scholarly journals Ventricular longitudinal shortening is an independent predictor of death in heart failure patients with reduced ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
J. Berg ◽  
R. Jablonowski ◽  
M. Mohammad ◽  
K. Solem ◽  
R. Borgquist ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Univariate Analysis ◽  
Global Longitudinal Strain ◽  
National Registry ◽  
Reduced Ejection Fraction ◽  
Kaplan Meier ◽  
Incremental Value ◽  
Atrioventricular Plane Displacement ◽  
Plane Displacement

AbstractReduced ventricular longitudinal shortening measured by atrioventricular plane displacement (AVPD) and global longitudinal strain (GLS) are prognostic markers in heart disease. This study aims to determine if AVPD and GLS with cardiovascular magnetic resonance (CMR) are independent predictors of cardiovascular (CV) and all-cause death also in heart failure with reduced ejection fraction (HFrEF). Patients (n = 287) were examined with CMR and AVPD, GLS, ventricular volumes, myocardial fibrosis/scar were measured. Follow-up was 5 years with cause of death retrieved from a national registry. Forty CV and 60 all-cause deaths occurred and CV non-survivors had a lower AVPD (6.4 ± 2.0 vs 8.0 ± 2.4 mm, p < 0.001) and worse GLS (− 6.1 ± 2.2 vs − 7.7 ± 3.1%, p = 0.001). Kaplan–Meier analyses displayed increased survival for patients in the highest AVPD- and GLS-tertiles vs. the lowest tertiles (AVPD: p = 0.001, GLS: p = 0.013). AVPD and GLS showed in univariate analysis a hazard ratio (HR) of 1.30 (per-mm-decrease) and 1.19 (per-%-decrease) for CV death. Mean AVPD and GLS were independent predictors of all-cause death (HR = 1.24 per-mm-decrease and 1.15 per-%-decrease), but only AVPD showed incremental value over age, sex, body-mass-index, EF, etiology and fibrosis/scar for CV death (HR = 1.33 per-mm-decrease, p < 0.001). Ventricular longitudinal shortening remains independently prognostic for death in HFrEF even after adjusting for well-known clinical risk factors.

scholarly journals Prognostic Value of Pulmonary Transit Time by Cardiac Magnetic Resonance on Mortality and Heart Failure Hospitalization in Patients With Advanced Heart Failure and Reduced Ejection Fraction

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Laura Houard ◽  
Mihaela S. Amzulescu ◽  
Geoffrey Colin ◽  
Helene Langet ◽  
Sebastian Militaru ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Feature Tracking ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Reduced Ejection Fraction ◽  
Lv Ejection Fraction ◽  
Overall Mortality

Background: Pulmonary transit time (PTT) from first-pass perfusion imaging is a novel parameter to evaluate hemodynamic congestion by cardiac magnetic resonance (cMR). We sought to evaluate the additional prognostic value of PTT in heart failure with reduced ejection fraction over other well-validated predictors of risk including the Meta-Analysis Global Group in Chronic Heart Failure risk score and ischemic cause. Methods: We prospectively followed 410 patients with chronic heart failure with reduced ejection fraction (61±13 years, left ventricular (LV) ejection fraction 24±7%) who underwent a clinical cMR to assess the prognostic value of PTT for a primary endpoint of overall mortality and secondary composite endpoint of cardiovascular death and heart failure hospitalization. Normal reference values of PTT were evaluated in a population of 40 asymptomatic volunteers free of cardiovascular disease. Results PTT was significantly increased in patients with heart failure with reduced ejection fraction as compared to controls (9±6 beats and 7±2 beats, respectively, P <0.001), and correlated not only with New York Heart Association class, cMR–LV and cMR–right ventricular (RV) volumes, cMR-RV and cMR-LV ejection fraction, and feature tracking global longitudinal strain, but also with cardiac output. Over 6-year median follow-up, 182 patients died and 200 reached the secondary endpoint. By multivariate Cox analysis, PTT was an independent and significant predictor of both endpoints after adjustment for Meta-Analysis Global Group in Chronic Heart Failure risk score and ischemic cause. Importantly in multivariable analysis, PTT in beats had significantly higher additional prognostic value to predict not only overall mortality (χ 2 to improve, 12.3; hazard ratio, 1.35 [95% CI, 1.16–1.58]; P <0.001) but also the secondary composite endpoints (χ 2 to improve=20.1; hazard ratio, 1.23 [95% CI, 1.21–1.60]; P <0.001) than cMR-LV ejection fraction, cMR-RV ejection fraction, LV–feature tracking global longitudinal strain, or RV–feature tracking global longitudinal strain. Importantly, PTT was independent and complementary to both pulmonary artery pressure and reduced RV ejection fraction<42% to predict overall mortality and secondary combined endpoints. Conclusions: Despite limitations in temporal resolution, PTT derived from first-pass perfusion imaging provides higher and independent prognostic information in heart failure with reduced ejection fraction than clinical and other cMR parameters, including LV and RV ejection fraction or feature tracking global longitudinal strain. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03969394.

