scholarly journals All-Cause Mortality as an End Point for Heart Failure With Preserved Ejection Fraction: Underperformance or Overambitious?

2022 ◽  
Author(s):  
Parag Goyal ◽  
Andrew J. Sauer ◽  
Michael W. Rich
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
End Point ◽  
All Cause Mortality

Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Huang ◽  
C Liu
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: <120mmHg, ≥120mmHg and <130mmHg, ≥130mmHg and <140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of <120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of <120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

scholarly journals Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pankaj Garg ◽  
Hosamadin Assadi ◽  
Rachel Jones ◽  
Wei Bin Chan ◽  
Peter Metherall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Native T1 ◽  
Lv Mass ◽  
All Cause Mortality ◽  
Ventricular Fibrosis

AbstractCardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.

scholarly journals Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Kentaro Kamiya ◽  
Yukihito Sato ◽  
Tetsuya Takahashi ◽  
Miyuki Tsuchihashi-Makaya ◽  
Norihiko Kotooka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Preserved Ejection Fraction ◽  
Composite Outcome ◽  
Term Survival ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Related Quality

Background: Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction. Methods: This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants. Results: Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients. Conclusions: Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.

Right ventricular diameter predicts all-cause mortality in heart failure with preserved ejection fraction

2019 ◽  
Vol 14 (7) ◽  
pp. 1091-1100 ◽  
Author(s):  
Gaspare Parrinello ◽  
Daniele Torres ◽  
Silvio Buscemi ◽  
Tiziana Di Chiara ◽  
Francesco Cuttitta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Preserved Ejection Fraction ◽  
All Cause Mortality

Abstract 16170: Impact of Anemia on Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Monil Majmundar ◽  
Ashish Kumar ◽  
Rajkumar P Doshi ◽  
Palak shah ◽  
Mariam Shariff ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Publication Bias ◽  
Meta Analysis ◽  
Final Analysis ◽  
Study Data ◽  
Curve Analysis ◽  
Secondary Outcome ◽  
Preserved Ejection Fraction ◽  
All Cause Mortality

Introduction: The effect of anemia on outcomes in Heart failure with preserved ejection fraction (HFpEF) patients is not well-established. Some previous studies have shown increased mortality and hospitalizations in HFpEF patients with anemia. Hypothesis: We hypothesize that anemia affects all-cause mortality and hospitalization in HFpEF patients. Methods: A review of literature for studies comparing outcomes in HFpEF with and without anemia was done in PubMed, MEDLINE, and EMBASE databases through June 1st, 2020. The standard definitions of HFpEF and anemia were used for inclusion criteria. Two investigators extracted the study data independently. The primary outcome of interest was all-cause mortality. The secondary outcome was all-cause hospitalizations. We used the PM estimator of Tau with Knapp-Hartung adjustment to pool adjusted hazard ratio (HR) and 95% confidence interval (CI). P curve analysis was used to assess publication bias. R version 3.6.2 was used for all statistical analyses. Results: Seven studies (23,424 patients) were included in the final analysis. Anemia in patients with HFpEF was associated with higher rates of all-cause mortality [HR: 1.35, 95% CI: 1.17-1.55]. Additionally, anemia in HFpEF patients was associated with higher rates of all-cause hospitalization [HR: 1.22, 95% CI: 1.03-1.44]. P curve analysis for all-cause mortality didn’t report publication bias or P hacking (Figure) . Conclusions: Anemia in HFpEF patients was associated with higher rates of all-cause mortality and all-cause hospitalizations compared to HFpEF patients without anemia.

scholarly journals Cornell product is an ECG marker of heart failure with preserved ejection fraction

Heart Asia ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. e011108 ◽  
Author(s):  
Eugene SJ Tan ◽  
Siew Pang Chan ◽  
Chang Fen Xu ◽  
Jonathan Yap ◽  
Arthur Mark Richards ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Asian Population ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Preserved Ejection Fraction ◽  
S Wave ◽  
All Cause Mortality ◽  
Cornell Product

