2024
Association of Sacubitril/Valsartan versus Valsartan with Blood Pressure Changes, and Symptomatic Hypotension: The PARAGLIDE-HF Trial
Fudim M, Cyr D, Ward J, Hernandez A, Lepage S, Morrow D, Sharma K, Claggett B, Starling R, Velazquez E, Williamson K, Desai A, Zieroth S, Solomon S, Braunwald E, Mentz R, Investigators P. Association of Sacubitril/Valsartan versus Valsartan with Blood Pressure Changes, and Symptomatic Hypotension: The PARAGLIDE-HF Trial. Journal Of Cardiac Failure 2024 PMID: 38802053, DOI: 10.1016/j.cardfail.2024.04.030.Peer-Reviewed Original ResearchLeft ventricular ejection fractionWorsening heart failureBaseline systolic blood pressureSystolic blood pressureVentricular ejection fractionEjection fractionSymptomatic hypotensionNT-proBNPHeart failureBlood pressureLow baseline systolic blood pressureTime-averaged proportional changeMildly reduced ejection fractionPlasma NT-proBNP levelsAssociated with clinical benefitB-type natriuretic peptideNT-proBNP levelsReduced ejection fractionMedian blood pressureBlood pressure changesSH eventsTime-averaged changePrimary endpointNatriuretic peptideRandomized patientsTorsemide Versus Furosemide After Discharge in Patients Hospitalized With Heart Failure Across the Spectrum of Ejection Fraction: Findings From TRANSFORM-HF
Kapelios C, Greene S, Mentz R, Ikeaba U, Wojdyla D, Anstrom K, Eisenstein E, Pitt B, Velazquez E, Fang J, Investigators T. Torsemide Versus Furosemide After Discharge in Patients Hospitalized With Heart Failure Across the Spectrum of Ejection Fraction: Findings From TRANSFORM-HF. Circulation Heart Failure 2024, 17: e011246. PMID: 38436075, PMCID: PMC10950535, DOI: 10.1161/circheartfailure.123.011246.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionLVEF groupsKansas City Cardiomyopathy Questionnaire Clinical Summary ScoreMildly reduced left ventricular ejection fractionBaseline left ventricular ejection fractionReduced left ventricular ejection fractionClinical summary scoreHeart failureNo significant differenceEjection fractionClinical outcomesLVEF spectrumSignificant differenceLeft ventricular ejection fraction dataEnd pointsSpectrum of ejection fractionEffect of torsemideRisk of clinical outcomesVentricular ejection fractionStudy end pointBaseline patient characteristicsClinical end pointsSummary scoreAll-cause mortalityPrevalence of comorbiditiesSacubitril/Valsartan in Patients Hospitalized With Decompensated Heart Failure
Morrow D, Velazquez E, Desai A, DeVore A, Lepage S, Park J, Sharma K, Solomon S, Starling R, Ward J, Williamson K, Zieroth S, Hernandez A, Mentz R, Braunwald E. Sacubitril/Valsartan in Patients Hospitalized With Decompensated Heart Failure. Journal Of The American College Of Cardiology 2024, 83: 1123-1132. PMID: 38508844, DOI: 10.1016/j.jacc.2024.01.027.Peer-Reviewed Original ResearchConceptsWorsening heart failureHeart failureEjection fractionNT-proBNPSpectrum of EFPIONEER-HFSpectrum of left ventricular ejection fractionRandomized trialsTime-averaged proportional changeN-terminal pro-B-type natriuretic peptidePro-B-type natriuretic peptideLeft ventricular ejection fractionWorsening heart failure eventDecompensated heart failureVentricular ejection fractionPlasma NT-proBNPPIONEER-HF trialDouble-blindMedian ageMedian EFSNatriuretic peptideSymptomatic hypotensionBaseline characteristicsClinical outcomesPooled analysisFactors associated with reporting left ventricular ejection fraction with 3D echocardiography in real‐world practice
