Clinical significance of Q waves in ischemic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): CIBER-CV AIMS The scintigraphic translation of Q waves in patients with ischemic cardiomyopathy and LVEF < 40% has not yet been assessed. The aim of this study was to explore the relationship between Q waves and necrotic tissue and to analyze their impact in prognosis. METHODS AND RESULTS A retrospective study enrolling 487 consecutive patients (67,0 [57,4 – 75,4] years), with ischemic cardiomyopathy, LVEF <40% and narrow QRS who underwent stress-rest SPECT was conducted. Patients with Q waves (320 patients [65,7%]) had less comorbidity and ischemia, but more necrosis. Q waves correlated poorly with lack of viability (AUC = 0,63) and were independently associated with the subendocardial extent of the necrosis. After a follow-up of 5,07 years, the primary outcome (cardiovascular death, heart failure hospitalization or myocardial infarction) occurred in 192 (39,4%) patients, without differences between groups in multivariate analysis. After accounting for non-cardiovascular death as a competitive risk, the interaction between >10% of ischemia and revascularization remained in Cox model both in the total cohort (aHR= 0,46 [0,24 – 0,86]), and in patients with Q waves (aHR = 0,27 [0,11–0,69]). CONCLUSION Patients with ischemic cardiomyopathy with Q waves have larger subendocardial scarring and more transmural necrosis, although correlation between Q waves and transmural scarring is poor. Revascularization if >10% ischemia is present is associated with a better prognosis. Ischemia burden should be assessed and accordingly treated in these patients, and no differences in management should be made in the presence of Q waves. Table 1. Cox proportional hazards model Total cohort (N = 471) Patients with Q waves (N = 315) aHR p-value 95% CI aHR p-value 95% CI Age (per year) 1,02 0,007 1,01 - 1,04 n.s. Diabetes mellitus 1,35 0,047 1,00 - 1,81 1,54 0,016 1,09 - 2,20 eGFR < 60 ml/min 1,59 0,005 1,15 - 2,21 1,96 <0,001 1,36 - 2,82 Previous HF hospitalization 1,71 0,002 1,23 - 2,38 1,76 0,007 1,17 - 2,64 Previous PCI 1,32 0,069 0,98 - 1,78 n.s. Previous CABG n.s. 1,77 0,009 1,15 - 2,72 Angina or dyspnea 1,68 0,001 1,24 - 2,28 1,71 0,004 1,19 - 2,46 Indexed TDV (per quartile) 1,16 0,047 1,02 - 1,33 n.s. Revascularization*ischemia > 10% 0,46 0,015 0,24 - 0,86 0,27 0,006 0,11 - 0,69 Cox regression for the primary endpoint (cardiovascular death, heart failure hospitalization or myocardial infarction), accounting for non-cardiovascular death as a competitive risk. Abstract Figure. Survival for the primary endpoint

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Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial

European Heart Journal ◽

10.1093/eurheartj/ehaa132 ◽

2020 ◽

Vol 41 (17) ◽

pp. 1673-1683 ◽

Cited By ~ 5

Author(s):

Michael Böhm ◽

João Pedro Ferreira ◽

Felix Mahfoud ◽

Kevin Duarte ◽

Bertram Pitt ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cox Regression ◽

