patients with indication for invasive assessment receive right and left heart catheter and parallel biventricular conductance catheter at rest and stress

Heart Failure, Diastolic

biventricular parallel conductance catheter measurement at rest and stress conditions, + CMR at rest and stress

conductance catheter measurement

Goethe University Hospital

University Hospital Justus-Liebig University

Mechanisms of Right Ventricular Adaptation in Patients With Heart Failure With Preserved Ejection Fraction

Disclosing Mechanisms of Right Ventricular Adaptation in Patients With Heart Failure With Preserved Ejection Fraction With and Without Pulmonary Hypertension - Insights From Invasive Hemodynamic and Imaging

RV stiffness measured by conductance catheter is reduced alreday in early HFpEF stages

homeometric followed by teterometric adaptation with consecutive dilation of the RV occurs with disease progression from HFpEF-Non-PH ti ICC-PH_HFpEF to cpc-PH-HFpEFprogressive H, impacting position and motion of the septum with stress

RV longitudinal strain (related to RV EDV) is the best predictor of RV diastolic stiffness (Eed) in HFpEF-PH (correlation analysis)

acute change of the transmural pressure gradients from rest to stress conditions, adversly impacts LV filling

Birgit Assmus

Director Heart Failure Department, Cardiology

Johann Wolfgang Goethe University Hospital

University of Giessen

single cohort observational pathophysiologic study

In the levosimendan group, levosimendan will be used in addition to standard inotropic therapy (one or more agent including; dopamine, dobutamine, noradrenaline, adrenaline)for 24 hours.Levosimendan dosage; a loading dose of levosimendan (6 μg kg-1) will be administered after removal of the aortic cross-clamp, followed by an infusion of levosimendan at a dose of 0.1 μg kg-1 min-1.

In the control group, only standard inotropic therapy (one or more agent including; dopamine, dobutamine, noradrenaline, adrenaline)will be administered

Mitral Valve Stenosis With Incompetence or Regurgitation

The effects of levosimendan on renal function

Levosimendan

Dobutamine

Kartal Kosuyolu High Speciality Training and Research Hospital

The Effects of Levosimendan During Mitral Valve Surgery

The Effects of Levosimendan on Renal Function in Patients With Low Ejection Fraction Undergoing Mitral Valve Surgery.

The effects of levosimendan on postoperative renal function measured by serum creatinine (sCr) levels and estimated glomerular filtration rate (eGFR).

Secondary end points were the effects of levosimendan on clinical outcomes which include the pre- and perioperative prognostic risk factors such as; 1-aortic cross-clamp time, 2- cardiopulmonary bypass time, 3- the use of inotropic support, 4-intra-aortic balloon pump, 5- prolonged mechanical ventilation, 6-development of pneumonia, 7- Perioperative myocardial infarction, 8- cerebrovascular event (stroke, transient ischemic attack), 9- atrial fibrillation and other rhythm disturbances, 10- need for renal replacement therapy (RRT), 11-reoperation secondary to bleeding, 12-intensive care unit stay and 13- hospital stay.

Hemodynamic measurements include;
1- Cardiac output, 2-cardiac index (CI), 3-mean arterial pressure (MAP), 4-heart rate (HR), were recorded just before the start of surgery, at the end of CPB, on admission to the ICU, and postoperatively at 6 and 24 h later in the ICU. Hemodynamic targets were as follows: MAP ≥70 mmHg, CI ≥ 2.0 L/min/m2 without signs of poor peripheral perfusion (oliguria, acidosis).

Ayse Baysal

Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital

At study entry, patients have 1) a clinical assessment including metabolic risk profile; 2) a blood sample for analysis of metabolic, cardiac neurohormonal blood biomarkers and DNA collection; 3) a complete rest doppler echocardiography; 4) an exercise stress doppler echocardiography; 5) a cardiopulmonary exercise testing; 6) a magnetic resonance Imaging (MRI); 7) a 24-hour Holter ECG.
At follow-up, patients have 1) a clinical events assessment; 2) a blood sample analysis; 3) a resting echocardiography every year; 4) MRI (at preop. evaluation in the subset of patients undergoing surgery); 5) a 24-hour Holter ECG (at 2-year and postop.).

Fasting blood sample (serum, lithium-heparin, EDTA) and white cells - Tissue (explanted mitral valves)

Mitral Valve Insufficiency

Observational Study using Imaging and Biomarkers

Blood biomarkers

DNA collection

Echocardiography

Cardiopulmonary exercise testing

Magnetic resonance imaging (MRI)

Exercise stress doppler echocardiography

Holter ECG

University Hospital of Sart Tilman

Institut Universitaire de Cardiologie et de Pneumologie de Québec

University Hospital (CHU) of Brest, Hôpital La Cavale Blanche

University Hospital of Rennes

Determinants of the Progression and Outcome of Mitral Regurgitation

Determinants of the Progression and Outcome of Mitral Regurgitation-PROGRAM STUDY

The primary outcome is the time to occurrence of the first composite end-point: development of symptoms, left ventricular (LV) dysfunction (LV Ejection Fraction<60% and/or LV end diastolic diameter >40mm), ventricular arrhytmia requiring hospitalization, mediaction and/or implantation of defibrillator, atrial fibrillation or flutter, pulmonary arterial hypertension (resting systolic pressure >50mmHg), occurence of pulmonary oedema, congestive heart failure or cardiovascular death.

The annualized progression rate of MR severity will be calculated as the difference between effective regurgitant orifice, regurgitant volume, and vena contracta width measured at baseline and those measured at the last follow-up divided by the time between the first and last examinations.

The annualized progression rate of resting systolic pulmonary arterial pressure will be calculated.

The annualized progression rate of LVEF, LV end-systolic dimension, and LV myocardial global peak systolic velocities and global longitudinal strain will be calculated.

Maximum exercise capacity at baseline as measured by the percentage of age and gender predicted VO2max. We will determine which are, among the clinical and Doppler-echocardiographic variables, the independent determinants of maximum exercise capacity at baseline. The baseline exercise capacity will also be used as an independent variable, i.e. we will determine if it is an independent predictor of the primary end-point and of the other secondary end-points

Motivated by the occurrence of symptoms, LV systolic dysfunction, atrial fibrillation, and/or resting pulmonary pressure > 50 mmHg.

Number and percentage of ventricular ectopic per 24 h, percent time in atrial fibrillation, or flutter per 24 h.

Philippe Pibarot

Doctor

Laval University

Canadian Institutes of Health Research (CIHR)

Heart and Stroke Foundation of Canada

University Hospital, Brest

The intervention group will be called EGHEM - Echo Guided HEmodyanmic Management - and will receive their intraoperative maintenance fluid and possible drug therapy (furosemide) based on their hourly intraoperative LVDD grade.

The control group will be
called SHEM - Standard HEmodynamic Management - and will NOT receive the study intervention, but will receive standard anesthesia and hemodynamic management based on current standards within the institution.

mitral valve insufficiency/obesità

Mechanisms of Right Ventricular Adaptation in Patients With Heart Failure With Preserved Ejection Fraction

The Effects of Levosimendan During Mitral Valve Surgery

Determinants of the Progression and Outcome of Mitral Regurgitation

Echocardiography Management for Patients Requiring Care for Non-Cardiac Surgery

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