Faridi K, Zhu Z, Shah N, Crandall I, McNamara R, Flueckiger P, Bachand K, Lombo B, Hur D, Agarwal V, Reinhardt S, Velazquez E, Sugeng L. Factors associated with reporting left ventricular ejection fraction with 3D echocardiography in real‐world practice. Echocardiography 2024, 41: e15774. PMID: 38329886, DOI: 10.1111/echo.15774.Peer-Reviewed Original ResearchConceptsTransthoracic echocardiogramVentricular ejection fractionOutpatient transthoracic echocardiogramsReal-world practiceEjection fractionLeft ventricular ejection fractionAssess left ventricular ejection fractionInpatient transthoracic echocardiogramsMultivariate logistic regressionLVEFHospitalized patientsMedical CenterSonographersClinical settingLogistic regressionUltrasound machineChemotherapyContrast enhancement agentsPortable studiesNegative association
2023
Predicting aortic stenosis progression using a video-based deep learning model of aortic stenosis built for single-view two-dimensional echocardiography
Oikonomou E, Holste G, Mcnamara R, Velazquez E, Nadkarni G, Ouyang D, Krumholz H, Wang Z, Khera R. Predicting aortic stenosis progression using a video-based deep learning model of aortic stenosis built for single-view two-dimensional echocardiography. European Heart Journal 2023, 44: ehad655.040. DOI: 10.1093/eurheartj/ehad655.040.Peer-Reviewed Original ResearchLeft ventricular ejection fractionSevere aortic stenosisAortic stenosisAS progressionAV VmaxTransthoracic echocardiographyYale New Haven Health SystemBaseline left ventricular ejection fractionAortic stenosis progressionModerate aortic stenosisRetrospective cohort studyVentricular ejection fractionTwo-dimensional echocardiographyMean rateModerate ASAS severityCohort studyEjection fractionPatient sexStenosis progressionTTE studiesEligible participantsSerial monitoringSpecialized centersTimely diagnosisSacubitril/valsartan in heart failure with mildly reduced or preserved ejection fraction: a pre-specified participant-level pooled analysis of PARAGLIDE-HF and PARAGON-HF
Vaduganathan M, Mentz R, Claggett B, Miao Z, Kulac I, Ward J, Hernandez A, Morrow D, Starling R, Velazquez E, Williamson K, Desai A, Zieroth S, Lefkowitz M, McMurray J, Braunwald E, Solomon S. Sacubitril/valsartan in heart failure with mildly reduced or preserved ejection fraction: a pre-specified participant-level pooled analysis of PARAGLIDE-HF and PARAGON-HF. European Heart Journal 2023, 44: 2982-2993. PMID: 37210743, PMCID: PMC10424880, DOI: 10.1093/eurheartj/ehad344.Peer-Reviewed Original ResearchConceptsSacubitril/valsartanRenal composite endpointPARAGON-HFHeart failureEjection fractionPooled analysisHF eventsRenal eventsCardiovascular deathComposite endpointLeft ventricular ejection fractionVentricular ejection fractionActive-controlled trialParticipant-level dataPrimary endpointSecondary endpointsClinical outcomesNatriuretic peptideLike patientsTreatment benefitCare settingsPatientsPrimary analysisLVEFValsartan
2019
Myocardial Viability and Long-Term Outcomes in Ischemic Cardiomyopathy
Panza JA, Ellis AM, Al-Khalidi HR, Holly TA, Berman DS, Oh JK, Pohost GM, Sopko G, Chrzanowski L, Mark DB, Kukulski T, Favaloro LE, Maurer G, Farsky PS, Tan RS, Asch FM, Velazquez EJ, Rouleau JL, Lee KL, Bonow RO. Myocardial Viability and Long-Term Outcomes in Ischemic Cardiomyopathy. New England Journal Of Medicine 2019, 381: 739-748. PMID: 31433921, PMCID: PMC6814246, DOI: 10.1056/nejmoa1807365.Peer-Reviewed Original ResearchMeSH KeywordsAgedCoronary Artery BypassEchocardiography, StressFemaleFollow-Up StudiesHeartHumansIncidenceKaplan-Meier EstimateMaleMiddle AgedMyocardial IschemiaProportional Hazards ModelsProspective StudiesStroke VolumeTomography, Emission-Computed, Single-PhotonTreatment OutcomeVentricular Function, LeftConceptsLeft ventricular ejection fractionVentricular ejection fractionMedical therapyEjection fractionMyocardial viabilityIschemic cardiomyopathyLeft ventricular systolic functionGoals of revascularizationCoronary artery bypassPrimary end pointVentricular systolic functionCoronary artery diseaseLeft ventricular functionLong-term outcomesLong-term survivalSurgical revascularizationDobutamine echocardiographyMedian durationSystolic functionArtery diseaseVentricular functionViable myocardiumLong-term benefitsLower incidenceCABGRepresentativeness of the PIONEER-HF Clinical Trial Population in Patients Hospitalized with Heart Failure