Cardiovascular Death ◽

Left Ventricular ◽

Coronary Perfusion ◽

Increased Risk ◽

The Impact

Abstract Aims The described association of low diastolic blood pressure (DBP) with increased cardiovascular outcomes could be due to reduced coronary perfusion or is simply due to reverse causation. If DBP is physiologically relevant, coronary reperfusion after myocardial infarction (MI) might influence DBP–risk association. Methods and results The relation of achieved DBP with cardiovascular death or cardiovascular hospitalization, cardiovascular death, and all-cause death was explored in 5929 patients after acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial according to their reperfusion status. Cox regression models were used to assess the impact of reperfusion status on the association of DBP and systolic blood pressure (SBP) with outcomes in an adjusted fashion. In patients without reperfusion, lower DBP <70 mmHg was associated with increased risk for all-cause death [adjusted hazard ratios (HRs) 1.80, 95% confidence interval (CI) 1.41–2.30; P < 0.001], cardiovascular death (HR 1.70, 95% CI 1.3–3.22; P < 0.001), cardiovascular death or cardiovascular hospitalization (HR 1.54, 95% CI 1.26–1.87; P < 0.001). In patients with reperfusion, the risk increase at low DBP was not observed. At low SBP, risk increased independently of reperfusion. A sensitivity analysis in the subgroup of patients with optimal SBP of 120–130 mmHg showed again risk reduction of reperfusion at low DBP. Adding the treatment allocation to eplerenone or placebo into the models had no effects on the results. Conclusion Patients after AMIs with a low DBP had an increased risk, which was sensitive to reperfusion therapy. Low blood pressure after MI identifies in patients with particular higher risk. These data support the hypothesis that low DBP in patients with stenotic coronary lesions is associated with risk, potentially involving coronary perfusion pressure and the recommendations provided by guidelines suggesting lower DBP boundaries for these high-risk patients.

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Effectiveness of telemedicine in patients with heart failure according to frailty phenotypes: insights from the iCOR randomised controlled trial

European Heart Journal ◽

10.1093/eurheartj/ehab724.3099 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Yun Viladomat ◽

C Enjuanes Grau ◽

E Calero Molina ◽

E Hidalgo Quiros ◽

N Jose Bazan ◽

...

Keyword(s):

Heart Failure ◽

Primary Endpoint ◽

Cox Regression ◽

Controlled Trial ◽

Cox Proportional Hazards ◽

P Value ◽

Post Discharge ◽

Secondary Endpoints ◽

Positive Effect

Abstract Background/Introduction The potential impact of telemedicine (TM) in the monitoring of heart failure (HF) patients is still uncertain, largely due to the heterogeneity of the studies published to date. A subgroup of patients in which its key role is particularly uncertain is that of the frailest patients mainly due to TM-based strategies have been often discouraged on the basis of a foreseeable limited benefit in them. Purpose The aim of this study was to define the efficacy of a TM-based managed care solution across different HF patient frailty phenotypes in a cohort of HF patients recruited in a randomized clinical trial (The Insuficiència Cardíaca Optimitzaciό Remota [iCOR] study) evaluating the efficacy of a TM-based management compared to usual care (UC) in the early post-discharge period. Methods Five previously described frailty clusters were analysed. Cox proportional-hazards regression models were used to evaluate the effect of each cluster and group of treatment (and its interaction) on a series of endpoints (the incidence of non-fatal HF events as primary endpoint and all-cause hospitalization, all-cause death and the composite endpoint combining of all-cause death or non-fatal HF events as secondary endpoints). The incidence proportion of the first occurrence of each of the study endpoints was calculated for each study arm and for cluster, and these compared using χ2 tests. Additionally, a survival analysis was conducted using Cox regression to describe the event-free survival experience of the combination of the clusters with each of the 2 treatment groups for the study endpoints evaluated, and p-value was used to compare the different curves. Results The positive effect of TM compared to UC strategy was consistent across all frailty phenotypes (p-value for interaction 0.711). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC (p-value=0.016). As shown for the primary endpoint, the positive effect of TM compared to UC strategy was consistent across all frailty phenotypes also for the secondary endpoints (all p-value for interaction >0.05). Likewise, the risk of all-cause hospitalization or the composite end-point of all-cause death or non-fatal HF event was significantly lower in patients that underwent allocation to the TM arm compared to UC (p-value=0.030 and 0.016 respectively). However, the risk of all-cause death did not differ across subgroup strata (p-value>0.05). Conclusion(s) This study showed that non-invasive TM-based follow-up tools are effective compared to UC in preventing fatal and non-fatal adverse events in the early post-discharge period, regardless of the 5 different frailty phenotypes. Importantly, when comparing TM-based follow-up with UC management in patients belonging to equal frailty cluster, those who were followed-up by eHealth had a considerably lower risk of non-fatal HF events, hospitalization or death. FUNDunding Acknowledgement Type of funding sources: None. Cox regression non-fatal HF events Cox regression all-cause hospitalization