Abstract 17264: Predictive Value of Plasma Ceramide C24:0/C16:0 Ratio in Patients With Heart Failure With Preserved Ejection Fraction in the TOPCAT Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Linda R Peterson ◽  
Xuntian Jiang ◽  
Hannah Campbell ◽  
Sharon Cresci
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cell Structure ◽  
Univariate Analysis ◽  
The United States ◽  
Preserved Ejection Fraction ◽  
Bioactive Lipids ◽  
Confidence Bounds ◽  
Liquid Chromatograph ◽  
Reduced Ejection Fraction

Introduction: Heart failure (HF) with preserved ejection fraction (HFpEF) is an “emerging epidemic” as nearly half of all patients with HF have HFpEF. However, most HF biomarkers, including plasma brain natriuretic peptide, have less robust utility in HFpEF than in those with HF with reduced ejection fraction. In order to better understand HFpEF and its associated morbidity and mortality, it is vital to identify robust biomarkers that predict outcomes in patients who suffer from HFpEF. Ceramides are bioactive lipids involved in signaling, cell death programs, mitochondrial function, and cell structure. Our group showed that the ratio of specific plasma ceramides (C24:0/C16:0) is inversely related to primary incident HF and to death in large community-based cohorts. Whether plasma C24:0/C16:0 has utility in prediction of secondary events/outcomes in patients with HFpEF is unclear. Hypothesis: We hypothesized that there is an association between plasma C24:0/16:0 ratio and outcomes in HFpEF. Methods: Data and plasma was obtained from 477 subjects in the TOPCAT study via the BioLINCC biobank. Plasma ceramides C24:0 and C16:0 were measured using targeted liquid chromatograph/tandem mass spectrometry. Results: Inclusion criteria for TOPCAT was age >50 years, ejection fraction of 45% or higher and diagnosis of HF. Subjects were randomized to treatment with spironolactone or placebo. In the 477 subjects who provided samples to BioLINCC, the mean age was 69.3 years; 47% were women; 43.9% were from the United States; 94.4% had hypertension; 31 were African American. Mean follow-up was 3.3 years. Univariate analysis showed that time to hospitalization for heart failure was inversely related to plasma C24:0/C16:0 concentration (Hazard ratio 0.901 [Confidence bounds 0.82,0.99], P = 0.026. Conclusions: Plasma ceramide (C24:0/C16:0) is inversely related to time to hospitalization in patients with HFpEF. Plasma C24:0/C16:0 may be a useful new biomarker in HFpEF and may point to novel, targetable pathophysiologic pathways .

