Matches in SemOpenAlex for { <https://semopenalex.org/work/W3213307045> ?p ?o ?g. }
Showing items 1 to 75 of
75
with 100 items per page.
- W3213307045 abstract "Abstract Background Abnormal cardiac mitochondrial function and energetics may be a unifying feature in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Transient pulmonary congestion during exercise is emerging as an important determinant of reduced exercise capacity and symptoms in patients with HFpEF. Purpose We sought to determine if impaired myocardial energetics limits cardiac exercise reserve and leads to exercise-induced pulmonary congestion in HFpEF. Methods 42 patients across the spectrum of diastolic dysfunction and HFpEF (controls n=10; type 2 diabetes (T2DM) n=9; HFpEF n=14; severe diastolic dysfunction due to cardiac amyloid n=9) (Fig. 1a) underwent assessment of cardiac energetics (myocardial phosphocreatine to adenosine triphosphate ratio, PCr/ATP) and function using cardiovascular magnetic resonance (CMR) imaging and echocardiography, and lung-water using a novel pulmonary proton-density MR sequence. Studies were performed at rest and during exercise (20W for 6 minutes) using a CMR-ergometer. Results Paralleling the stepwise decline in diastolic function across the groups (E/e' ratio, p<0.0001) was an increase in NT-pro BNP (p<0.0001, Fig. 1b) and reduction in PCr/ATP (control 2.00 [1.86,2.15], T2DM 1.71 [1.61,1.91], HFpEF 1.66 [1.44,1.89], amyloid 1.30 [1.16,1.53], p<0.0001, Fig. 1c). During exercise, there was progressive blunting of left ventricular (LV) diastolic filling (p<0.0001) (Fig. 2a-b), left atrial (LA) dilatation (p<0.0001), failure of RVEF augmentation (p=0.003), RV-PA uncoupling (RV stroke volume to end-systolic volume (SV/ESV) ratio, p=0.0002), and right atrial (RA) dilatation (p<0.0001) across the groups (Fig. 2b). LV diastolic filling (r 0.41, p=0.008), LA dilatation (r −0.35, p=0.03), RVEF augmentation (r 0.46, p=0.003), RV-PA uncoupling (r 0.36, p=0.02), and RA dilatation (r −0.68, p<0.001) during exercise were strongly linked with impaired myocardial energetics (Fig. 2b). The novel pulmonary proton-density sequence provided images that scaled linearly with water content (validated using a water-doped sponge phantom; r 0.98, p<0.0001), and revealed a progressive increase in lung water signal/pulmonary congestion (Fig. 2c) post-exercise (p<0.0001) across the groups (controls: +0.25% [−1.8, 3.1], p=0.82; T2DM: +0.8% [−1.7, 1.9], p=0.82; HFpEF: +4.4% [0.5, 6.4], p=0.002; amyloid: +6.4% [3.3, 10.0], p=0.004). Pulmonary congestion was associated with impaired LV diastolic filling (r −0.32, p=0.04), RV-PA uncoupling (r −0.39, p=0.01) and RA dilatation (r 0.4, p=0.01) during exercise, and impaired myocardial energetics (r −0.36, p=0.02). Conclusion A gradient of myocardial energetic deficit exists across the spectrum of HFpEF. This energetic deficit is related to markedly abnormal cardiac exercise responses, which leads to transient pulmonary congestion. The findings support an energetic basis for impaired cardiac reserve and exercise-induced pulmonary congestion in HFpEF. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Baseline clinical and CMR parametersExercise cardiopulmonary parameters" @default.
- W3213307045 created "2021-11-22" @default.
- W3213307045 creator A5015562989 @default.
- W3213307045 creator A5026013278 @default.
- W3213307045 creator A5026575926 @default.
- W3213307045 creator A5026760717 @default.
- W3213307045 creator A5037871418 @default.
- W3213307045 creator A5058049431 @default.
- W3213307045 creator A5058235792 @default.
- W3213307045 creator A5074710678 @default.
- W3213307045 creator A5082077038 @default.
- W3213307045 creator A5086239114 @default.
