BACKGROUND: Dyspnea is the subjective symptom that means breathing difficulty or discomfort. Clinical evaluation to etiology of dyspnea in elderly patient may be difficult because of underlying disease and physiological change. NT-pro BNP is noted that is good clinical marker to diagnose congestive heart failure and then evaluated clinical efficiency in elderly dyspnea patients. METHODS: Medical records, echocardiogram and laboratoty result including NT-pro BNP were analysed in elderly patients who were admitted due to dyspnea from January 2004 to July 2005 that were finally diagnosed as systolic or diastolic heart failure and exacerbation of chronic obstructive lung disease. RESULTS: The patents were divided into three groups; group 1(systolic heart failure), group 2(diastolic heart failure), group 3 (exacerbation of chronic obstructive lung disease). The mean age and study number were 78.5+/-7.7 yrs(group 1; 24), 79.0+/-8.0 yrs(group 2; 22), 73.8+/-6.7 yrs(group 3; 18). The ejection fraction and left atrial size of group 1, 2, 3 were 42.9+/-7.5%, 69.7+/-9.1%. 66.19.5%(p<0.001) and 4.2+/-0.9 cm, 4.6+/-1.0 cm, 3.7+/-0.7cm(p=0.005). The value of NT-pro BNP were 12912.0+/-13179.9 pg/mL(group 1), 2842.8+/-2014.8pg/mL(group 2) and 168.2+/-148.8pg/mL(group 3)(p<0.001). CONCLUSION: NT-pro BNP can be used to evaluate etiologic disease as systolic heart failure in elderly patients who complain dyspnea as like echocardiogram although more large study is needed to evaluate clinical significance of NT-pro BNP.
Aged* ; Biomarkers ; Dyspnea* ; Heart ; Heart Failure ; Heart Failure, Diastolic ; Heart Failure, Systolic ; Humans ; Lung ; Medical Records ; Pulmonary Disease, Chronic Obstructive ; Respiration

BACKGROUND: Exercise intolerance is a common symptom of heart failure and has a detrimental impact on the quality of life. Skeletal muscle atrophy has been considered an important contributor to exercise intolerance; however, most studies have been conducted in patients with advanced systolic heart failure. METHODS: We studied 39 ambulatory heart failure patients (age, 77.9+/-6.5; male, 17 [43.6%]) and 39 age and gender-matched, community-dwelling, elderly subjects. Clinical, laboratory, and echocardiographic evaluations were performed. Dual-energy X-ray absorptiometry was performed to assess the body composition. Exercise capacity was measured by a six-minute walk test. Comprehensive geriatric assessments were also performed to evaluate comorbidity, medication, physical function, cognitive function, and nutritional status. RESULTS: Skeletal muscle mass of heart failure patients showed no differences when compared with that of age- and gender-matched control subjects in any part of the body or in the whole body. Although diastolic heart failure patients showed lower levels of skeletal muscle mass than systolic heart failure patients, no significant difference was identified in either systolic or diastolic heart failure patients compared with respective age- and gender-matched control groups. The six-minute walk distances showed no difference between the groups (257.2+/-117.8 m in the diastolic heart failure group versus 302.7+/-109.4 m in the systolic heart failure group, p=0.226). CONCLUSION: Although skeletal muscle mass has been known to be an independent factor associated with exercise capacity in advanced heart failure patients, skeletal muscle mass was not decreased in ambulatory, elderly heart failure patients when comparing age- and gender-matched control subjects.
Absorptiometry, Photon ; Aged ; Atrophy ; Body Composition ; Comorbidity ; Geriatric Assessment ; Heart ; Heart Failure ; Heart Failure, Diastolic ; Heart Failure, Systolic ; Humans ; Male ; Muscle, Skeletal ; Quality of Life