P1634Comparison of inflammation based prognostic scores in patients with stable heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Arfsten ◽  
A Cho ◽  
S Prausmueller ◽  
G Spinka ◽  
J Novak ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Reduced Ejection Fraction ◽  
Lymphocyte Ratio ◽  
Nutritional Risk Index ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Elevated inflammatory markers and malnutrition are characteristic for heart failure with reduced ejection fraction (HFrEF) correlating with disease severity and prognosis. Nutritional decline is closely linked to inflammation. Evidence emerges that heart failure can be triggered by inflammation directly, meaning that progression of HF is a function of individual inflammatory host response. We aimed to investigate and compare the impact of well-established inflammation based scores and inflammation-related nutritional scores on survival in HFrEF. Methods Stable HFrEF-patients undergoing routine ambulatory care between 2011 and 2017 have been identified from a prospective registry. Comorbidities and laboratory data at baseline were assessed. All-cause mortality was defined the primary endpoint. The modified Glasgow Prognostic Score (mGPS: 0/1/2 based on CRP and albumin), the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), the platelet-to-lymphocyte ratio (PLR) as well as the Nutritional Risk Index (NRI = (1.519 × serum albumin, g/dL) + (41.7 × present weight (kg)/ideal body weight (kg)) and the Prognostic Nutritional Index (PNI = albumin (g l–1) × total lymphocyte count × 109 l–1) were calculated. The association of the scores with HF severity and impact on overall survival were determined. Results Data of 443 patients receiving well titrated guideline directed HF therapy have been analyzed. Median age was 64 years (IQR 53–72), 73% were male. Median body mass index (BMI) was 26.6kg/m2 (IQR 23.8–30.2), median NT-proBNP was 2053pg/ml (IQR 842–4345) with most patients presenting in NYHA class II (178, 40%) and III (173, 39%). The mGPS was 0 for 352 (80%), 1 for 76 (17%) and 2 for 14 (3%) patients, respectively. All scores correlated with HF severity reflected by NT-proBNP [p<0.001 for mGPS, r=−0.48; p<0.001 for PNI] and NYHA class [p<0.001 for mGPS and PNI]. All scores were associated with all-cause mortality in univariate analysis. After adjustment for age, gender and kidney function only mGPS, PLR, NRI and PNI remained significantly associated with outcome. Out of these the ROC were highest for PNI and mGPS [0.674 and 0.652 respectively] and solely these scores remained significantly associated with mortality after including NT-proBNP in the multivariate model [adj.HR 1.87 (95% CI: 1.20–2.91), p=0.006 for mGPS; 0.62 (95% CI: 0.40–0.96), p=0.032 for PNI]. Kaplan Meier analysis confirmed the discriminatory power of mGPS and PNI (Figure 1). Conclusions Enhanced inflammation and malnutrition are more common in advanced heart failure. Among established inflammation and nutritional scores merely mGPS and PNI are associated with survival in HFrEF patients independently of NT-proBNP. This relationship emphasizes the significance of the individual proinflammatory response on prognosis.This easily available score may help clinicians to identify HFrEF patients with worse prognosis with urgent need for intensified therapy and/or alternate treatment options.

scholarly journals Procalcitonin (PCT) Predicts Worse Outcome in Patients with Chronic Heart Failure with Reduced Ejection Fraction (HFrEF)

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
J. Banach ◽  
Ł. Wołowiec ◽  
D. Rogowicz ◽  
L. Gackowska ◽  
I. Kubiszewska ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Roc Analysis ◽  
Diagnostic Marker ◽  
Lower Probability ◽  
Reduced Ejection Fraction ◽  
Probability Of Survival ◽  
Kaplan Meier

Introduction. Procalcitonin (PCT) is an excellent marker of sepsis but was not extensively studied in cardiology. The present study investigated PCT plasma concentration in patients with chronic heart failure with reduced ejection fraction (HFrEF) and its prognostic value during 24-month follow-up. Material and Methods. Study group consisted of 130 patients with HFrEF (LVEF ≤ 45%) and 32 controls. PCT level was assessed on admission in all patients. Telephone follow-up was performed every three months over a period of 2 years. Endpoints were death of all causes and readmission for HFrEF exacerbation. Results. HFrEF patients had significantly higher PCT concentration than controls (166.95 versus 22.15 pg/ml; p<0.001). Individuals with peripheral oedema had increased PCT comparing to those without oedema (217.07 versus 152.12 pg/ml; p<0.02). In ROC analysis, PCT turned out to be a valuable diagnostic marker of HFrEF (AUC 0.91; p<0.001). Kaplan-Meier survival curves revealed that patients with PCT in the 4th quartile had significantly lower probability of survival than those with PCT in the 1st and 2nd quartiles. In univariate, but not multivariate, analysis, procalcitonin turned out to be a significant predictor of death during 24-month follow-up. (HR 1.002; 95% CI 1.000–1.003; p<0.03). Conclusions. Elevated PCT concentration may serve as another predictor of worse outcome in patients with HFrEF.