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Factors predicting adverse cardiovascular outcomes in patients with atrial fibrillation and heart failure with preserved ejection fraction

EP Europace ◽

10.1093/europace/euab116.125 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

S Saksena ◽

APRIL Slee ◽

D Lakkireddy ◽

DIPEN Shah ◽

LUIGI Di Biase ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Ejection Fraction ◽

Cox Model ◽

Cardiovascular Death ◽

Adverse Outcomes ◽

P Value ◽

Preserved Ejection Fraction ◽

Pump Failure

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Electrophysiology Research Foundation Introduction Atrial fibrillation (AF) is known to impact cardiovascular(CV) mortality in heart failure (HF) patients (pts) with preserved ejection fraction (pEF) but its exact causes are unknown. Methods We analyzed demographic, clinical, ECG and AF presentation as predictors of CV mortality, sudden death( SCD) and pump failure death(PFD) in HFpEF pts in the TOPCAT AMERICAS trial. We analyzed two AF presentations 1. Pts in sinus rhythm (SR, n = 1319) compared to AF on ECG (n = 446) at entry or 2. Pts with no AF event by history or ECG ( n = 1007 ) to those with any AF event (n = 760 ). Results (Table): 5 year (yr) CV mortality was higher in pts with AF on ECG (30%) than SR (18%, p = 0.014) but 5 yr SCD was (10% in AF on ECG & 7% in any AF) & comparable to SR (7% & 9% respectively, p = ns). 5 yr PFD was higher in AF on ECG (13%) than SR (5%, p = 0.007) Conclusions : 1. CV death risk in HFpEF pts increased with AF on ECG.. 2. SCD was not more frequent with both AF presentations 3. PFD in HFpEF increased with age, ECG recorded AF & elevated heart rate. 4. The recording of AF on ECG was more strongly associated with CV death & PFD, possibly due to greater AF burden . Predictors of adverse outcomes in HFpEF AF on ECG* Any AF* Endpoint Covariate HR (95% CI) p-value HR (95% CI) p-value Time to cardiovascular death Atrial Fibrillation* 1.44 (1.08, 1.92) 0.014 1.15 (0.87, 1.51) 0.338 Age (years) 1.03 (1.02, 1.05) <.001 1.03 (1.02, 1.05) <.001 Black/AA (vs. White) 0.97 (0.65, 1.46) 0.002 0.96 (0.64, 1.44) 0.004 Other race (vs. White) 2.41 (1.46, 3.99) 2.32 (1.41, 3.83) Smoking 2.62 (1.63, 4.20) <.001 2.60 (1.62, 4.17) <.001 Diabetes 1.47 (1.12, 1.94) 0.006 1.45 (1.10, 1.91) 0.009 Systolic BP (mmHg) 0.99 (0.98, 1.00) 0.022 0.99 (0.98, 1.00) 0.014 Heart rate (bpm) 1.02 (1.00, 1.03) 0.012 1.02 (1.01, 1.03) 0.006 Time to Any sudden cardiac death Atrial Fibrillation* 1.17 (0.69, 1.96) 0.563 0.85 (0.53, 1.35) 0.484 Female (vs. Male) 0.46 (0.28, 0.75) 0.002 0.46 (0.28, 0.74) 0.002 Black/AA (vs. White) 1.57 (0.87, 2.82) 0.194 1.49 (0.83, 2.69) <.001 Other race (vs. White) 1.76 (0.70, 4.41) 1.70 (0.68, 4.25) Diabetes 1.70 (1.07, 2.70) 0.024 1.65 (1.04, 2.62) 0.033 Time to pump failure death Atrial Fibrillation* 2.04 (1.22, 3.42) 0.007 1.62 (0.96, 2.75) 0.074 Age (years) 1.06 (1.03, 1.10) <.001 1.06 (1.03, 1.10) <.001 Heart rate (bpm) 1.03 (1.00, 1.05) 0.034 1.03 (1.01, 1.05) 0.015 Cox model of covariates associated with outcomes adjusted for baseline imbalances

