scholarly journals P1580 Global regurgitant volume - approaching the critical mass in valvular-driven heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Spinka ◽  
P Bartko ◽  
H Arfsten ◽  
G Heitzinger ◽  
N Pavo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Critical Mass ◽  
Regurgitant Volume ◽  
All Cause Mortality ◽  
Convergence Method ◽  
Flow Convergence ◽  
Increasing Risk ◽  
Valve Lesions

Abstract Aims Recent progress in the diagnosis of functional valve regurgitation forms a coherent perception of severity thresholds by quantitative assessment. However, thresholds focused on either valve in isolation -not accounting for the global hemodynamic burden arising from concomitant functional regurgitation of the mitral and tricuspid valves. We sought to determine whether the global regurgitant volume is associated with adverse cardiac remodeling and mortality. Methods and results This long-term observational study included 414 patients on guideline-directed medical therapy. Baseline global regurgitant load defined as the sum of mitral and tricuspid regurgitant volume was assessed by the proximal flow convergence method. All-cause mortality during five years follow-up served as the primary endpoint. The median global regurgitant load was 30ml (IQR 15-49) with 67% accounting for mitral and 33% accounting for tricuspid regurgitant volume. The global regurgitant load had significant impact on outcome with a crude HR of 1.46 (1.28-1.66; P < 0.001) for a 1-SD increase in global regurgitant volume, results that remained virtually unchanged after bootstrap or clinical confounder-based adjustment (P < 0.001 for adjusted models). Spline curve analysis showed a linearly increasing risk with a threshold of 50ml and sustained increasing risk thereafter. Conclusions The present study demonstrates the detrimental effect of the global regurgitant load in patients with HFrEF. The threshold where heart failure is driven by the valve lesions is a global regurgitant volume of 50ml with continuously increasing risk beyond that threshold. Future studies need to address whether an attempt to reduce the global regurgitant volume can improve outcome. Abstract P1580 Figure 1 - Global RegVol

Global regurgitant volume: approaching the critical mass in valvular-driven heart failure

2019 ◽  
Author(s):  
Philipp E Bartko ◽  
Henrike Arfsten ◽  
Gregor Heitzinger ◽  
Noemi Pavo ◽  
Georg Spinka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Critical Mass ◽  
Regurgitant Volume ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Convergence Method ◽  
Flow Convergence ◽  
Increasing Risk

Abstract Aims Recent progress in the diagnosis of functional valve regurgitation forms a coherent perception of severity thresholds by quantitative assessment. However, thresholds focused on either valve in isolation—not accounting for the global haemodynamic burden arising from concomitant functional regurgitation of the mitral and tricuspid valves. We sought to determine whether the global regurgitant volume is associated with adverse cardiac remodelling and mortality. Methods and results This long-term observational study included 414 patients on guideline-directed medical therapy. Baseline global regurgitant load defined as the sum of mitral and tricuspid regurgitant volume was assessed by the proximal flow convergence method. All-cause mortality during 5 years follow-up served as the primary endpoint. The median global regurgitant load was 30 mL (interquartile range 15–49) with 67% accounting for mitral and 33% accounting for tricuspid regurgitant volume. The global regurgitant load had significant impact on outcome with a crude hazard ratio of 1.46 (1.28–1.66; P < 0.001) for a 1-SD increase in global regurgitant volume, results that remained virtually unchanged after bootstrap or clinical confounder-based adjustment (P < 0.001 for adjusted models). Spline curve analysis showed a linearly increasing risk with a threshold of 50 mL and sustained increasing risk thereafter. Conclusions The present study demonstrates the detrimental effect of the global regurgitant load in patients with heart failure with reduced ejection fraction. The threshold where heart failure is driven by the valve lesions is a global regurgitant volume of 50 mL with continuously increasing risk beyond that threshold. Future studies need to address whether an attempt to reduce the global regurgitant volume can improve outcome.

scholarly journals Long-Term and Short-Term Prognostic Value of Circulating Soluble Suppression of Tumorigenicity-2 Concentration in Chronic Heart Failure: A Systematic Review and Meta-Analysis

