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PubMed2026

Spironolactone, early acute eGFR changes, and clinical outcomes in patients with heart failure with preserved ejection fraction: insights from TOPCAT Americas.

AIMS: Early acute changes in estimated glomerular filtration rate (eGFR) have been well described with renin-angiotensin system inhibitors and sodium-glucose cotransporter-2 inhibitors, but less is known about the frequency, prognostic relevance, and implications of these changes after mineralocorticoid receptor antagonist (MRA) initiation in patients with heart failure with preserved ejection fraction (HFpEF). METHODS: We performed a post-hoc analysis of 1648 patients enrolled in the TOPCAT trial (Americas regional subgroup), defining an early eGFR dip as a ≥15% decrease in eGFR between baseline and week 4. Landmark analyses assessed the association of eGFR changes, treatment, and the primary composite endpoint (cardiovascular death, HF hospitalization, or aborted cardiac arrest). RESULTS: Within 4 weeks of treatment initiation, 431 (26%) patients experienced acute eGFR decrease with a higher proportion of patients assigned to spironolactone [269 (33%)] compared with placebo [162 (20%)] (odds ratio 1.97; 95% confidence interval 1.58-2.47). An acute eGFR decrease was independently associated with higher risk of subsequent cardiovascular outcomes, irrespective of treatment arm. However, treatment with spironolactone appeared beneficial in reducing the primary cardiovascular outcome irrespective of the presence [hazard ratio 0.75 (0.53-1.08)] or absence [0.80 (0.64-1.00)] of early eGFR decrease (Pinteraction = .81). At any given magnitude of eGFR decline, risk of the primary endpoint was consistently lower with spironolactone compared with placebo (Pinteraction = .64). CONCLUSIONS: Early acute eGFR changes were common and adversely prognostic in patients with HFpEF. Spironolactone treatment was beneficial in improving cardiovascular outcomes, despite a modest increase in the likelihood of acute eGFR decrease. An acute eGFR decrease early after MRA initiation should not automatically prompt treatment discontinuation. TRIAL REGISTRATION: ClinicalTrials.gov NCT00094302.

Humans↗
PubMed2025

Finerenone in Heart Failure With Improved Ejection Fraction: The FINEARTS-HF Randomized Clinical Trial.

IMPORTANCE: Patients with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) less than 40% who experience LVEF improvement to 40% or higher (HFimpEF) may still face residual risks. OBJECTIVE: To assess the clinical profiles, risk, and treatment response to finerenone in participants with HFimpEF. DESIGN, SETTING, AND PARTICIPANTS: A total of 6001 patients with HE, LVEF of 40% or higher, New York Heart Association class II to IV symptoms, and elevated natriuretic peptide levels, were enrolled between September 14, 2020, and January 10, 2023. Patients with a prior history of LVEF less than 40% were included. Data analysis was conducted between September 1 to December 10, 2024. INTERVENTION: Participants received finerenone (titrated to 20 mg or 40 mg) or placebo. MAIN OUTCOMES AND MEASURES: The primary end point was the composite of cardiovascular (CV) death and total (first and recurrent) worsening HF events. RESULTS: Of the 6001 participants (mean [SD] age, 72 [9.7], years; 3269 male [55%]), 273 (5%) had a prior LVEF less than 40%. Among those with a prior LVEF of less than 40%, the median recorded prior LVEF was 35% [IQR, 30%-37%], with a median improvement of 12% [IQR, 8%-17%]. Over a median follow-up of 2.6 years, those with a history of LVEF of less than 40% experienced higher rates of the primary outcome of a composite of CV death and worsening of HF events (21.4 per 100 patient-years vs 16.0 per 100 patient-years) than did those whose LVEF was consistently 40% or higher. After adjustment for clinically relevant covariates; however, this rate ratio (RR) was not statistically different (absolute RR, 1.13; 95% CI, 0.85-1.49, P = .39). The treatment effect of finerenone on the primary outcome was consistent among those with a history of LVEF less than 40% and those with LVEF that was consistently 40% or higher (P for interaction = .36). Owing to higher baseline risk, the absolute risk reduction was greater among those with HFimpEF (9.2 vs 2.5 per 100 patient-years). Patients with HFimpEF tended to develop more hypotension with finerenone treatment, but otherwise, the safety profile of finerenone was similar in patients with and without previous LVEF less than 40%. CONCLUSIONS AND RELEVANCE: In this prespecified analysis of a randomized clinical trial, patients with HFimpEF remained at high risk of CV events, underscoring the need for continued management despite LVEF improvement. The treatment benefits of finerenone observed among the overall population of patients with HF with preserved EF were consistent among patients with HFimpEF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04435626.