More than 50% of patients who are diagnosed with heart failure have preserved ejection fraction (HFpEF), and they have an equally poor prognosis when compared to patients with heart failure with reduced ejection fraction (HFrEF). However, a comprehensive understanding and awareness of heart failure with preserved ejection fraction is still limited and there are currently no optimized treatments to improve morbidity and mortality in these patients. This review summarizes the differences in the epidemiology, pathophysiology, diagnosis, and prognosis between HFpEF and HFrEF. We also review current management strategies of HFpEF patients according to evidence-based treatment guidelines.
Diagnosis ; Epidemiology ; Heart Failure* ; Heart Failure, Diastolic ; Humans ; Mortality ; Prognosis

BACKGROUND AND OBJECTIVES: Diastolic heart failure (DHF) is defined as clinical evidences of heart failure, with a normal ejection fraction (EF) and abnormal diastolic function. However, the distinction between DHF and SHF is often difficult. Strain (S) and strain rate (SR) echocardiography can measure the regional myocardial function as a magnitude and rate of deformation. The hypothesis"myocardial velocity (Vel), S & SR can provide additional information for differentiation DHF from SHF"was assessed. SUBJECTS AND METHODS: 30 patients with symptomatic HF and low EF (SHF group) and 27 with symptomatic HF, and normal EF and diastolic dysfunction (DHF group) were enrolled. 37 age-and sex-matched control subjects were recruited. Conventional echo and regional indices (Vel, S and SR), measured at the mid septum and posterior wall, were obtained. RESULTS: Almost all clinical and echo indices of control were different between the two HF groups. The EF, LV mass, S' and DT in DHF were greater than those with SHF. The LA size, diastolic dysfunction grades; E, A, E/A, E', A' and E/E', were not different between the two HF groups. In the regional indices, the peak S (long axis: 12.0+/-5.4 vs. 17.6+/-5.9%, radial axis: 26.4+/-12.7 vs. 46.0+/-16.7%) and systolic Vel (long axis: 2.6+/-0.8 vs. 3.6+/-0.9 cm/s, radial axis: 2.1 (1.2 vs. 3.7+/-1.4 cm/s) with SHF were significantly lower than those with DHF. However, the SR of the two groups was not different. The best cutoff values of peak S were 13.7% (long axis) and 329% (radial axis), and the systolic Vel were 3.0 cm/s (long axis) and 2.8 cm/s (radial axis). CONCLUSION: The peak S and systolic Vel may be useful indices for differentiating DHF from SHF. A similarly decreased SR in the two HF groups suggests that DHF has decreased myocardial contractility, despite the normal EF.
Axis, Cervical Vertebra ; Echocardiography* ; Heart Failure ; Heart Failure, Diastolic* ; Humans

BACKGROUND AND OBJECTIVES: Although Doppler echocardiography has been used to identify left ventricular (LV) diastolic dysfunction, its limitations suggest there is a need for new biomarkers to measure the diastolic dysfunction. Because the B-type natriuretic peptide (BNP) levels correlate with the LV diastolic pressure, we hypothesized that the BNP would be useful for diagnosing and monitoring the patients with diastolic heart failure. SUBJECTS AND METHODS: We prospectively studied a total of 69 consecutive patients (mean age: 68+/-12 yrs, 31 men and 38 women) who presented to the emergency room with suspected dyspnea of a cardiac origin from November 2003 to May 2004. BNP sampling and Doppler echocardiography were performed for all the study patients. We diagnosed the systolic heart failure (SHF) and diastolic heart failure (DHF) on the conditions that both the clinical and echocardiographic criteria for systolic and diastolic dysfunction were fulfilled. From June 2004 to May 2005, we also performed clinical examinations, measurement of the tissue Doppler derived E/E' and the BNP level at baseline and at 1 year after pharmacologic treatment for 42 consecutive patients who were diagnosed with DHF in the ER and the outpatient clinic. RESULTS: We diagnosed SHF in 37 patients, DHF in 19 patients and we excluded HF in 13 patients (the control group). The mean BNP levels of the SHF and DHF groups were 716+/-532 pg/mL and 390+/-446 pg/mL, respectively, and these values were significantly higher than that of the control group (13+/-14 pg/mL, p<0.01). The area under the receiver-operating characteristic (ROC) curve for BNP to diagnose DHF was 0.94 (95% CI: 0.86 to 1.02, p<0.001). We also compared the BNP levels with the E/E' in terms of the changes of the functional status for the 42 patients suffering with DHF. After treatment, the blood pressure (BP) was significantly decreased from 162+/-26/91+/-15 to 141+/-16/80+/-12 mmHg (p<0.001), the New York Heart Association (NYHA) functional class was decreased from 2.3+/-0.7 to 1.7+/-0.6 (p<0.001), and the E/E' was decreased from 15.9+/-5.7 to 13.8+/-5.1 (p<0.01), but there were no significant changes of the BNP levels, from 213+/-404 to 208+/-464 pg/mL, following treatment. CONCLUSION: A BNP assay is clinically useful for diagnosing DHF, and a cut-off value of BNP can be suggested for screening DHF. However, the tissue doppler derived E/E' is the better index for monitoring changes in the functional status of DHF patients than is the BNP level.
Ambulatory Care Facilities ; Biomarkers ; Blood Pressure ; Diagnosis* ; Dyspnea ; Echocardiography ; Echocardiography, Doppler ; Emergency Service, Hospital ; Follow-Up Studies* ; Heart ; Heart Failure ; Heart Failure, Diastolic* ; Heart Failure, Systolic ; Humans ; Male ; Mass Screening ; Natriuretic Peptide, Brain* ; Prospective Studies