Plasma Proteomic Profile Predicts Survival in Heart Failure with Reduced Ejection Fraction

2021 ◽  
Author(s):  
Hongsheng Gui ◽  
Ruicong She ◽  
Jasmine Luzum ◽  
Jia Li ◽  
Timothy D. Bryson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Risk Score ◽  
Cox Regression ◽  
Clinical Score ◽  
Cardiovascular Death ◽  
Reduced Ejection Fraction ◽  
C Statistic ◽  
Kaplan Meier

Background - It remains unclear whether the plasma proteome adds value to established predictors in heart failure (HF) with reduced ejection fraction (HFrEF). We sought to derive and validate a plasma proteomic risk score for survival in HFrEF patients (HFrEF-PRS). Methods - Patients meeting Framingham criteria for HF with EF<50% were enrolled (n=1017) and plasma underwent SOMAscan® profiling (4453 targets). Patients were randomly divided 2:1 into derivation and validation cohorts. The HFrEF-PRS was derived using Cox regression of all-cause mortality adjusted for clinical score and N-Terminal pro-B-Type Natriuretic Peptide (NTproBNP), then was tested in the validation cohort. Risk stratification improvement was evaluated by C-statistic, integrated discrimination index (IDI), continuous net reclassification index (NRI), and median improvement in risk score (MIRS) for 1-year and 3-year mortality. Results - Participants' mean age was 68 years, 48% identified as African American, 35% were female and 296 deaths occurred. In derivation (n=681), 128 proteins associated with mortality, 8 comprising the optimized HFrEF-PRS. In validation (n=336) the HFrEF-PRS associated with mortality (hazard ratio (HR) =2.27 [95% Confidence interval (95%CI) 1.84-2.82], p =6.3x10 -14 ), Kaplan-Meier curves differed significantly between HFrEF-PRS quartiles ( p =2.2x10 -6 ), and it remained significant after adjustment for clinical score and NTproBNP (HR=1.37, 95%CI 1.05-1.79, p =0.021). The HFrEF-PRS improved metrics of risk stratification (C-statistic change=0.009, p =0.612; IDI=0.041, p =0.010; NRI=0.391, p =0.078; MIRS=0.039, p =0.016) and associated with cardiovascular death and HF phenotypes (e.g. 6-minute walk distance, EF change). Most HFrEF-PRS proteins had little known connection to HFrEF. Conclusions - A plasma multi-protein score improved risk stratification in HFrEF patients and identified novel candidates.

scholarly journals Global Longitudinal Strain Is a Superior Predictor of All-Cause Mortality in Heart Failure With Reduced Ejection Fraction

2015 ◽  
Vol 8 (12) ◽  
pp. 1351-1359 ◽  
Author(s):  
Morten Sengeløv ◽  
Peter Godsk Jørgensen ◽  
Jan Skov Jensen ◽  
Niels Eske Bruun ◽  
Flemming Javier Olsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Reduced Ejection Fraction ◽  
All Cause Mortality

scholarly journals Septal mitral annular systolic excursion but not global longitudinal strain predicts outcome in non-ischemic heart failure patients with reduced ejection fraction and mild diastolic dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Hu ◽  
C Wagner ◽  
D Liu ◽  
B Lengenfelder ◽  
G Ertl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
All Cause Mortality