Sayeed S, Fudim M, Xu H, Matsouaka R, Heidenreich P, Yancy C, Fonarow G, Velazquez E, Hernandez A, DeVore A. Representativeness of the PIONEER-HF Clinical Trial Population in Patients Hospitalized with Heart Failure. Journal Of Cardiac Failure 2019, 25: s151. DOI: 10.1016/j.cardfail.2019.07.436.Peer-Reviewed Original ResearchAcute decompensated heart failurePIONEER-HF trialSacubitril/valsartanHFrEF patientsCause mortalityEjection fractionEligible cohortHeart failureLeft ventricular ejection fractionGWTG-HF registryHF rehospitalization ratesDecompensated heart failureReduced ejection fractionInitial study populationVentricular ejection fractionClinical trial populationsLong-term outcomesDaily clinical practiceTrial eligibility criteriaGWTG-HFHF hospitalizationHospital initiationPIONEER-HFHF readmissionIndex dischargeDoes prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial
Nicolau JC, Stevens SR, Al-Khalidi HR, Jatene FB, Furtado RHM, Dallan LAO, Lisboa LAF, Desvigne-Nickens P, Haddad H, Jolicoeur EM, Petrie MC, Doenst T, Michler RE, Ohman EM, Maddury J, Ali I, Deja MA, Rouleau JL, Velazquez EJ, Hill JA. Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial. International Journal Of Cardiology 2019, 291: 36-41. PMID: 30929973, PMCID: PMC6579621, DOI: 10.1016/j.ijcard.2019.03.029.Peer-Reviewed Original ResearchConceptsPrior percutaneous coronary interventionPercutaneous coronary interventionLeft ventricular ejection fractionSTICH trialCV hospitalizationCV mortalityCause mortalityMedical treatmentSuperiority of CABGOutcomes of patientsSurgical coronary revascularizationCoronary artery bypassVentricular ejection fractionArtery bypassCoronary revascularizationCoronary interventionCoronary angioplastyEjection fractionMedian timeWorse prognosisRandomized treatmentCABGHospitalizationMortalityPatientsSpeckle Tracking Analysis of Left Ventricular Systolic Function Following Traumatic Brain Injury: A Pilot Prospective Observational Cohort Study
Krishnamoorthy V, Chaikittisilpa N, Lee J, Mackensen GB, Gibbons EF, Laskowitz D, Hernandez A, Velazquez E, Lele AV, Vavilala MS. Speckle Tracking Analysis of Left Ventricular Systolic Function Following Traumatic Brain Injury: A Pilot Prospective Observational Cohort Study. Journal Of Neurosurgical Anesthesiology 2019, 32: 156-161. PMID: 30676403, PMCID: PMC6646112, DOI: 10.1097/ana.0000000000000578.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionGlobal longitudinal strainTraumatic brain injuryAge/sex-matched controlsSex-matched controlsModerate-severe traumatic brain injurySystolic dysfunctionCohort studyBrain injuryMean global longitudinal strainProspective observational cohort studyObservational cohort studyProspective cohort studySubclinical myocardial dysfunctionVentricular ejection fractionSpeckle trackingSpeckle tracking analysisFirst dayMid-ventricular segmentsModerate-severe TBI patientsSystolic functionTransthoracic echocardiographyEjection fractionMyocardial dysfunctionTBI patients
2018
Childhood and adult exposure to secondhand tobacco smoke and cardiac structure and function: results from Echo-SOL