Cardiology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Guoqi Dong ◽  
Hao Chen ◽  
Hongru Zhang ◽  
Yihuang Gu
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Prognostic Value ◽  
Web Of Science ◽  
Meta Analysis ◽  
Short Term ◽  
Prisma Statement ◽  
All Cause Mortality ◽  
Increasing Risk

<b><i>Introduction:</i></b> Soluble suppression of tumorigenicity-2 (sST2) has been considered as a prognostic factor of cardiovascular disease. However, the prognostic value of sST2 concentration in chronic heart failure remains to be summarized. <b><i>Methods:</i></b> We searched PubMed, Embase, and Web of Science for eligible studies up to January 1, 2020. Data extracted from articles and provided by authors were used in agreement with the PRISMA statement. The endpoints were all-cause mortality (ACM), cardiovascular mortality (CVM)/heart failure-related hospitalization (HFH), and all-cause mortality (ACM)/heart failure-related readmission (HFR). <b><i>Results:</i></b> A total of 11 studies with 5,121 participants were included in this analysis. Higher concentration of sST2 predicted the incidence of long-term ACM (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.02–1.04), long-term ACM/HFR (HR: 1.42, CI: 1.27–1.59), and long-term CVM/HFH (HR: 2.25, CI: 1.82–2.79), regardless of short-term ACM/HFR (HR: 2.31, CI: 0.71–7.49). <b><i>Conclusion:</i></b> Higher sST2 concentration at baseline is associated with increasing risk of long-term ACM, ACM/HFR, and CVM/HFH and can be a tool for the prognosis of chronic heart failure.

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: &lt;120mmHg, ≥120mmHg and &lt;130mmHg, ≥130mmHg and &lt;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 &lt;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 &lt;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)

P1885Cha2ds-2vasc score lacks of ability to predict mortality in patients attending the emergency department with atrial fibrillation in the presence of troponin i

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M I Gonzalez Del Hoyo ◽  
G Cediel ◽  
A Carrasquer ◽  
G Bonet ◽  
K Vasquez-Nunez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Regression Analysis ◽  
Troponin I ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
All Cause Mortality

Abstract Background CHA2DS2-VASc score has been used as a surrogate marker for predicting outcomes beyond thromboembolic risk in patients with atrial fibrillation (AF). Likewise, cardiac troponin I (cTnI) is a predictor of mortality in AF. Purpose This study aimed to investigate the association of cTnI and CHA2DS2-VASc score with long-term prognosis in patients admitted to the emergency department with AF. Methods A retrospective cohort study conducted between January 2012 and December 2013, enrolling patients admitted to the emergency department with AF and having documented cTnI measurements. CHA2DS2-VASc score was estimated. Primary endpoint was 5-year all-cause mortality, readmission for heart failure (HF), readmission for myocardial infarction (MI) and the composite end point of major adverse cardiac events defined as death, readmission for HF or readmission for MI (MACE). Results A total of 578 patients with AF were studied, of whom 252 patients had elevated levels of cTnI (43.6%) and 334 patients had CHA2DS2-VASc score >3 (57.8%). Patients with elevated cTnI tended to be oldercompared with those who did not have cTnI elevation and were more frequently comorbid and of higher ischemic risk, including hypertension, prior MI, prior HF, chronic renal failure and peripheral artery disease. The overall median CHA2DS2-VASc score was higher in those with cTnI elevation compared to those patients elevated cTnI levels (4.2 vs 3.3 points, p<0.001). Main diagnoses at hospital discharge were tachyarrhythmia 30.3%, followed by heart failure 17.7%, respiratory infections 9.5% and acute coronary syndrome 7.3%. At 5-year follow-up, all-cause death was significantly higher for patients with cTnI elevation compared with those who did not have cTnI elevation (56.4% vs. 27%; logrank test p<0.001). Specifically, for readmissions for HF and readmissions for MI there were no differences in between patients with or without cTnI elevation. In addition, MACE was reached in 165 patients (65.5%) with cTnI elevation, compare to 126 patients (38.7%) without cTnI elevation (p<0.001). On multivariable Cox regression analysis, cTnI elevation was an independent predictor of all-cause death (hazard ratio, 1.67, 95% confidence interval [CI]: 1.24–2.26, p=0.001) and of MACE (hazard ratio 1.47, 95% confidence interval 1.15–1.88; P=0.002), but it did not reach statistical significance for readmissions for MI and readmissions for HF. CHA2DS2-VASc score was a predictor on univariate Cox regression analysis for each endpoint, but it did not reach significance on multivariable Cox regression analysis for any endpoint. Conclusions cTnI is independently associated with long-term all-cause mortality in patients attending the emergency department with AF. cTnI compared to CHA2DS2-VASc score is thus a biomarker with predictive capacity for mortality in late follow-up, conferring utility in the risk stratification of patients with atrial fibrillation.