Humans↗
PubMed1986

Thermodilution measurement of right ventricular ejection fraction with a modified pulmonary artery catheter.

In 14 critically ill patients in stable cardiopulmonary status, right ventricular ejection fraction (RVEF) was measured by thermodilution technique and by radionuclear (gated first pass) technique. The pulmonary artery catheter was equipped with a fast-response thermistor and an intracardiac ECG monitor. In addition, the proximal lumen ended in a 3-hole port 21 cm from the tip of the catheter to facilitate mixing of the cold bolus above the tricuspid valve. The use of a new algorithm based on an exponential curve analysis of the thermodilution curve limited the variability of RVEF determinations to 7.6%. The correlation between RVEF measured by thermodilution and radionuclear techniques was significant (y = 12.7 +/- 0.49x, r = 0.67, p less than 0.01). However, the values obtained by thermodilution were usually lower, especially for high RVEF. Nevertheless, although some discrepancy was found, thermodilution techniques allow simple, accurate and repetitive bedside measurements of right ventricular volumes in the critically ill.

Cardiac Catheterization↗
PubMed1985

Assessment of right ventricular ejection fraction during intravenous 133Xe pulmonary ventilation study.

Intravenous 133Xe in saline was used to estimate right-ventricular ejection fraction (RVEF). In three healthy volunteers, the first pass RVEF with 133Xe was followed by RVEF estimation by intravenous 99mTc-pertechnetate. There was agreement between the 133Xe and 99mTc determined values. Subjects rebreathed the liberated 133Xe gas, allowing an estimation of regional pulmonary ventilation. Intravenous 133Xe in saline may have potential use in measuring RVEF, as well as in evaluating pulmonary function in cor pulmonale.

Cardiac Output↗
PubMed2005

Predictive power of ejection fraction and renal failure in patients admitted for chest pain without ST elevation in the troponin era.

BACKGROUND: Ejection fraction (EF) and renal failure (RF) are powerful predictors of mortality in patients with myocardial infarction (MI). There are limited data assessing the predictive value of EF and RF compared with clinical variables in patients without ST elevation using troponin as the diagnostic MI criteria. METHODS: Consecutive patients admitted from the emergency department underwent serial assessment of cardiac markers, including troponin I. Abnormal EF was defined as < 50%; RF, as creatinine clearance (CrCl) < 60 mL/min. Multivariate analysis was used to compare clinical variables, CrCl, and EF for predicting short- and long-term outcomes. RESULTS: A total of 3074 patients had EF assessed. Mild to moderately reduced EF and CrCl were present in 639 (21%) and 582 (19%) patients, with 403 (13%) and 233 (7.6%) having severe systolic dysfunction and severe RF, respectively. Abnormal EF and RF were both present in 13% of patients (1-year mortality 26%), whereas 52% had both normal EF and CrCl (1-year mortality 3.2%). The presence of either systolic dysfunction or RF increased mortality 3- to 4-fold compared with patients without either. The most important multivariate predictors of 1-year mortality were EF (OR 2.6 [95% CI 1.7-3.8, P < .0001]) and CrCl (OR 2.8 [95% CI 1.8-4.2, P < .0001]). CONCLUSIONS: Both RF and EF are strong predictors of cardiac mortality in patients admitted for exclusion of MI. Prediction models that do not include these 2 variables will underestimate risk.