Peña M, Swett K, Kaplan RC, Perreira K, Daviglus M, Kansal MM, Cai J, Giachello AL, Gellman MD, Velazquez EJ, Rodriguez CJ. Childhood and adult exposure to secondhand tobacco smoke and cardiac structure and function: results from Echo-SOL. Open Heart 2018, 5: e000831. PMID: 30402256, PMCID: PMC6203071, DOI: 10.1136/openhrt-2018-000831.Peer-Reviewed Original ResearchLeft ventricular global longitudinal strainLeft ventricular ejection fractionIsovolumic relaxation timeSHS exposureCardiac structureTobacco smokersRight ventricular fractional area changeVentricular global longitudinal strainVentricular fractional area changeHousehold SHS exposureAtrial volume indexClinical heart failureSevere valvular diseaseVentricular ejection fractionCoronary artery diseaseGlobal longitudinal strainSecondhand smoke exposureFractional area changeHousehold secondhand smoke exposureAdolescents/adultsECHO-SOLArtery diseaseCardiac systolicDiastolic functionEchocardiographic measuresVariability in Ejection Fraction Measured By Echocardiography, Gated Single-Photon Emission Computed Tomography, and Cardiac Magnetic Resonance in Patients With Coronary Artery Disease and Left Ventricular Dysfunction
Pellikka PA, She L, Holly TA, Lin G, Varadarajan P, Pai RG, Bonow RO, Pohost GM, Panza JA, Berman DS, Prior DL, Asch FM, Borges-Neto S, Grayburn P, Al-Khalidi HR, Miszalski-Jamka K, Desvigne-Nickens P, Lee KL, Velazquez EJ, Oh JK. Variability in Ejection Fraction Measured By Echocardiography, Gated Single-Photon Emission Computed Tomography, and Cardiac Magnetic Resonance in Patients With Coronary Artery Disease and Left Ventricular Dysfunction. JAMA Network Open 2018, 1: e181456-e181456. PMID: 30646130, PMCID: PMC6324278, DOI: 10.1001/jamanetworkopen.2018.1456.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionCoronary artery diseaseCardiovascular magnetic resonanceVentricular ejection fractionArtery diseaseCore laboratorySingle photon emissionVentricular dysfunctionEjection fractionBland-Altman plotsLVEF measurementsAssociation of LVEFGated single-photon emissionIschemic heart failureLeft ventricular dysfunctionSubset of patientsOptimal treatment strategyImaging modalitiesMulticenter diagnostic studyCardiac magnetic resonanceInternational multicenter studyLVEF dataMost patientsHeart failureSurgical treatmentThe relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients
Friedman DJ, Fudim M, Overton R, Shaw LK, Patel D, Pokorney SD, Velazquez EJ, Al-Khatib SM. The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients. American Heart Journal 2018, 201: 17-24. PMID: 29910051, PMCID: PMC6309220, DOI: 10.1016/j.ahj.2018.03.017.Peer-Reviewed Original ResearchConceptsLeft ventricular assist devicePrimary prevention ICD patientsAppropriate ICD therapyVentricular ejection fractionImplantable cardioverter defibrillatorICD therapyICD implantationEjection fractionICD patientsMultivariable Cox proportional hazards modelsPrimary prevention implantable cardioverter defibrillatorsCo-primary study endpointsPrimary prevention ICD recipientsFollow-up left ventricular ejection fractionLeft ventricular ejection fractionCox proportional hazards modelComposite of timeLong-term followProportional hazards modelVentricular assist deviceLong-term riskBaseline LVEFLVEF improvementAdverse eventsComposite endpoint
2017
Assessment of cardiac allograft systolic function by global longitudinal strain: From donor to recipient
DeVore AD, Alenezi F, Krishnamoorthy A, Ersboll M, Samsky MD, Schulte PJ, Patel CB, Rogers JG, Milano CA, Velazquez EJ, Khouri MG. Assessment of cardiac allograft systolic function by global longitudinal strain: From donor to recipient. Clinical Transplantation 2017, 31: e12961. PMID: 28294407, DOI: 10.1111/ctr.12961.Peer-Reviewed Original ResearchConceptsLV global longitudinal strainLeft ventricular ejection fractionGlobal longitudinal strainMedian left ventricular ejection fractionSystolic functionLongitudinal strainLV systolic dysfunctionMyocardial systolic performancePost-transplant outcomesLV systolic functionVentricular ejection fractionDonor-recipient pairsMyocardial deformation analysisAllograft dysfunctionCardiac allograftsCause hospitalizationSystolic dysfunctionPretransplant levelsEjection fractionSystolic performanceCorresponding recipientsClinical implicationsRecipientsEchocardiogramFurther studiesSudden Cardiac Death in Patients With Ischemic Heart Failure Undergoing Coronary Artery Bypass Grafting
