptom severity at follow-up). Five hundred and sixteen patients reported worsening symptoms of heart failure, a moderate inverse correlation(r=-0.53; P=0.0001) was displayed between Δsymptoms and Δ6-MWT. For all patients, irrespective of symptom status, a high inverse correlation(r=-0.75; P=0.0001) was evident. On the basis of the data for patients with unchanged symptoms, it is calculated that to detect an increase in 6-MWT of 50 m, with 90%power, a study size of approximately 120 is required. Conclusion: In elderly patients with CHF, the 6-MWT shows satisfactory agreement when repeated 1 year later. Change in 6-MWT distance is sensitive to change in self-perceived symptoms of heart failure.
文摘Objective: To examine the relation between longitudinal left ventricular funct ion assessed by tissue Doppler imaging (TDi) and exercise capacity in heart fail ure. Subjects: 153 patients with chronic heart failure from left ventricular sys tolic dysfunction (ejection fraction< 45%) and 87 age and sex matched controls. Methods: Echocardiography was used to measure conventional indices of left vent ricular systolic function. TDi was used to assess left and right ventricular lon gitudinal function by measuring mitral and lateral tricuspid annular velocities during the cardiac cycle. Velocities measured at each point were the systolic pe ak (Sm) and the diastolic troughs(Em and Am), corresponding to passive and activ e (atrial) left ventricular filling. Each patient also underwent treadmill exerc ise testing with metabolic gas exchange measurements. Results: Left and right ve ntricular TDi velocities were greater in controls than in patients. Left ventric ular ejection fraction (LVEF) correlated with Sm(r=0.30, p=0.0005), but not with Em, Am, or the Em/Am ratio. There were no significant differences between New Y ork Heart Association (NYHA) functional class for any of the TDi variables. Righ t ventricular indices were not related to exercise capacity. Systolic myocardial motion measured by TDi correlated more closely with peak oxygen consumption (p VO2) (r=0.35, p< 0.0001) than LVEF (r=0.21,< 0.02). The Em/Am ratio was not corr elated with P VO2. In multiple regression, Sm was the only left ventricular TDi variable to predict exercise capacity independently(p< 0.05). Conclusions: Exerc ise capacity and symptoms are poorly related to conventional measures of cardiac function and more closely correlated with indices of longitudinal left ventricu lar function as assessed by TDi.
文摘Anemia and renal dysfunction(RD) are frequent complications seen in chronic heart failure(HF). However, the prevalence and interaction of these co-morbidities in a representative population of outpatients with chronic HF is poorly described. In this study, it was sought to determine the association between RD and anemia in patients with HF enrolled in a community-based HF program. Nine hundred fifty-five patients with HF due to left ventricular systolic dysfunction were investigated for the prevalence of anemia and its cause and followed for a median of 531 days. Anemia was defined as hemoglobin< 12.0 g/dl in women and< 13.0 g/dl in men. RD was defined as a calculated glomerular filtration rate of< 60 ml/min. The prevalence of anemia was 32%. Fifty-three percent of patients with and 27%of those without anemia had ≥1 test suggesting hematinic deficiency. The prevalence of RD was 54%. Forty-one percent of patients with and 22%of patients without RD had anemia, with similar proportions associated with iron deficiency in the presence or absence of RD. Anemia and RD independently predicted a worse outcome, and this effect was additive. In conclusion, in outpatients with chronic HF, anemia and RD are common and co-exist but confer independent prognostic information. A deficiency of conventional hematinic factors may cause about 1/3 of anemia in this clinical setting.