Aged↗
PubMed2006

Prognostic value of preoperative atrial fibrillation in patients with aortic stenosis and low ejection fraction having aortic valve replacement.

Aortic valve replacement in severe aortic stenosis (AS) with a low left ventricular ejection fraction (EF) is associated with high perioperative mortality. The aim of this study was to assess the prognostic value of preoperative atrial fibrillation (AF) in patients with AS and low EFs who undergo aortic valve replacement. Eighty-three consecutive patients with severe AS (area <1 cm2) and low EFs (< or =35%) were prospectively included. Perioperative mortality was 12%. Twenty-nine patients (35%) had preexisting paroxysmal or permanent AF. Perioperative mortality was higher in the AF group than in the non-AF group (24% vs 5.5%, p = 0.03). Preoperative AF was identified as an independent predictor of perioperative mortality (odds ratio 7.5, 95% confidence interval 1.19 to 47.06, p = 0.03). Five-year overall survival was lower in the AF group than in the non-AF group (47% vs 77%, p = 0.0017). Associated multivessel coronary artery disease and preoperative AF were identified as 2 independent predictors of overall mortality. In conclusion, in patients with AS with low left ventricular EFs, preoperative AF is associated with higher operative risk and lower postoperative survival. The presence of AF in patients with severe AS and low EFs should be taken into account for operative risk stratification, along with low pressure gradient and associated multivessel coronary artery disease.

Aged↗
PubMed1998

Effect of benazepril on complex ventricular arrhythmias in older patients with congestive heart failure, prior myocardial infarction, and normal left ventricular ejection fraction.

Sixty patients, mean age 82 +/- 8 years, with congestive heart failure, prior myocardial infarction, normal left ventricular ejection fraction, and > or = 30 ventricular premature complexes per hour detected by 24-hour ambulatory electrocardiograms, and who were treated with diuretics, were randomized to treatment with benazepril 20 to 40 mg/day (30 patients) or to no benazepril (30 patients). At a median of 6 months after treatment, follow-up 24-hour ambulatory electrocardiograms showed that compared with no benazepril, benazepril caused no significant reduction in the number of ventricular premature complexes per hour or in the number of runs of ventricular tachycardia per 24 hours.

Aged↗
PubMed2000

The relation between mitral annulus motion and ejection fraction: a nonlinear function.

In previous studies of the relation between mitral annulus motion (MAM) and left ventricular ejection fraction (EF), a linear relationship has been suggested. In this meta-analysis of 434 patients, we show that the relation is nonlinear and that a linear regression model overestimates EF in the lower range of MAM. The relation is better described by an S function and is influenced by age and heart size.

Adolescent↗
PubMed1992

Changes in septal regional ejection fraction early and late following coronary artery bypass grafting in patients without postoperative myocardial infarction.

Changes in regional ejection fraction (rEF) of the interventricular septum following coronary artery bypass graft (CABG) surgery were examined using first-pass radionuclide ventriculography (RNVG) in patients without objective evidence of postoperative myocardial infarction (MI). One hundred and one patients had pre- (mean 6.3 days) and early postoperative (mean 8.7 days) RNVGs, and 60 of these patients had follow-up studies at 14-39 months (mean 27 months) postsurgery. Early post-CABG, mean rEF in the proximal septum was unchanged from the preoperative value (35.3%), with almost equal numbers of patients showing increased (n = 36), unchanged (n = 33) or decreased (n = 32) rEFs. In the distal septum, mean rEF increased from 47.1 to 50.7%, with more than twice as many patients having increased (n = 44) as decreased (n = 20) rEF. At late follow-up, proximal septum rEF in individual patients tended to revert to the presurgery baseline, with 72% (13/18) of regions with early decrease improved and 61% (14/23) of those with early improvement decreased. In the distal septum, rEF was less than early post-CABG in 76% (19/25) of patients with early improvement, while being improved in 27% (3/11) of those with early decrease in rEF. In the absence of MI, changes in rEF in the proximal septum early post-CABG tend to resolve over time. While global changes in cardiac systolic motion are the probable cause of many new post-CABG septal abnormalities, persistent septal dysfunction probably reflects effects of permanent damage as a result of the operative procedure.

