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Tesi etd-07132018-102416


Thesis type
Tesi di specializzazione (5 anni)
Author
ROVAI, ILARIA
URN
etd-07132018-102416
Title
Diastolic Dysfunction and Left Ventricular Remodeling: classification and prognostic impact of a combined structural and functional echocardiographic analysis in a cohort of patients with Stage A and B Heart Failure with preserved Ejection Fraction (HFpEF)
Struttura
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Corso di studi
MALATTIE DELL'APPARATO CARDIOVASCOLARE
Supervisors
relatore Dott. Dini, Frank L.
correlatore Prof. Pedrinelli, Roberto
Parole chiave
  • diastolic dysfunction
  • Heart failure
  • preserved ejection fraction
  • cardiac remodeling
  • prognosis
Data inizio appello
08/08/2018;
Consultabilità
Secretata d'ufficio
Riassunto analitico
Background. Patients with Heart failure with preserved ejection fraction (HFpEF) are
characterized by diastolic dysfunction (DD) and adverse left ventricular (LV)
remodeling.
Objectives. To assess the prognostic impact of different diastolic function algorithms
and a complex remodeling classification (CRC, including relative wall thickness, LV
mass index and end-diastolic volume index) in stage A and B HFpEF.
Methods. We selected 1923 stage A and B HFpEF patients (male 43%; age 57, 33-76
years) from a multicenter study, using three algorithms for LV diastolic function
(Paulus 2007, Nagueh 2009, Nagueh 2016), with classic and CRC. We considered a
composite end-point: all-cause death, hospitalization for worsening HF and acute
pulmonary edema.
Results. DD was observed in a minority of the population according to the three
different algorithms. The highest presence of DD was diagnosed by Nagueh 2009 (211
patients, 11%), while the prevalence according to Nagueh 2016 (63 patients, 3.3%)
turned out to be the lowest (p<0.001 vs the other two algorithms). The proportion of
patients with undetermined diastolic function was similar across the 3 algorithms,
with a non-significant higher prevalence in Nagueh 2016 (n=154, 8%). According to
CRC, 486 (25,3%) patients had adverse hypertrophic remodeling: 294 (15,3%)
concentric hypertrophy, 73 (3.8%) eccentric hypertrophy, 80 (4.2%) dilated
hypertrophy and 39 (2%) mixed hypertrophy. 294 (15.3%) were unclassifiable. After
a median follow-up of 29 months, multivariate Cox-regression (adjusted for age,
gender, history of stable ischemic heart disease, classic remodeling classification)
identified CRC (p=0.01) and Nagueh 2016 (p<0.001) as independent predictors of
end-point. Hypertrophic remodeling patterns (in particular concentric and eccentric
hypertrophy) showed the worst prognosis in the survival analysis. The coexistence of
an adverse LV remodeling by CRC and DD by Nagueh 2016 was associated with the
worst prognosis. CRC succeeded in stratifying also the subgroup with undetermined
diastole, proving the coexistence of an adverse hypertrophy pattern is associated
with a worse prognosis in these patients.
Conclusions. A concurrent structural (CRC) and functional (Nagueh 2016) analysis
improves prognostic stratification in stage A and B HFpEF patients.
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