ObjectiveECG markers of heart failure (HF) with preserved ejection fraction (HFpEF) are lacking. We hypothesised that the Cornell product (CP) is a risk marker of HFpEF and has prognostic utility in HFpEF.MethodsCP =[(amplitude of R wave in aVL+depth of S wave in V3)×QRS] was measured on baseline 12-lead ECG in a prospective Asian population-based study of 606 healthy controls (aged 55±10 years, 45% men), 221 hypertensive controls (62±9 years, 58% men) and 242 HFpEF (68±12 years, 49% men); all with EF ≥50% and followed for 2 years for all-cause mortality and HF hospitalisations.ResultsCP increased across groups from healthy controls to hypertensive controls to HFpEF, and distinguished between HFpEF and hypertension with an optimal cut-off of ≥1800 mm*ms (sensitivity 40%, specificity 85%). Age, male sex, systolic blood pressure (SBP) and heart rate were independent predictors of CP ≥1800 mm*ms, and CP was associated with echocardiographic E/e′ (r=0.27, p<0.01) and left ventricular mass index (r=0.46, p<0.01). Adjusting for clinical and echocardiographic variables and log N-terminal pro B-type natriuretic peptide (NT-proBNP), CP ≥1800 mm*ms was significantly associated with HFpEF (adjusted OR 2.7, 95% CI 1.0 to 7.0). At 2-year follow-up, there were 29 deaths and 61 HF hospitalisations, all within the HFpEF group. Even after adjusting for log NT-proBNP, clinical and echocardiographic variables, CP ≥1800 mm*ms remained strongly associated with a higher composite endpoint of all-cause mortality and HF hospitalisations (adjusted HR 2.1, 95% CI 1.2 to 3.5).ConclusionThe Cornell product is an easily applicable ECG marker of HFpEF and predicts poor prognosis by reflecting the severity of diastolic dysfunction and LV hypertrophy.

scholarly journals Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000961 ◽  
Author(s):  
Kalyani Anil Boralkar ◽  
Yukari Kobayashi ◽  
Kegan J Moneghetti ◽  
Vedant S Pargaonkar ◽  
Mirela Tuzovic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Score ◽  
Multivariable Analysis ◽  
Laboratory Data ◽  
Primary Diagnosis ◽  
Risk Scores ◽  
Preserved Ejection Fraction ◽  
Hospitalised Patients ◽  
All Cause Mortality

IntroductionThe Intermountain Risk Score (IMRS) was developed and validated to predict short-term and long-term mortality in hospitalised patients using demographics and commonly available laboratory data. In this study, we sought to determine whether the IMRS also predicts all-cause mortality in patients hospitalised with heart failure with preserved ejection fraction (HFpEF) and whether it is complementary to the Get with the Guidelines Heart Failure (GWTG-HF) risk score or N-terminal pro-B-type natriuretic peptide (NT-proBNP).Methods and resultsWe used the Stanford Translational Research Integrated Database Environment to identify 3847 adult patients with a diagnosis of HFpEF between January 1998 and December 2016. Of these, 580 were hospitalised with a primary diagnosis of acute HFpEF. Mean age was 76±16 years, the majority being female (58%), with a high prevalence of diabetes mellitus (36%) and a history of coronary artery disease (60%). Over a median follow-up of 2.0 years, 140 (24%) patients died. On multivariable analysis, the IMRS and GWTG-HF risk score were independently associated with all-cause mortality (standardised HRs IMRS (1.55 (95% CI 1.27 to 1.93)); GWTG-HF (1.60 (95% CI 1.27 to 2.01))). Combining the two scores, improved the net reclassification over GWTG-HF alone by 36.2%. In patients with available NT-proBNP (n=341), NT-proBNP improved the net reclassification of each score by 46.2% (IMRS) and 36.3% (GWTG-HF).ConclusionIMRS and GWTG-HF risk scores, along with NT-proBNP, play a complementary role in predicting outcome in patients hospitalised with HFpEF.

scholarly journals Left atrial pressure overload and prognosis in elderly patients with heart failure and preserved ejection fraction: a prospective multicenter observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e044605
Author(s):  
Shiro Hoshida ◽  
Koichi Tachibana ◽  
Yukinori Shinoda ◽  
Tomoko Minamisaka ◽  
Takahisa Yamada ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Pressure Overload ◽  
Volume Index ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

ObjectivesThe severity of diastolic dysfunction is assessed using a combination of several indices of left atrial (LA) volume overload and LA pressure overload. We aimed to clarify which overload is more associated with the prognosis in patients with heart failure and preserved ejection fraction (HFpEF).SettingA prospective, multicenter observational registry of collaborating hospitals in Osaka, Japan.ParticipantsWe enrolled hospitalised patients with HFpEF showing sinus rhythm (men, 79; women, 113). Blood tests and transthoracic echocardiography were performed before discharge. The ratio of diastolic elastance (Ed) to arterial elastance (Ea) was used as a relative index of LA pressure overload.Primary outcome measuresAll-cause mortality and admission for heart failure were evaluated at >1 year after discharge.ResultsIn the multivariable Cox regression analysis, Ed/Ea, but not LA volume index, was significantly associated with all-cause mortality or admission for heart failure (HR 2.034, 95% CI 1.059 to 3.907, p=0.032), independent of age, sex, and the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level. In patients with a higher NT-proBNP level, the effect of higher Ed/Ea on prognosis was prominent (p=0.015).ConclusionsEd/Ea, an index of LA pressure overload, was significantly associated with the prognosis in elderly patients with HFpEF showing sinus rhythm.Trial registration numberUMIN000021831.

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