Adult↗
PubMed1982

[Assessment to fixed and variable ROI (region-of-interest) settings in the determination of left ventricular ejection fraction by multiple gated cardiac pool imaging: the benefit of variable ROI setting].

The accuracy of left ventricular ejection fractions (EF) determined by multiple gated cardiac pool imaging (RI-EF) and by M-mode echocardiography (Echo-EF) (Teichholz's method) was evaluated by comparing with those derived from angiocardiography (LVG-EF) in 19 patients including 9 with myocardial infarction, 3 with rest angina, 2 with effort angina, 2 with valvular disease, 1 with hypertrophic cardiomyopathy, 1 with congestive cardiomyopathy and 1 with hypertensive heart. Measurement of RI-EF was carried out by the fixed ROI method using a single end-diastolic ROI, and the variable ROI method where end-diastolic and end-systolic ROI were used.

Adult↗
PubMed1995

Geometric changes allow normal ejection fraction despite depressed myocardial shortening in hypertensive left ventricular hypertrophy.

OBJECTIVES: This study of hypertensive left ventricular hypertrophy 1) assessed myocardial shortening in both the circumferential and long-axis planes, and 2) investigated the relation between geometry and systolic function. BACKGROUND: In hypertensive left ventricular hypertrophy, whole-heart studies have suggested normal systolic function on the basis of ejection fraction-systolic stress relations. By contrast, isolated muscle data show that contractility is depressed. It occurred to use that this discrepancy could be related to geometric factors (relative wall thickness). METHODS: We studied 43 patients with hypertensive left ventricular hypertrophy and normal ejection fraction (mean +/- SD 69 +/- 13%) and 50 clinically normal subjects. By echocardiography, percent myocardial shortening was measured in two orthogonal planes; circumferential shortening was measured at the endocardium and at the midwall, and long-axis shortening was derived from mitral annular motion (apical four-chamber view). Circumferential shortening was related to end-systolic circumferential stress and long-axis shortening to meridional stress. RESULTS: Endocardial circumferential shortening was higher than normal (42 +/- 10% vs. 37 +/- 5%, p < 0.01) and midwall circumferential shortening lower than normal in the left ventricular hypertrophy group (18 +/- 3% vs. 21 +/- 3%, p < 0.01). Differences between endocardial and midwall circumferential shortening are directly related to differences in relative wall thickness. Long-axis shortening was also depressed in the left ventricular hypertrophy group (18 +/- 6% in the left ventricular hypertrophy group, 21 +/- 5% in control subjects, p < 0.05). Midwall circumferential shortening and end-systolic circumferential stress relations in the normal group showed the expected inverse relation; those for approximately 33% of the left ventricular hypertrophy group were > 2 SD of normal relations, indicating depressed myocardial function. There was no significant relation between long-axis shortening and meridional stress, indicating that factors other than afterload influence shortening in this plane. CONCLUSIONS: High relative wall thickness allows preserved ejection fraction and normal circumferential shortening at the endocardium despite depressed myocardial shortening in two orthogonal planes.

Adult↗
PubMedDate not supplied

Cardiac ejection fraction: phantom study comparing cine MR imaging, radionuclide blood pool imaging, and ventriculography.

