ASSOCIATION BETWEEN SERUM POTASSIUM LEVEL AND OUTCOMES IN HEART FAILURE WITH REDUCED EJECTION FRACTION: A COHORT STUDY FROM THE SWEDISH HEART FAILURE REGISTRY

Introduction: Hyper- and hypo-kalemia have each been associated with higher risk of death in in heart failure with reduced ejection fraction but the relationship between serum potassium and risk of death in heart failure with preserved ejection fraction (HFpEF) is not well established. We assessed the risk associated with high and low potassium in patients with HFpEF enrolled in the PARAGON-HF trial. Aim: To explore the association between serum potassium and mortality in patients with HFpEF and examine the interaction with renal function. Methods: Repeated events, Cox and mixed-effects models. The primary outcome in this analysis was death from any cause. Results: Patients: mean age 73 years, 52% female. Higher potassium was not associated with higher risk of death: adjusted time-updated HR (95%CI) for potassium >5.0 mmol/l =1.06 (0.85-1.32); p=0.61 (potassium 4-5 mmol/l referent HR=1.0). However, lower potassium was associated with higher risk of death: adjusted HR for potassium <4.0 mmol/l=1.51 (1.21-1.87); p<0.001. However, the risk related to potassium was modified by baseline renal function (p for interaction <0.05), whereby the excess mortality in patients with low potassium was most prominent in patients with an eGFR <60 ml/min/1.73m 2 (Figure). Conclusion: In adjusted analyses, low potassium was independently associated with mortality in patients with HFpEF, especially in the context of renal impairment.

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Increased Ratio of sST2/LVMI Predicted Cardiovascular Mortality and Heart Failure Rehospitalization in Heart Failure with Reduced Ejection Fraction Patients: A Prospective Cohort Study

10.21203/rs.3.rs-91660/v1 ◽

2020 ◽

Author(s):

Fuhai Li ◽

Mengying Xu ◽

Mingqiang Fu ◽

Xiaotong Cui ◽

Jingmin Zhou ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Cohort Study ◽

Ejection Fraction ◽

Left Ventricular ◽

Prognostic Impact ◽

Composite Outcome ◽

Cox Regression Analysis ◽

Reduced Ejection Fraction ◽

Increased Risk

Abstract Background: Inflammation is considered to be one of the principal triggering mechanisms for Left ventricular (LV) fibroblast and remodeling in heart failure(HF), which are related to adverse events in HF failure patients. Soluble ST2 (sST2), a member of the interleukin-1 receptor family, is assumed to play a significant role in the inflammatory response of fibroblasts. The present study aimed to investigate the prognostic value of sST2/ left ventricular mass index (LVMI), a parameter of the pre-fibrotic inflammatory phase of heart failure in comparative to remodeling, in the heart failure with reduced ejection fraction (HFrEF).Methods: The present study was a cohort study. A total of 45 consecutive patients with suspected HFrEF from 1/9/2015 to 31/12/2016 were prospectively enrolled. The target-independent variable was the ratio of sST2/LVMI measured at baseline. The primary endpoint was the composite endpoint of cardiovascular-cause mortality or heart failure readmission. The prognostic impact of the ratio of sST2/LVMI was evaluated by multivariable Cox proportional-hazards regression model.Results: 45 patients were enrolled, the average age was 48±14 years old, and about 20% of them were male. Patients were followed for 9 months, during which the primary outcome occurred in 15 patients. By Kaplan–Meier analysis, patients with high ratio of the ratio of sST2/LVMI ≥ 0.39 had shorter event-free survival than the middle ( ratio of sST2/LVMI between 0.39 and 0.24) and low ratio of sST2/LVMI (ratio of sST2/LVMI < 0.24) patients (log-rank, P = 0.022). Results of fully-adjusted multivariable Cox regression analysis showed the ratio of sST2/LVMI was positively associated with the composite outcome of HFrEF patients after adjusting confounders hazard ratio (HR) 1.64, 95% CI (1.06, 2.54). By subgroup analysis, a stronger association was found in patients whose ages between 40 and 55 years old, systolic blood pressure ＜115 or≥129mmHg, diastolic blood pressure< 74 mmHg, hematocrit < 44.5%, and interventricular septum ≥8.5mm.Conclusion: In HFrEF patients, the relationship between the ratio of sST2/LVMI and the composite outcome is linear. A higher baseline ratio of sST2/LVMI levels is associated with increased risk of cardiovascular-cause mortality and HF rehospitalization in patients with HFrEF in the short term follow up.