Abstract Background Speckle tracking derived global longitudinal strain (GLS) could provide incremental prognostic information over left ventricular ejection fraction (LVEF) in the general population and a variety of cardiovascular diseases. Mitral annular systolic excursion (MAPSE) is a classical echocardiographic index with prognostic implication in patients with various cardiovascular diseases. Present study aimed to test the hypothesis that reduced GLS is superior to MAPSE on predicting all-cause mortality in non-ischemic heart failure patients with reduced ejection fraction. Methods A total of 952 patients with non-ischemic heart failure and reduced LVEF, who referred to our department between 2009 and 2017, were included in this study (mean age: 66±15 years, 68.8% male). All patients underwent a routine transthoracic echocardiography examination at baseline visit. Standard echocardiographic measurements were conducted according to recent guidelines. GLS was derived from the segmental averaging (18-segment) of the three apical views. M-mode MAPSE of septal and lateral walls were obtained from standard apical 4-chamber view. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoint was defined as all-cause mortality or heart transplantation (HTx). Results Over a median follow-up period of 27 (14–40) months, 259 (27.2%) patients died and 9 (0.9%) underwent HTx. MAPSE_septal was significantly lower in non-survivors than in survivors (6 (5–8) vs. 7 (5–8) mm, P=0.009), while LVEF (36% vs. 36%, P=0.927) and GLS (−9.6% vs. −9.8%, P=0.473) were similar between non-survivors and survivors. All-cause mortality was significant higher in patients with MAPSE_septal&lt;5mm than those with MAPSE_septal ≥5mm (34.9% vs. 26.7%, P=0.032). All-cause death increased in proportion with increased severity of diastolic dysfunction (DD, 20.4%, 29.6% and 34.0% in patients with mild, moderate and severe DD, P=0.002). Multivariable Cox regression analysis showed that reduced MAPSE_septal (&lt;5mm, HR=1.451, 95% CI=1.079–1.951, P=0.014) was independently associated with increased all-cause mortality adjusted for clinical confounders including age, sex, NYHA class, atrial fibrillation, diabetes, hyperuricemia, chronic respiratory diseases, sleep disturbance, while MAPSE_lateral, LVEF, and GLS were not outcome determinants in this patient cohort. Subgroup analysis showed that mild DD (n=269), reduced MAPSE_septal were significantly associated with increased all-cause mortality (adjusted HR=3.734, 95% CI=1.850–7.536, P&lt;0.001), while MAPSE_septal was not a risk factor of all-cause mortality in the subgroup of moderate to severe DD (n=667, HR=1.314, P=0.108). Conclusions Septal MAPSE, but not LVEF or GLS, serves as an independent determinant of all-cause mortality in non-ischemic heart failure patients with reduced LVEF and mild diastolic dysfunction. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research

scholarly journals E/E′ Is a New Independent Predictor of Recovered Ejection Fraction in Patients With Systolic Heart Failure Undergoing Ablation for Atrial Fibrillation

2022 ◽  
Vol 8 ◽  
Author(s):  
Minghui Yang ◽  
Rongfeng Zhang ◽  
Huamin Tang ◽  
Guocao Li ◽  
Xumin Guan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Systolic Heart Failure ◽  
Characteristic Analysis ◽  
Reduced Ejection Fraction ◽  
Af Ablation

Aims: Catheter ablation should be considered in patients with atrial fibrillation (AF) and with heart failure (HF) with reduced ejection fraction (EF; HFrEF) to improve survival and reduce heart failure hospitalization. Careful patient selection for AF ablation is key to achieving similar outcome benefits. However, limited data exist regarding predictors of recovered ejection fraction. We aimed to evaluate the predictors of recovered ejection fraction in consecutive patients with HF undergoing AF ablation.Methods and Results: A total of 156 patients [67.3% men, median age 63 (11)] with AF and HF underwent initial catheter ablation between September 2017 and October 2019 in the First Affiliated Hospital of Dalian Medical University. Overall, the percentage of recovered ejection fractions was 72.3%. Recovered EFs were associated with a 39% reduction in all-cause hospitalization compared to non-recovered EFs at the 1-year follow-up [23.8 vs. 62.8 (odds ratio) OR 2.09 (1.40–3.12), P &lt; 0.001]. Univariate analysis for recovered EFs showed that diabetes (P = 0.083), prevalent HF (P = 0.014), prevalent AF (P = 0.051), LVEF (P = 0.022), and E/E′ (P = 0.001) were associated with EF improvement. Multivariate analysis showed that the only independent predictor of EF recovery was E/E′ [OR 1.13 (1.03–1.24); P = 0.011]. A receiver operating characteristic analysis determined that the suitable cut-off value for E/E′ was 15 (sensitivity 38.7%, specificity 89.2%, the area under curve 0.704).Conclusions: Ejection fraction (EF) recovery occurred in 72.3% of patients, associated with a 39% reduction in all-cause hospitalization compared to the non-recovered EFs in our cohort. The only independent predictor of recovered EF was E/E′ &lt; 15 in our series.