The accuracy and reproducibility of cardiac ejection fraction (EF) measurements based on cine magnetic resonance (MR) imaging, radionuclide multigated acquisition (MUGA) blood pool imaging, and angiographic ventriculography were evaluated by comparing them with a volumetrically determined standard. A biventricular, compliant, fluid-filled heart phantom was developed to mimic normal cardiac anatomy and physiology. Ventricular EFs were measured with cine MR imaging by summation of nine contiguous 10-mm-thick sections in short and long axis, with single-plane ventriculography, and with MUGA. Three measurements were performed with each modality for each of three EFs. Ventriculography was least accurate, with average relative errors ranging from 7.9% for the largest EF to 60.1% for the smallest. Cine MR was most accurate, with average relative errors ranging from 4.4% to 8.5%. MUGA EF measurements showed good correlation, with average relative errors ranging from 7.1% to 22.4%. Comparison of the error variances for the three modalities with the F test revealed that MR and MUGA EF measurements were significantly more accurate than those based on ventriculography (P less than .01). No significant difference was demonstrated between the accuracy of short- and long-axis cine MR acquisitions.

Gated Blood-Pool Imaging↗
PubMed1986

Automated determination of the right ventricular ejection fraction by digital processing of 81mKr scintigrams.

A method is presented for the automated determination of the right ventricular ejection fraction (RVEF) by digital image processing of scintigrams obtained by intravenous infusion of Krypton 81m (81mKr) dissolved in a glucose solution. End-diastolic and end-systolic sum pictures were computed by the addition of approximately 30-40 frames selected from the time-activity curve of a preliminary, manually drawn, right ventricular region of interest. After processing these two images with an adaptive Wiener filter, the right ventricular contour was determined by a recently developed algorithm using morphological and functional criteria. The RVEF was calculated for a series of 51 patients from the counts in the detected right ventricular regions in the end-diastolic and end-systolic sum images. In 16 patients without evidence of cardiopulmonary disease, the mean RVEF was 50 +/- 6.1%. RVEF was significantly reduced in 18 patients with obstructive pulmonary disease (42 +/- 6.5%) and in 17 patients with congestive cardiomyopathy (36 +/- 7.1%). The correlation coefficient between two determinations of the RVEF was r = 0.94. Through digital image processing, the determination of the RVEF by radioventriculography with 81m Kr showed high reliability and reproducibility.

Algorithms↗
PubMed1986

Ejection fraction by combined inverse Fourier analysis and second-derivative technique: correlation with isocontour method.

In order to measure ejection fractions (EFs) from nuclear ventriculograms, we devised a semi-automated edge-detection technique based on a combination of inverse Fourier analysis and second-derivative techniques. Initial clinical studies showed that, for the left ventricle, our method gives EF values statistically identical with those obtained using a conventional isocontour technique. For the right ventricle, however, the values obtained using the two methods were somewhat more at variance. Despite requiring a longer processing time, the results obtained with our method are reproducible because less operator intervention is necessary.

Fourier Analysis↗
PubMed2001

Intra- and interhospital repeatability of radionuclide left ventricular ejection fraction in post-infarction patients.

OBJECTIVE: To evaluate intra- and interobserver and interhospital repeatability of radionuclide left ventricular ejection fraction in post-infarction patients. DESIGN: The study comprised 131 patients who were examined in three different hospitals 2-7 days post infarction. The radionuclide examinations were conducted in a standardized manner, and different observers carried out repeated measurements blind on the stored raw data. RESULTS: The coefficients of variation were between 1.5% and 6.2%, and limits of agreement between +/- 0.012 and 0.056. There were no significant differences between the intra- and interobserver or interhospital repeatability in average, but some significant differences between individual observers were noted. CONCLUSION: The repeatability of LVEF was acceptable, with limits of agreement in the range +/- 0.012-0.056. Some differences between observers and hence hospitals were noted, which may be of clinical relevance.

Adult↗
PubMed2005

Heart failure in patients with preserved and deteriorated left ventricular ejection fraction.

