Albuminuria is independently associated with cardiac remodeling, abnormal right and left ventricular function, and worse outcomes in heart failure with preserved ejection fraction.
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TL;DR: In HFpEF, increased UACR is a prognostic marker and is associated with increased RV and left ventricular remodeling and longitudinal systolic dysfunction.
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Abstract: Objectives The purpose of this study was to determine the relationship between albuminuria and cardiac structure/function in heart failure with preserved ejection fraction (HFpEF). Background Albuminuria, a marker of endothelial dysfunction, has been associated with adverse cardiovascular outcomes in HFpEF. However, the relationship between albuminuria and cardiac structure/function in HFpEF has not been well studied. Methods We measured urinary albumin-to-creatinine ratio (UACR) and performed comprehensive echocardiography, including tissue Doppler imaging and right ventricular (RV) evaluation, in a prospective study of 144 patients with HFpEF. Multivariable-adjusted linear regression was used to determine the association between UACR and echocardiographic parameters. Cox proportional hazards analyses were used to determine the association between UACR and outcomes. Results The mean age was 66 ± 11 years, 62% were female, and 42% were African American. Higher UACR was associated with greater left ventricular mass, lower preload-recruitable stroke work, and lower global longitudinal strain. Higher UACR was also significantly associated with RV remodeling (for each doubling of UACR, RV wall thickness was 0.9 mm higher [95% confidence interval: 0.05 to 0.14 mm; p = 0.001, adjusted p = 0.01]) and worse RV systolic function (for each doubling of UACR, RV fractional area change was 0.56% lower [95% confidence interval: 0.14 to 0.98%; p = 0.01, adjusted p = 0.03]. The association between UACR and RV parameters persisted after the exclusion of patients with macroalbuminuria (UACR >300 mg/g). Increased UACR was also independently associated with worse outcomes. Conclusions In HFpEF, increased UACR is a prognostic marker and is associated with increased RV and left ventricular remodeling and longitudinal systolic dysfunction. (Classification of Heart Failure With Preserved Ejection Fraction; NCT01030991 )
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Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options.
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TL;DR: PROMIS-HFpEF is the first prospective multi-centre, multinational study to demonstrate a high prevalence of CMD in HFpEF in the absence of unrevascularized macrovascular CAD, and to show its association with systemic endothelial dysfunction (RHI, UACR as well as markers of HF severity (NTproBNP and RV dysfunction).
Evaluation of kidney function throughout the heart failure trajectory - a position statement from the Heart Failure Association of the European Society of Cardiology.
Wilfried Mullens,Kevin Damman,Jeffrey M. Testani,Pieter Martens,Christian Mueller,Johan Lassus,W.H. Wilson Tang,Hadi Skouri,Frederik H. Verbrugge,Francesco Orso,Loreena Hill,Dilek Ural,Mitcha Lainscak,Patrick Rossignol,Marco Metra,Alexandre Mebazaa,Petar M. Seferovic,Frank Ruschitzka,Andrew J.S. Coats +18 more
TL;DR: This position paper of the Heart Failure Association Working Group on Cardio‐Renal Dysfunction aims at improving insights into the interpretation of renal function assessment in the different heart failure states, with the goal of improving heart failure care.
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Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis
Thomas M. Gorter,Elke S. Hoendermis,Dirk J. van Veldhuisen,Adriaan A. Voors,Carolyn S.P. Lam,Bastiaan Geelhoed,Tineke P. Willems,Joost P. van Melle +7 more
TL;DR: A systematic review and meta‐analysis according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses on the prevalence and prognostic value of RV dysfunction in heart failure with preserved ejection fraction is conducted.
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Association of cardiovascular biomarkers with incident heart failure with preserved and reduced ejection fraction
Rudolf A. de Boer,Matthew Nayor,Christopher DeFilippi,Danielle Enserro,Vijeta Bhambhani,Jorge R. Kizer,Michael J. Blaha,Frank P. Brouwers,Mary Cushman,Joao A.C. Lima,Hossein Bahrami,Pim van der Harst,Thomas J. Wang,Ron T. Gansevoort,Caroline S. Fox,Hanna K. Gaggin,Willem J. Kop,Kiang Liu,Ramachandran S. Vasan,Ramachandran S. Vasan,Bruce M. Psaty,Bruce M. Psaty,Douglas S. Lee,Hans L. Hillege,Traci M. Bartz,Emelia J. Benjamin,Emelia J. Benjamin,Cheeling Chan,Matthew A. Allison,Julius M. Gardin,James L. Januzzi,Sanjiv J. Shah,Daniel Levy,David M. Herrington,Martin G. Larson,Wiek H. van Gilst,John S. Gottdiener,Alain G. Bertoni,Jennifer E. Ho +38 more
TL;DR: 12 cardiovascular biomarkers with incident HFpEF vs HFrEF among adults from the general population were evaluated, with natriuretic peptides, high-sensitivity troponin, and CRP leading the way when directly compared.
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TL;DR: The Society of Echocardiography (SEDC) is an educational activity for cardiovascular physicians and cardiac sonographers with a knowledge base in the field of echo-cardiography as discussed by the authors.
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A direct approach to false discovery rates
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Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography
Lawrence G. Rudski,Wyman W. Lai,Jonathan Afilalo,Lanqi Hua,Mark D. Handschumacher,Krishnaswamy Chandrasekaran,Scott D. Solomon,Eric K. Louie,Nelson B. Schiller +8 more
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Sherif F. Nagueh,Christopher P. Appleton,Thierry C. Gillebert,Paolo Marino,Jae K. Oh,Otto A. Smiseth,Alan D. Waggoner,Frank A. Flachskampf,Patricia A. Pellikka,Arturo Evangelista +9 more
TL;DR: Recommendations for the evaluation of left ventricular diastolic function by echocardiography are made and further research is needed to determine the best method for this evaluation.
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