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Abstract

B a c k g r o u n d: A novel paradigm of diastolic heart failure with preserved ejection fraction (HFpEF) proposed the induction of coronary microvascular dysfunction by HFpEF comorbidities via a systemic pro-infl ammatory state and associated oxidative stress. Th e consequent nitric oxide deficiency would increase diastolic tension and favor fi brosis of adjacent myocardium, which implies not only left ventricular (LV), but all-chamber myocardial stiff ening. Our aim was to assess relations between low-grade chronic systemic infl ammation and left atrial (LA) pressure-volume relations in real-world HFpEF patients.

Me t h o d s: We retrospectively analyzed medical records of 60 clinically stable HpEFF patients in sinus rhythm with assayed high-sensitive C-reactive protein (CRP) during the index hospitalization. Subjects with CRP >10 mg/L or coexistent diseases, including coronary artery disease, were excluded. LV and LA diameters and mitral E/E’ ratio (an index of LA pressure) were extracted from routine echocardiographic 46 Cyrus M. Sani, Elahn P.L. Pogue, et al. records. A surrogate measure of LA stiff ness was computed as the averaged mitral E/e’ ratio divided by LA diameter.

R e s u l t s: With ascending CRP tertiles, we observed trends for elevated mitral E/e’ ratio (p <0.001), increased relative LV wall thickness (p = 0.01) and higher NYHA functional class (p = 0.02). Th e LA stiffness estimate and log-transformed CRP levels (log-CRP) were interrelated (r = 0.38, p = 0.003). On multivariate analysis, the LA stiff ness index was independently associated with log-CRP (β ± SEM: 0.21 ± 0.07, p = 0.007) and age (β ± SEM: 0.16 ± 0.07, p = 0.03), which was maintained upon adjustment for LV mass index and relative LV wall thickness.

C o n c l u s i o n s: Low-grade chronic infl ammation may contribute to LA stiff ening additively to age and regardless of the magnitude of associated LV hypertrophy and concentricity. LA stiff ening can exacerbate symptoms of congestion in HFpEF jointly with LV remodeling.

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Authors and Affiliations

Cyrus M. Sani
Elahn P.L. Pogue
Joanna B. Hrabia
Alexander G. Zayachkowski
Magdaline M. Zawadka
Adrian G. Poniatowski
Dorota Długosz
Wiktoria Leśniak
Olga Kruszelnicka
Bernadeta Chyrchel
Andrzej Surdacki
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Abstract

Proper heart’s nomenclature is very important in daily clinical practice and research studies, and when it is consistent, it can facilitate better communication between different medical specialists. The general rule of the anatomy is to describe organs and their structures in attitudinally correct position. However, the use of the old-fashioned Valentine position (where the heart is described as if it were standing on its apex) is still in use to describe important cardiac structures. Upon closer analysis, all main chambers of the heart and their associated subcomponents have mislabeled structures that should be renamed. In this article we aimed to emphasize the limitations of Valentinian nomenclature, present proper anatomical names of the most important heart’s structures and advocate to change certain mislabeled anatomical structures. Attitudinally correct designations presented in this study will benefit all medical specialties, and they will reinforce the importance of consistent orientational naming. Correct naming of heart’s structures will also help improve communication between different medical specialists.

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Authors and Affiliations

Elżbieta Szczepanek
Katarzyna A. Jasińska
Daromir Godula
Ewa Kucharska
Jerzy Walocha
Małgorzata Mazur

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