OBJECTIVES: To determine clinical and prognostic differences between preserved and deteriorated systolic function (defined as left ventricular (LV) ejection fractions > or = 50% and < 50%, respectively) in patients with heart failure satisfying modified Framingham criteria. PATIENTS AND METHODS: Records were studied of 1252 patients with congestive heart failure (CHF) (mean (SD) age 69.4 (11.7) years; 485 women, 767 men) who had been admitted to a cardiology service for CHF in the period 1991-2002 and whose LV systolic function had been echocardiographically evaluated within two weeks of admission. Data were collected on the main clinical findings, supplementary examinations, treatment, and duration of hospitalisation. Whether the patient was alive in the spring of 2003 was evaluated by searching the general archives of the hospital and by telephone survey. RESULTS: LV systolic function was preserved in 39.8% of patients. Age, female to male sex ratio, and prevalence of atrial fibrillation, valve disease, and other non-ischaemic, non-dilated cardiopathies were all significantly greater in the group with preserved systolic function. New York Heart Association functional class IV, third heart sound, jugular vein congestion, cardiomegaly, radiological signs of lung oedema, pathological Q waves, left bundle branch block, sinus rhythm, ischaemic cardiopathy, and dilated cardiomyopathy were all significantly more prevalent in the group with deteriorated systolic function, as was treatment with angiotensin converting enzyme inhibitors and most other antihypertensive drugs on discharge from hospital. There was no significant difference in survival between the groups with preserved and deteriorated systolic function (either survival regardless of age at admission or in subgroups aged < 75 and > or = 75 years at admission). In the whole group, survival rates after one, three, and five years were 84.0%, 66.7%, and 50.9%, respectively. CONCLUSION: In view of the poor prognosis of patients with CHF with preserved LV systolic function, who are currently treated empirically, it is to be hoped that relevant controlled clinical trials under way will afford information allowing optimisation of their treatment.

Adolescent↗
PubMed2006

Use of ejection fraction tests and coronary angiography in patients with heart failure.

OBJECTIVE: To examine the use of tests that measure ejection fraction (EF) and the use of coronary angiography among patients with an initial diagnosis of heart failure (HF). PATIENTS AND METHODS: All potential cases of incident HF in Olmsted County, Minnesota, between 1979 and 1999 were identifled. In a random sample of cases validated with the Framingham criteria, we examined the frequency of tests that measure EF (echocardiography, radionuclide ventriculography, and left ventricular angiography) and coronary angiography within 90 days after diagnosis. RESULTS: A total of 655 patients with incident HF were included in the analysis. The use of tests that measure EF and coronary angiography increased early in the study period but stabilized thereafter. In the most recent years (1995-1999), EF was measured in 65% of the patients and coronary angiography performed in 12%. After adjustment for year of diagnosis, body mass index, hypertension, diabetes mellitus, smoking, hyperlipidemia, comorbidity, prior myocardial infarction, and prior angina, men were more likely than women to have EF measured (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.01-2.16) and coronary angiography (OR, 2.61; 95% CI, 1.43-4.76). Increasing age was associated with less use of tests (OR, 0.83; 95% CI, 0.76-0.91; for EF measurement; OR, 0.72; 95% CI, 0.63-0.82; for coronary angiography for every 5-year increase in age). CONCLUSION: Among patients with HF, tests that measure EF are used substantially less than recommended, and coronary angiograms are used infrequently. Use was particularly low in women and elderly patients. Given the potential benefits of such tests, including more appropriate therapy and more objective monitoring of ventricular function, outcomes in persons with HF may be improved with more consistent use.

Aged↗
PubMed2002

[Off-pump coronary artery bypass grafting/beating coronary artery bypass grafting for a patient with low left ventricular ejection fraction].

Beating coronary artery bypass grafting could be performed for a 47-year-old man with left ventricular ejection fraction (LVEF) of 9.3%. Post-operative LVEF was improved to 51.6%. Conventional coronary artery bypass grafting (CABG) used to be contraindicative for patients with LVEF below 20%. Recently, such patients are involved to indication of off-pump CABG (OPCAB) or beating CABG, because we consider OPCAB are lower complications than conventional CABG. We were able to bypass the circumflex for the patient while we had been used percutaneous cardio-pulmonary support (PCPS). We could perform beating coronary artery bypass grafting for a patient of the low LVEF.

Coronary Artery Bypass↗