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Left ventricular trabeculation and major adverse cardiovascular events: the Copenhagen General Population Study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa110 ◽

2020 ◽

Vol 22 (1) ◽

pp. 67-74 ◽

Cited By ~ 2

Author(s):

Per E Sigvardsen ◽

Andreas Fuchs ◽

Jørgen T Kühl ◽

Shoaib Afzal ◽

Lars Køber ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

General Population ◽

Population Study ◽

Primary Endpoint ◽

Cardiovascular Events ◽

Cox Regression ◽

Left Ventricular ◽

Major Adverse Cardiovascular Events ◽

General Population Study

Abstract Aims Prominent left ventricular trabeculations is a phenotypic trait observed in cardiovascular diseases. In the general population, the extent of left ventricular trabeculations is highly variable, yet it is unknown whether increased trabeculation is associated with adverse outcome. Methods and results Left ventricular trabeculated mass (g/m2) was measured with contrast-enhanced cardiac computed tomography in 10 097 individuals from the Copenhagen General Population Study. The primary endpoint was a composite of major adverse cardiovascular events and defined as death, heart failure, myocardial infarction, or stroke. The secondary endpoints were the individual components of the primary endpoint. Cox regression models were adjusted for clinical parameters, medical history, electrocardiographic parameters, and cardiac chamber sizes. The mean trabeculated mass was 19.1 g/m2 (standard deviation 4.9 g/m2). During a median follow-up of 4.0 years (interquartile range 1.5–6.7), 710 major adverse cardiovascular events occurred in 619 individuals. Individuals with a left ventricular trabeculated mass in the highest quartile had a hazard ratio for major adverse cardiovascular events of 1.64 [95% confidence interval (CI) 1.30–2.08; P < 0.001] compared to those in the lowest quartile. Corresponding hazard ratios were 2.08 (95% CI 1.38–3.14; P < 0.001) for death, 2.63 (95% CI 1.61–4.31; P < 0.001) for heart failure, 1.08 (95% CI 0.56–2.08; P = 0.82) for myocardial infarction, and 1.07 (95% CI 0.72–1.57; P = 0.74) for stroke. Conclusion Increased left ventricular trabeculation is independently associated with an increased rate of major adverse cardiovascular events in the general population.

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Cardiovascular outcomes in patients who experienced a myocardial infarction while treated with liraglutide versus placebo in the LEADER trial

Diabetes and Vascular Disease Research ◽

10.1177/1479164118783935 ◽

2018 ◽

Vol 15 (5) ◽

pp. 465-468 ◽

Cited By ~ 10

Author(s):

