CIRCULATING GUT METABOLITES IN PATIENTS WITH HEART FAILURE WITH PRESERVED, REDUCED OR RECOVERED EJECTION FRACTION, AND IN THE AGE- AND SEX-MATCHED CONTROLS: RESULTS FROM THE PRESERVED VS. REDUCED EJECTION FRACTION BIOMECHANICAL MARKER REGISTRY FOR AMBULATORY HEART FAILURE PATIENTS (PREFER-HF) STUDY

Abstract Background The presence of atrial fibrillation (AF) has been demonstrated to be associated with poor clinical outcomes in heart failure patients with reduced ejection fraction. Objective This study aimed to elucidate the impact of the presence of atrial fibrillation (AF) on the clinical characteristics, therapeutics, and outcomes in patients with heart failure and preserved ejection fraction (HFpEF). Methods PURSUIT-HFpEF is a multicenter prospective observational study including patients hospitalized for acute heart failure with left ventricular ejection fraction of >50%. Patients with acute coronary syndrome or severe valvular disease were excluded. Results Of 486 HFpEF patients (age, 80.8±9.0 years old; male, 47%) from 24 cardiovascular centers, 199 (41%) had AF on admission. Patients with AF had lower systolic blood pressures (142±27 vs. 155±35mmHg, p<0.0001) and higher heart rates (91±29 vs. 82±26bpm, p<0.0001) than those without. There was no difference in the usage of inotropes or mechanical ventilation between the 2 groups. A higher quality of life score (EQ5D, 0.72±0.27 vs. 0.63±0.30, p=0.002) was observed at discharge in patients with than without AF. In addition, AF patients tended to demonstrate lower in-hospital mortality rates (0.5% vs. 2.4%, p=0.09) and shorter hospital stays (20.3±12.1 vs. 22.6±18.4 days, p=0.09) than those without. During a mean follow up of 360±111 days, mortality (14.1% vs. 15.3) and heart failure re-hospitalization rates (13.1% vs. 13.9%) were comparable between the 2 groups. Conclusion In contrast to heart failure patients with reduced ejection fraction, AF on admission was not associated with poor long-term clinical outcomes among HFpEF patients. Several in-hospital outcomes were better in patients with AF than in those without. Acknowledgement/Funding None

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Effect of age and sex on efficacy and tolerability of β blockers in patients with heart failure with reduced ejection fraction: individual patient data meta-analysis

BMJ ◽

10.1136/bmj.i1855 ◽

2016 ◽

pp. i1855 ◽

Cited By ~ 46

Author(s):

Dipak Kotecha ◽

Luis Manzano ◽

Henry Krum ◽

Giuseppe Rosano ◽

Jane Holmes ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Individual Patient Data ◽

Meta Analysis ◽

Patient Data ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Β Blockers ◽

Effect Of Age ◽

Age And Sex

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Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.757596 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yibo He ◽

Yihang Ling ◽

Wei Guo ◽

Qiang Li ◽

Sijia Yu ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Ejection Fraction ◽

Lower Risk ◽

Meta Analysis ◽

Left Ventricular Ejection ◽

Reduced Ejection Fraction ◽

Heart Failure Patients ◽

Risk Of Mortality ◽

Patients With Heart Failure

Background: Heart failure with improved ejection fraction (HFimpEF) is classified as a new type of heart failure, and its prevalence and prognosis are not consistent in previous studies. There is no systematic review and meta-analysis regarding the prevalence and prognosis of the HFimpEF.Method: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library from inception to May 22, 2021 (PROSPERO registration: CRD42021260422). Studies were included for analysis if the prognosis of mortality or hospitalization were reported in HFimpEF or in patients with heart failure with recovered ejection fraction (HFrecEF). The primary outcome was all-cause mortality. Cardiac hospitalization, all-cause hospitalization, and composite events of mortality and hospitalization were considered as secondary outcomes.Result: Nine studies consisting of 9,491 heart failure patients were eventually included. During an average follow-up of 3.8 years, the pooled prevalence of HFimpEF was 22.64%. HFimpEF had a lower risk of mortality compared with heart failure patients with reduced ejection fraction (HFrEF) (adjusted HR: 0.44, 95% CI: 0.33–0.60). HFimpEF was also associated with a lower risk of cardiac hospitalization (HR: 0.40, 95% CI: 0.20–0.82) and the composite endpoint of mortality and hospitalization (HR: 0.56, 95% CI: 0.44–0.73). Compared with patients with preserved ejection fraction (HFpEF), HFimpEF was associated with a moderately lower risk of mortality (HR: 0.42, 95% CI: 0.32–0.55) and hospitalization (HR: 0.73, 95% CI: 0.58–0.92).Conclusion: Around 22.64% of patients with HFrEF would be treated to become HFimpEF, who would then obtain a 56% decrease in mortality risk. Meanwhile, HFimpEF is associated with lower heart failure hospitalization. Further studies are required to explore how to promote left ventricular ejection fraction improvement and improve the prognosis of persistent HFrEF in patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260422, identifier: CRD42021260422.

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Abstract 16824: Circulating Microvesicles in Heart Failure Patients Prior to, and Following LVAD Implantation

Circulation ◽

10.1161/circ.142.suppl_3.16824 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

William K Cornwell ◽

Kelly A Stockelman ◽

Noah DeSouza ◽

Jared Greiner ◽

chris desouza

Keyword(s):

Heart Failure ◽

Flow Cytometry ◽

Endothelial Dysfunction ◽

Ejection Fraction ◽

Blood Samples ◽

Reduced Ejection Fraction ◽

Heart Failure Patients ◽

Hemodynamic Assessment ◽

Patients With Heart Failure ◽

Inflammatory State

Introduction: Elevated levels of circulating endothelial and platelet (EMV and PMV) microvesicles are associated with endothelial dysfunction and thrombosis/inflammation, respectively. EMVs and PMVs are elevated in patients with heart failure with reduced ejection fraction (HFrEF) and are associated with clinical outcomes. We sought to characterize longitudinal changes in EMV and PMV following LVAD implantation in these patients. Methods: Blood samples were obtained from patients with advanced HFrEF (59±9years, N=9 males) during an invasive hemodynamic assessment with Swan-Ganz catheterization 2.7±4.1 and 4.3±1.3 months prior to, and following CF-LVAD implantation, respectively. Circulating concentrations of total MV, EMVs (CD31+) and PMVs (CD42b+) were determined by flow cytometry. Results: Demographics and hemodynamics pre- and post-LVAD implantation are displayed in the table . Prior to LVAD, four patients were on inotropes. Six patients received a Heartware VAD, and four patients received a Heartmate 3 VAD. As demonstrated in the figure , there was a significant reduction in total MV concentration, as well as EMVs and PMVs following LVAD implantation. Conclusion: Circulating concentrations EMVs and PMVs decline significantly in HFrEF patients following LVAD implantation. These findings are indicative of improvements in both endothelial function and thrombotic/inflammatory state associated with the heart-failure syndrome.

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