BACKGROUND AND OBJECTIVES: This study was performed to, 1) evaluate the diagnostic value of the Brain Natriuretic Peptide (BNP), which is known to be present in the heart ventricle, for patients with dyspnea for the assessing its causes;diastolic or systolic heart failure or pulmonary disease, and 2) find if the BNP is correlated with the distance walked in 6 minutes, which is known to be a prognostic indicator for heart failure. SUBJECTS AND METHODS: Fifty-seven patients who admitted to the Kangbuk Samsung Medical Center, with the chief complaint of dyspnea, were enrolled in the study. The subjects were classified into three groups according to the causes of their dyspnea, which were systolic heart failure, diastolic heart failure and chronic obstructive pulmonary disease. The plasma BNP levels were measured by a radioimmunoassay, both at admission and discharge. The BNP levels at admission were compared among the three groups. The presence of a correlation between the distance walked in 6 minutes and the BNP at discharge were also evaluated. RESULTS: The patients group with systolic heart failure had the highest mean BNP concentration of 934.6+/-386.7 pg/mL. The other two groups had significantly lower levels of BNP. The patients group with chronic obstructive pulmonary disease had significantly lower level than the group with diastolic heart failure (33.2+/-25.6 vs. 181.8+/-222.2 pg/mL). The BNP concentrations at discharge, and the distance walked in 6 minutes, between the three groups showed no statistical significance (p=0.69). CONCLUSION: This study showed that the mean plasma BNP level was highest in the group with systolic heart failure, followed by diastolic heart failure and lastly chronic obstructive pulmonary disease. These findings suggest that diagnostic value of the plasma BNP concentration in the assessment of the causes of dyspnea. Although this study has failed to show a correlation between the plasma BNP concentration at discharge and the distance walked in 6 minutes, prospective cohort studies, with larger sample sizes, need to be performed to establish the relationship, if any.
Cohort Studies ; Diagnosis ; Diagnosis, Differential* ; Dyspnea* ; Heart Failure ; Heart Failure, Diastolic ; Heart Failure, Systolic ; Heart Ventricles ; Humans ; Lung Diseases ; Natriuretic Peptide, Brain* ; Plasma ; Pulmonary Disease, Chronic Obstructive ; Radioimmunoassay ; Sample Size