Michael A Nauck ◽

Karen Tornøe ◽

Søren Rasmussen ◽

Marianne Bach Treppendahl ◽

Steven P Marso

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Confidence Interval ◽

Animal Studies ◽

Cox Regression ◽

Myocardial Necrosis ◽

Composite Endpoint ◽

Cardiovascular Death ◽

Cardiovascular Outcomes ◽

Hazard Ratio

Objective: Animal studies demonstrated that glucagon-like peptide-1 receptor agonists reduce myocardial necrosis following regional ischaemia induction. This effect may improve cardiovascular outcomes after myocardial infarction. Risk of cardiovascular death or hospitalisation for heart failure after myocardial infarction was evaluated in patients with type 2 diabetes at high cardiovascular risk in the LEADER trial. Methods: Data from patients randomised to liraglutide or placebo, in addition to standard of care, in Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) (NCT01179048) were analysed post hoc. Cox regression, with myocardial infarction as a time-dependent covariate, was used to analyse time from randomisation to a composite of cardiovascular death or hospitalisation for heart failure. Results: Patients who experienced myocardial infarction had a sevenfold higher risk of the composite endpoint (with myocardial infarction: n = 148, 25.0%; without myocardial infarction: n = 716, 8.2%; hazard ratio: 7.0; 95% confidence interval: 5.8, 8.4). The risk of the composite endpoint after myocardial infarction was not significantly lower in the liraglutide group ( n = 63, 23.0%) compared with placebo ( n = 85, 26.7%; hazard ratio: 0.91; 95% confidence interval: 0.66, 1.26). Conclusion: The data demonstrated that having myocardial infarction significantly increased the risk of subsequent cardiovascular death or hospitalisation for heart failure. However, we did not find evidence for a reduced risk in these cardiovascular outcomes following myocardial infarction in patients treated with liraglutide versus placebo.

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Human epididymis protein 4: a novel predictor of ischemic cardiomyopathy

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02319-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yi Tang ◽

Yinzhen Wang ◽

Xiaoping Xu ◽

Laura Yan Tu ◽

Pei Huang ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Events ◽

Ischemic Cardiomyopathy ◽

Cox Regression ◽

Independent Predictor ◽

Cardiovascular Death ◽

Human Epididymis Protein 4 ◽

Cox Regression Analysis ◽

Human Epididymis

Abstract Background The prognostic value of human epididymis protein 4 (HE4) in patients with ischemic cardiomyopathy (ICM) is unknown. Methods A total of 103 patients with ICM were prospectively enrolled in this study from Hunan Provincial People’s Hospital between February 2019 and June 2019. All patients were tested for HE4 levels at baseline and follow-up. Endpoints of the study included cardiovascular death and heart failure-related hospitalization. Results A total of 96 patients with ICM were included for analysis. After a mean follow-up period of 263 (153–313) days, cardiovascular events were observed in 45 patients. Serum HE4 levels in patients with events were significantly higher than those in patients without events [188.70 (113.35–326.82) pmol/L versus 92.90 (61.50–123.20) pmol/L, P < 0.001]. Multivariate Cox regression analysis revealed that HE4 [χ2: 9.602, hazard ratio (HR): 1.003, 95% confidence interval (CI): 1.001–1.005, P = 0.002] and age [χ2: 4.55, HR: 1.044, 95% CI: 1.003–1.085, P = 0.033] were independent predictors of events. After adjusting for age and sex, the risk of events in patients with HE4 > 100.2 pmol/L was higher than that in patients with HE4 ≤ 100.2 pmol/L [HR: 3.372, 95% CI: 1.409–8.065, P < 0.001]. Conclusion HE4 is an independent predictor of cardiovascular death and heart failure-related rehospitalization in patients with ICM.

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Predicting long-term cardiovascular outcomes of patients with acute myocardial infarction using soluble ST2

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2019-0062 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Mustafa Umut Somuncu ◽

Belma Kalayci ◽

Ahmet Avci ◽

Tunahan Akgun ◽

Huseyin Karakurt ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cox Regression ◽