scholarly journals Long‐Term Imaging Evolution and Clinical Prognosis Among Patients With Acute Penetrating Aortic Ulcers: A Retrospective Observational Study

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Lin Yang ◽  
Quan‐Yu Zhang ◽  
Xiao‐Zeng Wang ◽  
Xin Zhao ◽  
Xuan‐Ze Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Adverse Events ◽  
Aortic Rupture ◽  
Cerebral Stroke ◽  
Bleeding Events ◽  
Clinical Prognosis ◽  
All Cause Mortality ◽  
Related Mortality

Background Acute penetrating aortic ulcers (PAUs) are reported to dynamically evolve into different clinical outcomes ranging from regression to aortic rupture, but no practice guidelines are available in China. Methods and Results All 109 patients with acute PAUs were monitored clinically. At 30 days follow‐up, 31 patients (28.44%) suffered from aortic‐related adverse events, a composite of aortic‐related mortality, aortic dissection, or an enlarged ulcer. In addition, 7 (6.42%) patients had clinically related adverse events, including all‐cause mortality, cerebral stroke, nonfatal myocardial infarction, acute heart failure alone or acute exacerbation of chronic heart failure, acute renal failure, arrhythmia, and bleeding events. In the present study, the intervention criteria for the Chinese PAU population included a PAU diameter of 12.5 mm and depth of 9.5 mm. The multivariate analysis showed that an ulcer diameter >12.5 mm (hazard ratio [HR], 3.846; 95% CI, 1.561–9.476; P =0.003) and an ulcer depth >9.5 mm (HR, 3.359; 95% CI, 1.505–7.494; P =0.003) were each independent predictors of aortic‐related events. Conclusions Patients with acute PAUs were at high risk for aortic‐related adverse events and clinically related adverse events within 30 days after onset. Patients with an ulcer diameter >12.5 mm or an ulcer depth >9.5 mm have a higher risk for disease progression, and early intervention may be recommended.