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Changes in Serum Potassium Levels During Hospitalization in Patients With Worsening Heart Failure and Reduced Ejection Fraction (from the EVEREST Trial)

The American Journal of Cardiology ◽

10.1016/j.amjcard.2014.12.045 ◽

2015 ◽

Vol 115 (6) ◽

pp. 790-796 ◽

Cited By ~ 25

Author(s):

Sadiya S. Khan ◽

Umberto Campia ◽

Ovidiu Chioncel ◽

Faiez Zannad ◽

Patrick Rossignol ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Serum Potassium ◽

Reduced Ejection Fraction

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Burden, treatment use, and outcome of secondary mitral regurgitation across the spectrum of heart failure: observational cohort study

BMJ ◽

10.1136/bmj.n1421 ◽

2021 ◽

pp. n1421

Author(s):

Philipp E Bartko ◽

Gregor Heitzinger ◽

Noemi Pavo ◽

Maria Heitzinger ◽

Georg Spinka ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Mitral Regurgitation ◽

Confidence Interval ◽

Ejection Fraction ◽

Excess Mortality ◽

Hazard Ratio ◽

Reduced Ejection Fraction ◽

Observational Cohort ◽

Secondary Mitral Regurgitation

Abstract Objectives To define prevalence, long term outcome, and treatment standards of secondary mitral regurgitation (sMR) across the heart failure spectrum. Design Large scale cohort study. Setting Observational cohort study with data from the Viennese community healthcare provider network between 2010 and 2020, Austria. Participants 13 223 patients with sMR across all heart failure subtypes. Main outcome measures Association between sMR and mortality in patients assigned by guideline diagnostic criteria to one of three heart failure subtypes: reduced, mid-range, and preserved ejection fraction, was assessed. Results Severe sMR was diagnosed in 1317 patients (10%), correlated with increasing age (P<0.001), occurred across the entire spectrum of heart failure, and was most common in 656 (25%) of 2619 patients with reduced ejection fraction. Mortality of patients with severe sMR was higher than expected for people of the same age and sex in the same community (hazard ratio 7.53; 95% confidence interval 6.83 to 8.30, P<0.001). In comparison with patients with heart failure and no/mild sMR, mortality increased stepwise with a hazard ratio of 1.29 (95% confidence interval 1.20 to 1.38, P<0.001) for moderate and 1.82 (1.64 to 2.02, P<0.001) for severe sMR. The association between severe sMR and excess mortality was consistent after multivariate adjustment and across all heart failure subgroups (mid-range ejection fraction: hazard ratio 2.53 (95% confidence interval 2.00 to 3.19, P<0.001), reduced ejection fraction: 1.70 (1.43 to 2.03, P<0.001), and preserved ejection fraction: 1.52 (1.25 to 1.85, P<0.001)). Despite available state-of-the-art healthcare, high volume heart failure, and valve disease programmes, severe sMR was rarely treated by surgical valve repair (7%) or replacement (5%); low risk transcatheter repair (4%) was similarly seldom used. Conclusion Secondary mitral regurgitation is common overall, increasing with age and associated with excess mortality. The association with adverse outcome is significant across the entire heart failure spectrum but most pronounced in those with mid-range and reduced ejection fractions. Despite these poor outcomes, surgical valve repair or replacement are rarely performed; similarly, low risk transcatheter repair, specifically in the heart failure subsets with the highest expected benefit from treatment, is seldom used. The current data suggest an increasing demand for treatment, particularly in view of an expected increase in heart failure in an ageing population.

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