High Serum ◽

Major Adverse Cardiovascular Events ◽

Lower Systolic Blood Pressure ◽

Cox Regression Analysis ◽

Killip Class ◽

Target Vessel Revascularization

AbstractBackgroundThe increase in soluble suppression of tumorigenicity 2 (sST2) both in the diagnosis and prognosis of heart failure is well established; however, existing data regarding sST2 values as the prognostic marker after myocardial infarction (MI) are limited and have been conflicting. This study aimed to assess the clinical significance of sST2 in predicting 1-year adverse cardiovascular (CV) events in MI patients.Materials and methodsIn this prospective study, 380 MI patients were included. Participants were grouped into low sST2 (n = 264, mean age: 60.0 ± 12.1 years) and high sST2 groups (n = 116, mean age: 60.5 ± 11.6 years), and all study populations were followed up for major adverse cardiovascular events (MACE) which are composed of CV mortality, target vessel revascularization (TVR), non-fatal reinfarction, stroke and heart failure.ResultsDuring a 12-month follow-up, 68 (17.8%) patients had MACE. CV mortality and heart failure were significantly higher in the high sST2 group compared to the low sST2 group (15.5% vs. 4.9%, p = 0.001 and 8.6% vs. 3.4% p = 0.032, respectively). Multivariate Cox regression analysis concluded that high serum sST2 independently predicted 1-year CV mortality [hazard ratio (HR) 2.263, 95% confidence interval (CI) 1.124–4.557, p = 0.022)]. Besides, older age, Killip class >1, left anterior descending (LAD) as the culprit artery and lower systolic blood pressure were the other independent risk factors for 1-year CV mortality.ConclusionsHigh sST2 levels are an important predictor of MACE, including CV mortality and heart failure in a 1-year follow-up period in MI patients.

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Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.2008 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Polimeni

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Primary Endpoint ◽

Cardiovascular Death ◽

Volume Index ◽

Valve Repair ◽

Percutaneous Valve Repair ◽

Percutaneous Valve

Abstract Background Percutaneous mitral valve repairs has been increasingly performed worldwide. The MITRA-UMG registry provides a snapshot of a real-world clinical data and outcomes. Purpose We sought to investigate predictors of clinical outcomes in patients with mitral regurgitation undergoing percutaneous valve repair. Methods The MITRA-UMG registry retrospectively collected data from consecutive patients with symptomatic moderate-to-severe or severe MR underwent MitraClip implantation. The primary endpoint of interest was the composite of cardiovascular death or rehospitalization for HF. Results Between March 2012 and July 2018, a total of 133 consecutive patients admitted to our institution were included. Acute procedural success was obtained in 95.4% of patients, with no intraprocedural death. The composite primary endpoint of cardiovascular death or rehospitalization for heart failure was met in 50 patients (38%) with cumulative incidences of 7%, 25%, at 30 days and 1 year, respectively. In the Cox multivariate model, NYHA functional class IV, left ventricular end-diastolic volume index (LVEDVi), Euroscore II, independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan-Meier analysis, a LVEDVi >92 ml/m2 was associated with an increased incidence of the primary endpoint. Conclusions In searching the ideal phenotype of patients who benefit most of percutaneous mitral valve repair, those presenting with severely dilated ventricles (LVEDVi >92 ml/m2), high operative risk (EUROSCORE II >7%) or advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis at long-term. Funding Acknowledgement Type of funding source: None

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Mortality in patients with atrial fibrillation with or without heart failure following hospital discharge

European Heart Journal ◽

10.1093/ehjci/ehaa946.0362 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Kartas ◽

A Samaras ◽

D Vasdeki ◽

G Dividis ◽

G Fotos ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Primary Endpoint ◽

Cox Regression ◽

Cross Sectional ◽

Tertiary Center ◽

All Cause Mortality ◽

Endpoint Event ◽

Secondary Endpoints ◽

Sectional Analysis

Abstract Background The association of heart failure (HF) with the prognosis of atrial fibrillation (AF) remains unclear. OBJECTIVES To assess all-cause mortality in patients following hospitalization with comorbid AF in relation to the presence of HF. Methods We performed a cross-sectional analysis of data from 977 patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018 and followed for a median of 2 years. The association between HF and the primary endpoint of death from any cause was assessed using multivariable Cox regression. Results HF was documented in 505 (51.7%) of AF cases at discharge, including HFrEF (17.9%), HFmrEF (16.5%) and HFpEF (25.2%). A primary endpoint event occurred in 212 patients (42%) in the AF-HF group and in 86 patients (18.2%) in the AF-no HF group (adjusted hazard ratio [aHR] 2.27; 95% confidence interval [CI], 1.65 to 3.13; P<0.001). HF was associated with a higher risk of the composite secondary endpoint of death from any cause, AF or HF-specific hospitalization (aHR 1.69; 95% CI 1.32 to 2.16 p<0.001). The associations of HF with the primary and secondary endpoints were significant and similar for AF-HFrEF, AF-HFmrEF, AF-HFpEF. Conclusions HF was present in half of the patients discharged from the hospital with comorbid AF. The presence of HF on top of AF was independently associated with a significantly higher risk of all-cause mortality than did absence of HF, irrespective of HF subtype. Funding Acknowledgement Type of funding source: None

