Resurgence of interest in the hemodynamic alterations of advanced heart failure

326 Pages·2017·4.26 MB·English

Resurgence of interest in the hemodynamic alterations of
advanced heart failure
Citation for published version (APA):
Mullens, W. (2009). Resurgence of interest in the hemodynamic alterations of advanced heart failure. [Phd
Thesis 2 (Research NOT TU/e / Graduation TU/e), Biomedical Engineering]. Technische Universiteit Eindhoven.
https://doi.org/10.6100/IR643048
DOI:
10.6100/IR643048
Document status and date:
Published: 01/01/2009
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Download date: 25. Feb. 2023
Resurgence of Interest in the Hemodynamic Alterations
of Advanced Heart Failure

Wilfried Mullens
Financial support for this book was given by St.Jude Medical, Medtronic and Biotronik.
ISBN: 978-90-386-1886-9
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Resurgence of Interest in the Hemodynamic Alterations
of Advanced Heart Failure

PROEFSCHRIFT

ter verkrijging van de graad van doctor aan de
Technische Universiteit Eindhoven, op gezag van de
rector magnificus, prof.dr.ir. C.J. van Duijn, voor een
commissie aangewezen door het College voor
Promoties in het openbaar te verdedigen
op woensdag 1 juli 2009 om 14.00 uur

door

Wilfried Mullens

geboren te Hasselt, België
3
Promotoren
prof.dr. J. Bartunek
prof.dr. N.H.J. Pijls

4
Voor Nele, Kaat, Saar en Teun
5
6
Table of Contents
I. Background and Objectives 9
1. Epidemiology and definition of heart failure 11
2. The role of the hemodynamic alterations in advanced heart failure 11
3. Cardiorenal interactions in heart failure 13
4. Effects of cardiac resynchronization therapy on cardiac hemodynamics and molecular
gene expression 15
5. Summary of objectives 17
II. Novel pathophysiologic insights in the hemodynamic alterations of advanced heart failure 19
1. Prognostic evaluation of ambulatory patients with advanced heart failure 21
2. Gender differences in patients admitted with advanced decompensated heart failure 39
3. Sodium nitroprusside for advanced low-output heart failure 54
4. Isosorbide dinitrate and hydralazine in patients admitted with advanced decompensated
heart failure 78
5. Limited value of tissue Doppler imaging in the estimation of left ventricular filling
pressure in advanced decompensated heart failure 97
III. New hemodynamic insights into the cardiorenal interactions of advanced heart failure 121
1. Importance of venous congestion for worsening of renal function in advanced
decompensated heart failure 123
2. Elevated intra-abdominal pressure: a contributor to worsening renal function? 142
3. Prompt reduction in intra-abdominal pressure following large volume mechanical fluid
removal improves renal insufficiency in refractory decompensated heart failure 162
IV. Unraveling the response to cardiac resynchronization therapy in advanced heart failure
effects on cardiac hemodynamics and molecular gene expression 177
1. Early and late effects of cardiac resynchronization therapy upon force frequency
relation and contractility regulating gene expression in heart failure patients 179
2. Endomyocardial upregulation of β1-adrenoreceptor gene expression and myocardial
contractile reserve following cardiac resynchronization therapy 203
3. Myocardial gene expression in heart failure patients treated with cardiac
resynchronization therapy: responders versus non-responders 220
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4. Persistent hemodynamic benefits of cardiac resynchronization therapy with disease
progression in advanced heart failure 242
5. Insights from a cardiac resynchronization optimization clinic as part of a heart failure
disease management program 263
V. Discussion 285
1. Prevalence and importance of hemodynamic alterations in advanced heart failure 287
2. Gender differences in advanced heart failure 288
3. Vasodilator therapy to restore an optimal hemodynamic balance 288
4. Echocardiography cannot replace an invasive hemodynamic assessment for the
estimation of filling pressures 291
5. New hemodynamic insights into cardiorenal interactions 291
a. Prevalence of worsening renal function during decompensated heart failure
b. The emerging concept of congestive kidney failure
c. A novel hemodynamic contributor: intra-abdominal pressure
6. Cardiac resynchronization therapy, a therapy beyond hemodynamic restoration 295
a. Background
b. Restoring the force frequency relation and myocardial contractile reserve
c. Restoring the myocardial contractile gene profile
d. Restoring hemodynamics, even in “non-responders”
7. References 298
VI. Summary 303
VII. Conclusions and Future Perspectives 307
VIII. Short Curriculum Vitae and List of Peer Reviewed Publications 313
IX. Acknowledgements 321

8
I. Background and Objectives
9