The diagnostic and prognostic value of galectin‐3 in patients at risk for heart failure with preserved ejection fraction: results from the DIAST‐CHF study

Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a rapidly growing global health problem. To date, diagnosis of HFpEF is based on clinical, invasive and laboratory examinations. Electrocardiographic findings may vary, and there are no known typical ECG features for HFpEF. Methods This study included two patient cohorts. In the derivation cohort, we included n = 1884 patients who presented with exertional dyspnea or equivalent and preserved ejection fraction (≥50%) and clinical suspicion for coronary artery disease. The ECGs were divided in segments, yielding a total of 77.558 samples. We trained a convolutional neural network (CNN) to classify HFpEF and control patients according to ESC criteria. An external group of 203 volunteers in a prospective heart failure screening program served as validation cohort of the CNN. Results The external validation of the CNN yielded an AUC of 0.80 (95% CI 0.74–0.86) for detection of HFpEF according to ESC criteria, with a sensitivity of 0.99 (CI 0.98–0.99) and a specificity of 0.60 (95% CI 0.56–0.64), with a positive predictive value of 0.68 (95%CI 0.64–0.72) and a negative predictive value of 0.98 (95% CI 0.95–0.99). Conclusion In this study, we report the first deep learning-enabled CNN for identifying patients with HFpEF according to ESC criteria including NT-proBNP measurements in the diagnostic algorithm among patients at risk. The suitability of the CNN was validated on an external validation cohort of patients at risk for developing heart failure, showing a convincing screening performance.

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Galectin-3 in Heart Failure – Linking Fibrosis, Remodelling and Progression

European Cardiology Review ◽

10.15420/ecr.2010.6.2.33 ◽

2010 ◽

Vol 6 (2) ◽

pp. 33 ◽

Cited By ~ 10

Author(s):

Christopher R deFilippi ◽

G Michael Felker ◽

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Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Risk Stratification ◽

Cardiac Fibrosis ◽

The Elderly ◽

Preserved Ejection Fraction ◽

Heart Failure Patients ◽

Large Populations ◽

Galectin 3

For many with heart failure, including the elderly and those with a preserved ejection fraction, both risk stratification and treatment are challenging. For these large populations and others there is increasing recognition of the role of cardiac fibrosis in the pathophysiology of heart failure. Galectin-3 is a novel biomarker of fibrosis and cardiac remodelling that represents an intriguing link between inflammation and fibrosis. In this article we review the biology of galectin-3, recent clinical research and its application in the management of heart failure patients.

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Abstract 13497: Prognostic Value of the Combination of the Echocardiographic Derived Pulmonary Artery Wedge Pressure and Body Mass Index in Patients With Heart Failure With Preserved Ejection Fraction: Insights From PURSUIT-HFpEF Registry

Circulation ◽

10.1161/circ.142.suppl_3.13497 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Kumpei Ueda ◽

Shungo Hikoso ◽

Daisaku D Nakatani ◽

Shunsuke Tamaki ◽

Masamichi Yano ◽

...

Keyword(s):

Heart Failure ◽

Body Mass Index ◽

Ejection Fraction ◽

Prognostic Value ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Pulmonary Artery Wedge Pressure ◽

Patients With Heart Failure ◽

Wedge Pressure

Background: An elevated pulmonary artery wedge pressure (PAWP), a surrogate of left ventricular filling pressure, is associated with poor outcomes in patients with heart failure (HF). In addition, obesity paradox is well recognized in HF patients and body mass index (BMI) also provides a prognostic information. However, there is little information available on the prognostic value of the combination of the echocardiographic derived PAWP and BMI in patients with HF with preserved ejection fraction (HFpEF). Methods and Results: Patients data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for acute decompensated heart failure (ADHF) patients with HFpEF. We analyzed 548 patients after exclusion of patients undergoing hemodialysis, patients with in-hospital death, missing follow-up data, or missing data to calculate PAWP or BMI. Body weight measurement and echocardiography were performed just before discharge. PAWP was calculated using the Nagueh formula [PAWP = 1.24* (E/e’) + 1.9] with e’ = [(e’ septal + e’ lateral ) /2]. During a mean follow up period of 1.5±0.8 years, 86 patients had all-cause death (ACD). Multivariate Cox analysis showed that both PAWP (p=0.020) and BMI (p=0.0001) were significantly associated with ACD, independently of age and previous history of HF hospitalization, after the adjustment with gender, left ventricular ejection fraction, NT-proBNP and estimated glomerular filtration rate. Kaplan-Meier curve analysis revealed that there was a significant difference in the risk of ACD when patients were stratified into 3 groups based on the median values of PAWP (17.3) and BMI (21.4). Conclusions: The combination of the echocardiographic derived PAWP and BMI might be useful for stratifying ADHF patients with HFpEF at risk for the total mortality.

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