scholarly journals Impact of female sex in transcatheter aortic valve replacement. Long-term outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Gambo Ruberte ◽  
B Peiro Aventin ◽  
T Simon Paracuellos ◽  
D Gomez Martin ◽  
A Perez Guerrero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Long Term Outcomes ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Introduction Women comprise ≥50% patients undergoing transcatheter aortic valve replacement (TAVR). Women have different baseline clinical characteristics and some studies have suggested that TAVR procedure carries better results and prognosis. Purpose Evaluate gender differences in baseline characteristics and long-term outcomes in patients with aortic stenosis undergoing TAVR. Methods A cohort study was conducted. Consecutive patients underwent TAVR from January 2012 to December 2020 were included. Clinical and follow-up characteristics were recorded. MACE (major adverse cardiovascular events including all-cause mortality, myocardial infarction, cerebrovascular accident and heart failure hospitalization) as primary outcome was searched. Results A total of 292 consecutive patients were included. 48.95% were women and median age was 81.07 years (77.73–86.22). 77% TAVR patients received self-expanding prosthesis. Compared with men, women were significantly older and had lower glomerular filtration rate but a lower prevalence of comorbid conditions, such as atrial fibrillation (AF), coronary and peripheral arterial disease (PAD) and cerebrovascular disease. Left ventricular ejection fraction (LVEF) was higher in women. Global baseline characteristics and events at follow-up are summarized in figure 1. At a median follow up of 21.30 (8.52–38.94) months, MACE were lower in women (Odds ratio [OR] 0.60 95% CI: 0.36–1.00). Additionally, women showed lower rates of heart failure hospitalizations (OR 0.34 95% CI 0.16–0.70). There were no statistically significant differences in all-cause mortality. Survival curves for the endpoint of heart failure hospitalizations are represented in figure 2, showing a significant difference between men and women, and demonstrating that the latter present fewer events during follow-up (HR 0.42 95% CI 0.21–0.83). Conclusion In our study, female TAVR recipients had better outcomes than men. The possible reasons for this female-sex-related benefit could be due to better LVEF and fewer comorbidities. Understanding the reasons why men have worse prognostic post-TAVR is essential for guarantee appropriate treatment selection, as well as for achieving the best possible long-term and safety outcomes. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Myocardial Work and long-term prognosis in patients after ST-segment elevation acute myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Timoteo ◽  
L Moura Branco ◽  
A Galrinho ◽  
T Mano ◽  
P Rio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Global Longitudinal Strain ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Elevation Acute Myocardial Infarction

Abstract Background Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction (LVEF) in patients with ST-segment-elevation acute myocardial infarction. However, LV global longitudinal strain (GLS) does not take into consideration the effect of afterload. Myocardial work (MW) by speckle-tracking echocardiography integrates blood pressure measurements (afterload) with LV GLS and it has been recently demonstrated that Global Work Efficiency (GWE) is associated with long-term all-cause mortality. It remains to be demonstrated if MW indices are associated with hard cardiovascular endpoints. The present study aimed to investigate the prognostic value of global LV MW obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction. Methods A total of 100 consecutive ST-segment-elevation myocardial infarction patients (mean age, 61±12 years; 75% men) that survived to discharge were retrospectively analysed. LVEF, GLS and all LVMW indices were measured by transthoracic echocardiography before discharge (4.6±2.0 days after admission). All patients had at least a two-year follow-up (mean follow-up of 833±172 days). Outcomes: all-cause mortality, major acute cardiovascular events (a composite of cardiovascular mortality, myocardial infarction, stroke, unplanned cardiovascular admission) and heart failure hospitalization. Results In the two-year follow-up, 6 patients died, there were 17 patients with MACE, and 3 patients were hospitalized with heart failure. We confirmed that for all-cause mortality, GWE showed higher discrimination, compared to GLS (Table 1), with a cut-off of 83% (log-rank &lt;0,001). For MACE, the performance of all methods is suboptimal, with an AUC &lt;0.65 for all variables, except for GLS. For heart failure admission, performance is slightly better, but GLS is still the better parameter to predict this event. Conclusions LVGWE is a better predictor of all-cause mortality compared to GLS, but MW indices failed to demonstrate a prognostic impact in long-term cardiovascular events. Prospective studies are warranted to confirm this finding. FUNDunding Acknowledgement Type of funding sources: None. Table 1

P5453Cardiorenal biomarker N-acteyl-beta-D-glucosaminidase (NAG) potentially predicts mortality in chronic heart failure - A 10 year follow up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A D Schober ◽  
C Strack ◽  
S Bauer ◽  
U Hubauer ◽  
A L Schober ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Kidney Injury ◽  
Secondary Endpoint ◽  
Youden Index ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Prospective Longitudinal