Rao MP, Al-Khatib SM, Pokorney SD, She L, Romanov A, Nicolau JC, Lee KL, Carson P, Selzman CH, Stepinska J, Cleland JG, Tungsubutra W, Desvigne-Nickens PM, Sueta CA, Siepe M, Lang I, Feldman AM, Yii M, Rouleau JL, Velazquez EJ. Sudden Cardiac Death in Patients With Ischemic Heart Failure Undergoing Coronary Artery Bypass Grafting. Circulation 2017, 135: 1136-1144. PMID: 28154006, PMCID: PMC5516272, DOI: 10.1161/circulationaha.116.026075.Peer-Reviewed Original ResearchMeSH KeywordsAgedAtrial FibrillationCoronary Artery BypassDeath, Sudden, CardiacFemaleFollow-Up StudiesHeart FailureHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIncidenceMaleMiddle AgedMultivariate AnalysisNatriuretic Peptide, BrainPostoperative PeriodProportional Hazards ModelsReceptors, Tumor Necrosis FactorRisk FactorsStroke VolumeVentricular Function, LeftConceptsCoronary artery bypass graft surgerySudden cardiac deathEnd-systolic volume indexB-type natriuretic peptideVentricular ejection fractionSurgical ventricular reconstructionCardiac deathEjection fractionHeart failureNatriuretic peptideVentricular reconstructionPreoperative end-systolic volume indexLow left ventricular ejection fractionIncidence of SCDPredictors of SCDArtery bypass graft surgeryCoronary Artery Bypass GraftingLeft ventricular ejection fractionVolume indexArtery Bypass GraftingBypass graft surgeryIschemic heart failureContemporary clinical trialsBlinded committeeSTICH trialMental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients
Sun JL, Boyle SH, Samad Z, Babyak MA, Wilson JL, Kuhn C, Becker RC, Ortel TL, Williams RB, Rogers JG, O’Connor C, Velazquez EJ, Jiang W. Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients. European Journal Of Preventive Cardiology 2017, 24: 591-599. PMID: 28067532, PMCID: PMC6093615, DOI: 10.1177/2047487316686435.Peer-Reviewed Original ResearchMeSH KeywordsAgedCitalopramDisease-Free SurvivalFemaleHumansMaleMental HealthMiddle AgedMultivariate AnalysisMyocardial IschemiaProportional Hazards ModelsRisk AssessmentRisk FactorsSelective Serotonin Reuptake InhibitorsStress, PsychologicalStroke VolumeTime FactorsTreatment OutcomeVentricular Dysfunction, LeftVentricular Function, LeftConceptsMental stress-induced myocardial ischemiaMajor adverse cardiovascular eventsAdverse cardiovascular eventsLeft ventricular ejection fraction changeVentricular ejection fraction changeStable ischemic heart diseaseIschemic heart disease patientsLeft ventricular ejection fractionStress-induced myocardial ischemiaEjection fraction changesVentricular ejection fractionIschemic heart diseaseCardiovascular eventsHeart disease patientsMyocardial ischemiaEjection fractionStudy endpointDisease patientsHeart diseaseMental Stress–Induced Myocardial IschemiaStress-induced left ventricular dysfunctionFuture adverse cardiovascular eventsLeft ventricular dysfunctionHeart failure statusAssociation of indices
2016
Associations between positive emotional well-being and stress-induced myocardial ischemia Well-being scores predict exercise-induced ischemia
