Rakesh, Pinninti (2012) Heart Failure with Preserved Ejection Fraction: Clinical Profile, Risk Factor Analysis and Echo Evaluation. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Heart failure is one of the leading causes of hospitalizations in both developed as well as developing nations. Regardless of the definition used, the prevalence of HF increases steeply with age, Prevalence is 1% between the ages of 50 and 59 years, progressively increasing to >10% over age of 80 years. Heart Failure is generally described as a clinical syndrome associated with impaired left ventricular (LV) contractility and cavity dilation. ―HF with preserved LVEF, or ―diastolic heart failure (DHF), is thought to be due to abnormalities in the diastolic properties of the LV, Diastolic heart failure (DHF) is responsible for almost nearly 50% of all patients with heart failure & is frequently referred as heart failure with normal ejection fraction of left ventricle (HFNEF). This form of heart failure may result in long run heart failure with reduced ejection fraction. The recent advances in understanding of diastolic ECHO characters & biomarkers for heart failure resulted in modification of protocol for the diagnosis of HFNEF and recent update to diagnostic criteria. Although such hearts contract normally, relaxation (diastole) is abnormal. Such abnormality in cardiac relaxation is more pronounced during periods of exertion & exercise as cardiac output cannot adequately increase due to increased filling pressures of left ventricle. Due to this high filling pressure there are resultant pulmonary congestion, dyspnoea, and edema features that appear similar in presentation to regular systolic dysfunction. Unfortunately, unlike heart failure due to systolic dysfunction, diastolic heart failure has been studied in few clinical trials, so there is little evidence to guide the care of patients with this condition. Physiological principles used in the treatment of such patients include the control of blood pressure, heart rate, myocardial ischemia, and blood volume. Although diastolic dysfunction is thought to be the only mechanism responsible for the development of heart failure with a preserved ejection fraction, community based studies suggest that additional mechanisms such as increased vascular & ventricular stiffness may also be responsible. AIM OF THE STUDY: 1. To do an observational study analysing the a) Clinical presentation, b) Risk factor profile, c) Diagnostic evaluation with Echocardiograph correlation of Heart failure with normal/preserved ejection fraction. 2. To understand the variability of several ECHO characteristics with increasing diastolic dysfunction. 3. To find a relation between several anthropometry measurements & increasing diastolic dysfunction. MATERIALS AND METHODS: Patient Selection: The present study included heart failure patients admitted to Government Stanley Hospital Medical Departments; a consecutive series of 52 heart failure patients admitted in the Department of Medicine, Stanley Medical College and Government Stanley Hospital, during the period of 6 months from July 1st 2010 to Dec 30th 2010. Patients selected fulfilled the Framingham‘s criteria for heart failure & Normal/preserved ejection fraction. Study Design: This study is a cross sectional observational study. Inclusion Criteria: 1. Symptoms and signs of HF (Framingham criteria), 2. LV Ejection Fraction > 45-50%, and 3. Ability to rule out: Mitral stenosis, Mitral regurgitation, pericardial disease, and non cardiac causes of dyspnoea, oedema and fatigue. Exclusion Criteria: 1. Heart failure patients with EF<45% any time during their clinical course. 2. Patients who underwent cardiac surgeries (CABG, valve repair, etc). 3. Chest wall injuries (blunt/penetrating). 4. Age < 14yrs. STATISTICAL ANALYSIS: The population of 52 patients included in the study belong to a unified group satisfying all the inclusion criteria & exclusion criteria. They are the patients with Heart failure with normal ejection fraction ‗HFNEF‘. Each patient underwent clinical examination to identify features of heart failure; biochemical investigations to identify the cardiac risk factors; 2D ECHO & Doppler ECHO study is quantify few specific Diastolic functional characteristics. STATISTICAL METHODS: All continuous variables were assumed to be normally distributed and are reported as arithmetic mean with their standard deviation. The 95% confidence intervals are also reported where clinically applicable. The strength of the linear relationship between two variables is analyzed as Correlation coefficient (spearman). The Fisher‘s Exact test (2x3 Fisher's exact test calculator) 53 was used to compare and analyze the data. The null hypothesis was rejected at the 95% confidence interval, considering a probability value of P < 0.05 as statistically significant & probability value of P <0.0001 as extremely significant. Fisher‘s Exact test done using 2x3 Fisher's exact test calculator, Joosse SA. 2011 Fisher's exact test, available from http://in-silico.net/statistics/fisher_exact_test. RESULTS: A total of 52 patients who consulted to the medical department Government Stanley Hospital & who satisfied the inclusion as well exclusion criteria were enrolled for this study. Among the 52 patients 22 were males & 30 were females, with an average age of 62.54 (SD 13.27), the youngest among the lot being 40 yr & the oldest being 88 yr. CONCLUSIONS: The conclusions of this study are following: 1. Patients with Heart failure with normal ejection fraction HFNEF are more likely to be older (75%) and women (57.69%). 2. Dyspnea and fatigue (90.38%) are most common presenting symptoms. 3. Hypertension (94.23%) is the most common risk factor. 4. Statistically significant association found with Hypertension (p=0.0195), Dyslipidemia (p=0.0447) & obesity (p=0.0437) with increasing Grade of diastolic dysfunction. 5. Among the physical findings Fourth Heart sound (S4) is most commonly associated with increasing grade of Diastolic dysfunction, this association is extremely significant statistically (p<0.0001); also increasing BMI (p=0.036) & W/H ratio (p=0.012) are associated with increasing Grade of Diastolic dysfunction & this association was also statistically significant.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Heart Failure ; Preserved Ejection Fraction ; Clinical Profile ; Risk Factor Analysis ; Echo Evaluation. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Mar 2018 06:06 |
| Last Modified: | 27 Mar 2018 15:37 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6568 |
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