The aim of the present study is to investigate the differences in cardiac function, and the expression and activity of calcium regulatory proteins between rabbit systolic heart failure (SHF) and diastolic heart failure (DHF) models. New Zealand white rabbits were randomly divided into three groups: sham operation (SO) group, DHF group (receiving abdominal aortic constriction) and SHF group (receiving aortic valve destruction and abdominal aortic constriction). The cardiac function was detected by echocardiographic and hemodynamic assays. The mRNA expression levels of sarcoplasmic reticulum Ca(2+) ATPase 2a (SERCA2a) and phospholamban (PLB) were evaluated by RT-PCR. The protein expression levels of SERCA2a, PLB, phosphoserine 16-PLB (pSer-16-PLB) and protein kinase A (PKA) were evaluated by Western blot, and the phosphorylation status of PLB was determined by the ratio of pSer-16-PLB protein level to that of PLB. The activity of SERCA2a was measured through inorganic phosphate. The activity of PKA was measured by gamma-(32)P ATP-binding assays. Compared with SO group, there were significantly increased ventricular wall thickness, raised left ventricular end diastolic pressure (LVEDP), reduced diastolic function in DHF group (P<0.05 or P<0.01), and significantly increased ventricular cavity size and LVEDP, reduced systolic function in SHF group (P<0.05 or P<0.01). The expression levels of SERCA2a in DHF and SHF groups were lower than that in SO group (P<0.05), while the expression and activity of PKA in DHF and SHF groups were higher than that in SO group (P<0.05 or P<0.01), and there was no significant difference between DHF and SHF groups. The expression levels of PLB and pSer-16-PLB as well as the phosphorylation status of PLB and activity of SERCA2a in SHF group were lower than those in DHF and SO groups respectively. Posing a contrast, the phosphorylation status of PLB and activity of SERCA2a in DHF group were higher than that in SO group (P<0.05). These results indicate that the SHF and DHF models were successfully established, and there are some differences in the expression and activity of calcium regulatory proteins between two models.
Animals ; Calcium-Binding Proteins ; metabolism ; Disease Models, Animal ; Heart Failure, Diastolic ; metabolism ; Heart Failure, Systolic ; metabolism ; Rabbits ; Sarcoplasmic Reticulum ; metabolism ; Sarcoplasmic Reticulum Calcium-Transporting ATPases ; metabolism

BACKGROUND: Diabetes mellitus (DM) increases risk of heart failure. It has been shown that diabetes leads to DM-cardiomyopathy, characterized by systolic and diastolic dysfunction. Pre-transplant diastolic dysfunction, has been associated with poor graft outcome and mortality. We assessed the hypothesis that end-stage liver disease (ESLD) patients with diabetes (DM-ESLD), have more advanced cardiac systolic and diastolic dysfunction, compared to ESLD patients without diabetes (Non DM-ESLD).METHODS: We retrospectively evaluated preoperative echocardiography of 1,319 consecutive liver transplant recipients (1,007 Non DM-ESLD vs. 312 DM-ESLD [23.7%]) January 2012–May 2016. Systolic and diastolic indices, such as left ventricular ejection fraction, transmital E/A ratio, tissue doppler s′, e′ velocity, and E/e′ ratio (index of left ventricular end-diastolic pressure), were compared using 1:2 propensity-score matching.RESULTS: DM-ESLD patients showed no differences in systolic indices of left ventricular ejection fraction and s′ velocity, whereas diastolic indices of E/A ratio ≤ 1 (49.0% vs. 40.2% P = 0.014), e′ velocity (median = 7.0 vs. 7.4 cm/s, P < 0.001) and E/e′ ratio (10.9 ± 3.2 vs. 10.1 ± 3.0, P < 0.001), showed worse diastolic function compare with Non DM-ESLD patients, respectively.CONCLUSIONS: DM-ESLD patients suffer higher degree of diastolic dysfunction compared with Non DM-ESLD patients. Based on this, careful preoperative screening for diastolic dysfunction in DM-ESLD patients is encouraged, because poor transplant outcomes have been noted in patients with preoperative diastolic dysfunction.
Diabetes Mellitus ; Echocardiography ; Heart Failure ; Heart Failure, Diastolic ; Heart Failure, Systolic ; Humans ; Liver Cirrhosis ; Liver Diseases ; Liver ; Mass Screening ; Mortality ; Propensity Score ; Retrospective Studies ; Stroke Volume ; Transplant Recipients ; Transplants

Heart Failure, Diastolic ; diagnosis ; prevention & control ; Humans

No abstract available.
Defibrillators* ; Heart Failure, Systolic* ; Humans