scholarly journals Metabolomics and a Breath Sensor Identify Acetone as a Biomarker for Heart Failure

2021 ◽  
Author(s):  
Patrick Alton Gladding ◽  
Renee Young ◽  
Maxine Cooper ◽  
Suzanne Loader ◽  
Kevin Smith ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Solid Phase ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Gas Chromatography Mass Spectrometry ◽  
Cardiac Pathology ◽  
Reduced Ejection Fraction ◽  
Aconitic Acid ◽  
Breath Acetone

Background Multiomics delivers more biological insight than targeted investigations. We applied multiomics to patients with heart failure with reduced ejection fraction (HFrEF). Methods 46 patients with HFrEF and 20 controls underwent metabolomic profiling, including liquid/gas chromatography mass spectrometry (LCMS/GCMS) and solid-phase microextraction (SPME) volatilomics in plasma and urine. HFrEF was defined using left ventricular global longitudinal strain, ejection fraction and NTproBNP. A consumer breath acetone (BrACE) sensor validated results in n=73. Results 28 metabolites were identified by GCMS, 35 by LCMS and 4 volatiles by SPME in plasma and urine. Alanine, aspartate and glutamate, citric acid cycle, arginine biosynthesis, glyoxylate and dicarboxylate metabolism were altered in HFrEF. Plasma acetone correlated with NT-proBNP (r = 0.59, 95% CI 0.4 to 0.7), 2-oxovaleric and cis-aconitic acid, involved with ketone metabolism and mitochondrial energetics. BrACE> 1.5 ppm discriminated HF from other cardiac pathology (AUC 0.8, 95% CI 0.61 to 0.92, P < 0.0001). Conclusion Breath acetone discriminated HFrEF from other cardiac pathology using a consumer sensor, but was not cardiac specific.

scholarly journals Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm

2021 ◽  
Author(s):  
Jae‐Hyeong Park ◽  
In‐Chang Hwang ◽  
Jin Joo Park ◽  
Jun‐Bean Park ◽  
Goo‐Yeong Cho
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Univariate Analysis ◽  
Global Longitudinal Strain ◽  
Significant Risk ◽  
Left Ventricular ◽  
Volume Index ◽  
Increased Risk

Background Stroke is a major comorbidity in patients with heart failure (HF), especially in those with decreased left atrial (LA) function, and thus, identifying patients highly at risk of stroke can prevent its occurrence. We evaluated the predictive value of global longitudinal strain of LA (LAGLS) in patients with acute HF and sinus rhythm. Methods and Results In this retrospective study, 2461 patients (53.3% men, 69.7±14.4 years old) with sinus rhythm and LAGLS among 4312 consecutive patients with acute HF from 3 tertiary hospitals were included. HF phenotypes were defined as HF with reduced ejection fraction (EF) (left ventricular EF ≤40%), HF with midrange EF (40% <left ventricular EF <50%), and HF with preserved ejection fraction (left ventricular EF ≥50%). Primary outcome was new‐onset stroke. The mean left ventricular EF was 39.4%±15.6%. Moreover, 1388 (57.5%), 342 (14.2%), and 682 (28.3%) were classified with HF with reduced EF, HF with midrange EF, and HF with preserved EF, retrospectively. LAGLS was 17.2%±10.4%. During the follow‐up duration (mean: 30.3±25.4 months), 100 patients experienced stroke. Patients with stroke had higher LA diameter ( P =0.031) and lower LAGLS ( P =0.010) than those without stroke. In the univariate analysis, age, diabetes mellitus, LA diameter, LA volume index, and LAGLS were significant risk factors for stroke. In the multivariate analysis, each 1% decrease in LAGLS was associated with a 3.8% increased risk for stroke (hazard ratio [HR], 1.038; 95% CI, 1.013–1.065; P =0.003). When applying a LAGLS cutoff point of 14.5%, patients with LAGLS <14.5% had approximately twice the risk for stroke after adjusting other significant variables (HR, 1.940; 95% CI, 1.269–2.965; P =0.002). Conclusions In patients with acute HF and sinus rhythm, decreased LAGLS (<14.5%) was associated with an increased risk for stroke, with an annual incidence of 2.38%.

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