- W3213307045 creator A5091299397 @default.
- W3213307045 date "2021-10-01" @default.
- W3213307045 modified "2023-09-27" @default.
- W3213307045 title "Impaired myocardial energetics limits cardiac functional reserve and leads to exercise-induced pulmonary congestion in heart failure with preserved ejection fraction" @default.
- W3213307045 doi "https://doi.org/10.1093/eurheartj/ehab724.0734" @default.
- W3213307045 hasPublicationYear "2021" @default.
- W3213307045 type Work @default.
- W3213307045 sameAs 3213307045 @default.
- W3213307045 citedByCount "0" @default.
- W3213307045 crossrefType "journal-article" @default.
- W3213307045 hasAuthorship W3213307045A5015562989 @default.
- W3213307045 hasAuthorship W3213307045A5026013278 @default.
- W3213307045 hasAuthorship W3213307045A5026575926 @default.
- W3213307045 hasAuthorship W3213307045A5026760717 @default.
- W3213307045 hasAuthorship W3213307045A5037871418 @default.
- W3213307045 hasAuthorship W3213307045A5058049431 @default.
- W3213307045 hasAuthorship W3213307045A5058235792 @default.
- W3213307045 hasAuthorship W3213307045A5074710678 @default.
- W3213307045 hasAuthorship W3213307045A5082077038 @default.
- W3213307045 hasAuthorship W3213307045A5086239114 @default.
- W3213307045 hasAuthorship W3213307045A5091299397 @default.
- W3213307045 hasBestOaLocation W32133070451 @default.
- W3213307045 hasConcept C111566952 @default.
- W3213307045 hasConcept C126322002 @default.
- W3213307045 hasConcept C164705383 @default.
- W3213307045 hasConcept C2777099384 @default.
- W3213307045 hasConcept C2778198053 @default.
- W3213307045 hasConcept C2778626300 @default.
- W3213307045 hasConcept C2986317502 @default.
- W3213307045 hasConcept C57900726 @default.
- W3213307045 hasConcept C71924100 @default.
- W3213307045 hasConcept C78085059 @default.
- W3213307045 hasConcept C84393581 @default.
- W3213307045 hasConceptScore W3213307045C111566952 @default.
- W3213307045 hasConceptScore W3213307045C126322002 @default.
- W3213307045 hasConceptScore W3213307045C164705383 @default.
- W3213307045 hasConceptScore W3213307045C2777099384 @default.
- W3213307045 hasConceptScore W3213307045C2778198053 @default.
- W3213307045 hasConceptScore W3213307045C2778626300 @default.
- W3213307045 hasConceptScore W3213307045C2986317502 @default.
- W3213307045 hasConceptScore W3213307045C57900726 @default.
- W3213307045 hasConceptScore W3213307045C71924100 @default.
- W3213307045 hasConceptScore W3213307045C78085059 @default.
- W3213307045 hasConceptScore W3213307045C84393581 @default.
- W3213307045 hasIssue "Supplement_1" @default.
- W3213307045 hasLocation W32133070451 @default.
- W3213307045 hasOpenAccess W3213307045 @default.
- W3213307045 hasPrimaryLocation W32133070451 @default.
- W3213307045 hasRelatedWork W1949634191 @default.
- W3213307045 hasRelatedWork W1964205598 @default.
- W3213307045 hasRelatedWork W2061321770 @default.
- W3213307045 hasRelatedWork W2157684603 @default.
- W3213307045 hasRelatedWork W2363366439 @default.
- W3213307045 hasRelatedWork W2386991455 @default.
- W3213307045 hasRelatedWork W2475222081 @default.
- W3213307045 hasRelatedWork W2915561147 @default.
- W3213307045 hasRelatedWork W2965474825 @default.
- W3213307045 hasRelatedWork W3033076790 @default.
- W3213307045 hasVolume "42" @default.
- W3213307045 isParatext "false" @default.
- W3213307045 isRetracted "false" @default.
- W3213307045 magId "3213307045" @default.
- W3213307045 workType "article" @default.