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Twin peaks diversity with sacubitril/valsartan treatment responses in cardiomyopathic heart failure patients of non-ischemic compared to ischemic etiologies

European Heart Journal ◽

10.1093/ehjci/ehaa946.1056 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H.Y Chang ◽

W.R Chiou ◽

P.L Lin ◽

C.Y Hsu ◽

C.T Liao ◽

...

Keyword(s):

Heart Failure ◽

Primary Endpoint ◽

Ischemic Cardiomyopathy ◽

Ventricular Remodeling ◽

Left Ventricular Ejection ◽

Funding Source ◽

Heart Failure Patients ◽

Twin Peaks ◽

All Cause Mortality

Abstract Background Ischemic cardiomyopathy (ICM) has been associated with increased mortality when compared with non-ischemic cardiomyopathy (NICM) from several heart failure (HF) cohorts. Instead, PARADIGM study demonstrated similar event rates of cardiovascular (CV) death, all-cause mortality and HF readmissions between ICM and NICM patients. Although the beneficiary effect of sacubitril/valsartan (SAC/VAL) compared to enalapril on these endpoints was consistent across etiologic categories, PARADIGM study did not analyze the effect of ventricular remodeling of SAC/VAL on patients with different HF etiologies, which may significantly affect treatment outcomes. Purpose We aim to compare alterations of left ventricular ejection fraction (LVEF) following SAC/VAL treatment and its association with clinical outcomes in patients with different HF etiologies. Methods Treatment with angiotensin receptor neprilysin inhibitor for Taiwan heart failure patients (TAROT-HF) study is a multicenter study which enrolled 1552 patients with LVEF <40%, whom had been on SAC/VAL treatment from 9 hospitals between 2017 and 2018. After excluding patients without having follow-up echocardiographic studies, patients were grouped by HF etiologies and by LVEF changes following treatment for 8-month period. LVEF improvement ≥15% was defined as “significant improvement”, 5–15% as “marginal improvement”, and <5% or worse as “lack of improvement”. The primary endpoint was a composite of CV death or a first hospitalization for HF. Mean follow-up period was 726 days. Results A total of 1230 patients were analyzed. Patients with ICM were significantly older, more male, and prone to have associated hypertension and diabetes. On the other hand, patients with NICM had lower LVEF and higher likelihood of atrial fibrillation. LVEF increase was significantly greater in patients with NICM compared to those with ICM (11.2±12.4% vs. 6.9±9.8, p<0.001). The effect of ventricular remodeling of SAC/VAL on patients with NICM showed twin peaks diversity (Significant improvement 37.1%, lack of improvement 42.3%), whereas in patients with ICM the proportions of significant, marginal and lack of improvement groups were 19.4%, 28.2% and 52.4%, respectively. The primary endpoint showed twin peaks diversity also in patients with NICM in line with LVEF changes: adjusted HR for patients with NICM and significant improvement was 0.41 (95% CI 0.29–0.57, p<0.001), for patients with NICM and lack of improvement was 1.54 (95% CI 1.22–1.94, p<0.001). Analyses for CV death, all-cause mortality, and HF readmission demonstrated consistent results. Conclusion Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients may indicate favorable outcome. NICM patients without response to SAC/VAL treatment should serve as an indicator for poor clinical outcome and warranted meticulous HF management. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Cheng Hsin General Hospital

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