Abstract Background The strong relation between chronic heart failure (CHF) and chronic kidney disease (CKD) is well known as cardiorenal syndrome (CRS). The current study focused on the impact of novel markers of kidney injury next to the established cardiac marker NT-proBNP as predictors for mortality in patients with CHF in a long term follow up. Methods We conducted a prospective longitudinal study. The novel renal biomarkers kidney injury molecule-1 (KIM-1), N-acteyl-β-D-glucosaminidase (NAG) and Neutrophil Gelatinase-Associated Lipocalin (NGAL) were assessed from urine samples. Additionally, blood levels of NT-proBNP were determined. The primary endpoint all-cause mortality was evaluated after a median follow-up of 104 months (interquartile range 42–117 months). Results 149 adolescents (mean age 62±12 years) with CHF (mean ejection fraction 32±9%) were enrolled. 79 (53%) patients died. The secondary endpoint was reached by 104 patients (70%). The renal marker NAG (HR 1.02, p=0.002) was a significant and independent predictor for all-cause mortality next to the established cardiac biomarker NTproBNP (HR 1.0, p<0,001) using Cox regression analysis, opposite to KIM-1 as well as NGAL (each p=n.s.). Similar results were obtained for the combined endpoint of all-cause mortality and hospitalization for heart failure. In a multivariate analysis model with biomarkers and clinical parameters NAG (HR 1.02, p=0.036) remained a significant predictor for all-cause mortality next to NT-proBNP (HR 1.0, p=0.027, older age (HR 1.04, p=0.004), the lack of diabetes mellitus (HR 0.39, p<0.001), reduced EF (HR 0.97, p=0.034) and creatinine (HR 1.45, p=0.026). Again similar results were obtained for the secondary endpoint. Patients were stratified into groups with markers above and below Youden Index to calculate Kaplan-Meier analysis. A combined analysis of NT-proBNP (< and ≥1906 pg/mL) and NAG (< and ≥10 U/gUCr) revealed an increase of the predictive value of each marker: patients with all three markers above Youden index had the highest mortality rate (79%) compared to patients with one (43%) or none (26%) marker above Youden Index. All-cause Mortality Conclusion The current 10-years long-term follow-up suggests that the tubular biomarker NAG as cardiorenal biomarker in combination with NT-proBNP may allow to discriminate a high-risk collective of chronic heart failure patients. These findings emphasize the close relationship of kidney injury and renal function in patients with CHF.

scholarly journals Long-term effectiveness of catheter ablation in patients with atrial fibrillation and heart failure

EP Europace ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 739-747 ◽  
Author(s):  
Michelle Samuel ◽  
Michal Abrahamowicz ◽  
Jacqueline Joza ◽  
Marie-Eve Beauchamp ◽  
Vidal Essebag ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Major Bleeding ◽  
World Population ◽  
Cox Models ◽  
Risk Of Death ◽  
All Cause Mortality

Abstract Aims Randomized trials suggest reductions in all-cause mortality and heart failure (HF) rehospitalizations with catheter ablation (CA) in patients with atrial fibrillation (AF) and HF. Whether these results can be replicated in a real-world population with long-term follow-up or varies over time is unknown. We sought to evaluate the long-term effectiveness of CA in reducing the incidence of all-cause mortality, HF hospitalizations, stroke, and major bleeding in AF–HF patients. Methods and results In a cohort of patients newly diagnosed with AF–HF in Quebec, Canada (2000–2017), CA patients were matched 1:2 to controls on time and frequency of hospitalizations. Confounders were controlled for using inverse probability of treatment weighting. Multivariable Cox models adjusted for the presence of cardiac electronic implantable devices and medication use during follow-up, and the effect of time since CA was modelled with B-splines. For non-fatal outcomes, the Lunn–McNeil approach was used to account for the competing risk of death. Among 101 933 AF–HF patients, 451 underwent CA and were matched to 899 controls. Over a median follow-up of 3.8 years, CA was associated with a statistically significant reduction in all-cause mortality [hazard ratio 0.4 (95% confidence interval 0.2–0.7)], but no difference in stroke or major bleeding. The hazard of HF rehospitalization for CA patients, relative to non-CA patients, varied with time since CA (P = 0.01), with a reduction in HF rehospitalizations until approximately 3 years post-CA. Conclusion Compared with matched non-CA patients, CA was associated with a long-term reduction in all-cause mortality and a reduction in HF rehospitalizations until 3 years post-CA.

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