Feigal JP, Boyle SH, Samad Z, Velazquez EJ, Wilson JL, Becker RC, Williams RB, Kuhn CM, Ortel TL, Rogers JG, O'Connor CM, Jiang W. Associations between positive emotional well-being and stress-induced myocardial ischemia Well-being scores predict exercise-induced ischemia. Journal Of Psychosomatic Research 2016, 93: 14-18. PMID: 28107887, PMCID: PMC6044283, DOI: 10.1016/j.jpsychores.2016.11.012.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionHealth-related behaviorsMyocardial ischemiaStable ischemic heart disease patientsIschemic heart disease patientsWall motion score indexExercise-induced ischemiaTreadmill exercise testingEpidemiologic Studies Depression ScaleStress-induced ischemiaInverse correlationHeart disease patientsSignificant inverse correlationInducible ischemiaAdult patientsExercise testingIschemic responseEjection fractionDisease patientsTreatment trialsSimilar inverse correlationDepression ScaleExercise stressDepressive symptomsUnderscore areasClinical and echocardiographic predictors of mortality in acute pulmonary embolism
Dahhan T, Siddiqui I, Tapson VF, Velazquez EJ, Sun S, Davenport CA, Samad Z, Rajagopal S. Clinical and echocardiographic predictors of mortality in acute pulmonary embolism. Cardiovascular Ultrasound 2016, 14: 44. PMID: 27793158, PMCID: PMC5086059, DOI: 10.1186/s12947-016-0087-y.Peer-Reviewed Original ResearchConceptsAcute pulmonary embolismChronic obstructive pulmonary diseaseBody mass indexTricuspid annular plane systolic excursionPulmonary artery acceleration timePulmonary embolismActive malignancyEjection fractionClinical parametersMass indexNYHA class III symptomsRV myocardial performance indexAnnular plane systolic excursionLeft ventricular ejection fractionMedian body mass indexClass III symptomsFraction area changeRV Tei indexSpeckle-tracking strainOutcomes of patientsAbsence of hypertensionTroponin T levelsMyocardial performance indexObstructive pulmonary diseaseSystolic blood pressurePulmonary function and adverse cardiovascular outcomes: Can cardiac function explain the link?
Peña M, Dunning A, Schulte PJ, Durheim MT, Kussin P, Checkley W, Velazquez EJ. Pulmonary function and adverse cardiovascular outcomes: Can cardiac function explain the link? Respiratory Medicine 2016, 121: 4-12. PMID: 27888991, DOI: 10.1016/j.rmed.2016.10.009.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionAdverse cardiovascular eventsPulmonary functionCause mortalityCardiovascular eventsCardiac hospitalizationCardiac functionDecreased LVEFNormal left ventricular ejection fractionSingle tertiary care medical centerTertiary care medical centerCox proportional hazards modelLeft heart remodelingRight heart dysfunctionAdverse cardiovascular outcomesRight ventricular functionTertiary care centerVentricular ejection fractionVentricular internal dimensionLeft heart structuresLeft heart sizeProportional hazards modelMultivariable linear regressionDecreased FVCCardiovascular outcomesMetabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure
Hunter WG, Kelly JP, McGarrah RW, Khouri MG, Craig D, Haynes C, Ilkayeva O, Stevens RD, Bain JR, Muehlbauer MJ, Newgard CB, Felker GM, Hernandez AF, Velazquez EJ, Kraus WE, Shah SH. Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure. Journal Of The American Heart Association 2016, 5: e003190. PMID: 27473038, PMCID: PMC5015273, DOI: 10.1161/jaha.115.003190.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionReduced ejection fractionEjection fractionHF controlsHFpEF casesHeart failureMetabolic impairmentVersus Reduced Ejection FractionHistory of HFNormal diastolic functionNovel circulating biomarkersClinical heart failureVentricular ejection fractionDiastolic dysfunction gradeHeart failure pathogenesisStrict inclusion criteriaFatty acid oxidationLVEF spectrumCardiac catheterizationDiastolic functionHF diagnosisSequential patientsMetabolic abnormalitiesInsulin resistanceCirculating Biomarkers