scholarly journals Global longitudinal strain as a predictor of cardiovascular events and mortality in patients with ischemic heart disease and heart failure with preserved/mid-range ejection fraction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Santos ◽  
I Pires ◽  
V Neto ◽  
L Goncalves ◽  
J Correia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Global Longitudinal Strain ◽  
Previous History ◽  
Composite Endpoint ◽  
Cox Regression Analysis ◽  
Patients With Heart Failure ◽  
History Of

Abstract Introduction Global longitudinal strain (GLS) is considered a more sensitive marker of systolic dysfunction than other measures commonly used in clinical practice, such as left ventricle ejection fraction (EF). Our objective was to evaluate the impact of reduced GLS in death and cardiovascular events in patients hospitalized due to heart failure with mid-range or preserved ejection fraction, with previous history of acute myocardial infarction. Methods A retrospective analysis of 170 patients admitted to a Cardiology ward due to acute heart failure (AHF) was performed. Patients with reduced EF (Simpson biplane method - EF<40%) were excluded based on echocardiographic evaluation after AHF stabilization. GLS measured by “speckle tracking” technique was calculated for each patient. Measurements were made by the same operator to minimize interoperator variability. Mann-Whitney U test was used for univariate analysis. Kaplan-Meier survival plots and Cox-regression analysis were performed to assess differences in 12-month mortality (12MM) and in the composite endpoint of cardiovascular event or death (12CVM) at 12 months. Results A total of 127 patients were included. Mean patient age was 64 (±14) years; 72% were men. 48% of patients had history of ST elevation AMI. Mean EF was 54% (±8) and mean GLS was −14.3 (±3.8). Rates of 12MM and 12CV M were 14.2% and 19.3%, respectively. A statistically significant association between 12MM and 12MCV was found in univariate analysis for GLS (p<0.001). Kaplan-Meyer survival plots revealed that a compromised GLS (<−16) was associated with significantly increased 12MM (23% vs 2.5%, X2: 7.999, p=0.005) and 12CVM (26.6% vs 10%, X2: 4.139, p=0.042). When stratified by mid-range vs preserved EF, GLS <−16 was associated with worse outcomes, although the results did not reach statistical significance (p>0.05). However, when considering a severely compromised GLS (<−13), GLS was significantly associated with increased 12MM (52% vs 8.3%, X2: 5.533, p=0.019) and 12CVM (50% vs 8.3%, X2: 4.970, p=0.026), in the subgroup of patients with heart failure with mid-range EF. Cox-regression analysis demonstrated that GLS was independently associated with 12MM (HR: 0.668p, <0.001) and the 12CVM composite endpoint (HR: 0.819, p=0.008), even after adjustment for other important prognostic markers such as chronic kidney disease, pulmonary disease and diabetes, with significant hazard ratio reduction for each positive point increase in GLS. Conclusion GLS is an independent predictor of 12MM and 12CVM in patients hospitalized due to AHF, with an EF ≥40% and previous history of acute myocardial infarction. In the subgroup of patients with heart failure with mid-range EF, a severely compromised GLS (<−13) is a strong predictor of 12MM and 12CVM. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals H2FPEF score predicts 1-year rehospitalisation of patients with heart failure with preserved ejection fraction

2020 ◽  
pp. postgradmedj-2019-137434
Author(s):  
Yifei Tao ◽  
Wenjing Wang ◽  
Jing Zhu ◽  
Tao You ◽  
Yi Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Support Vector ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Non Invasive ◽  
Patients With Heart Failure

BackgroundHeart failure with preserved ejection fraction (HFpEF) has received widespread attention in recent years. There is currently a lack of valuable predictors for the prognosis of this disease. Here, we aimed to identify a non-invasive scoring system that can effectively predict 1-year rehospitalisation for patients with HFpEF.MethodsWe included 151 consecutive patients with HFpEF in a prospective cohort study and investigated the association between H2FPEF score and 1-year readmission for heart failure using multivariate Cox regression analysis.ResultsOur findings indicated that obesity, age >70 years, treatment with ≥2 antihypertensives, echocardiographic E/e’ ratio >9 and pulmonary artery pressure >35 mm Hg were independent predictors of 1-year readmission. Three models (support vector machine, decision tree in R and Cox regression analysis) proved that H2FPEF score could effectively predict 1-year readmission for patients with HFpEF (area under the curve, 0.910, 0.899 and 0.771, respectively; p<0.001).ConclusionOur study demonstrates that the H2FPEF score has excellent predictive value for 1-year rehospitalisation of patients with HFpEF.

Abstract 14213: Different Prognostic Value of Proteinuria According to the Severity of Heart Failure in Patients With Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bolrathanak Oeun ◽  
Shungo Hikoso ◽  
Daisaku Nakatani ◽  
Hiroya Mizuno ◽  
Tetsuhisa Kitamura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Cox Regression ◽  
Composite Endpoint ◽  
Study Endpoint ◽  
Prognostic Impact ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
Additive Risk

Introduction: Proteinuria reflects systemic inflammation and endothelial dysfunction, and is a prognosticator in heart failure with preserved ejection fraction (HFpEF). However, it remains elusive whether the prognostic impact of proteinuria is different according to the severity of HFpEF. Recently, we and other groups reported that echocardiographic diastolic dysfunction (DD) is a worse prognostic factor in HFpEF. Objectives: We aimed to clarify the prognostic value of proteinuria in HFpEF according to the severity of HFpEF. We used the evidence of DD as criteria of the severity of HFpEF. Methods: We assessed 575 discharged-alive patients (pts) in the PURSUIT-HFpEF registry. Pts were divided into 2 groups according to the absence (DD-) or presence of DD (DD+). DD was defined using the 2016 ASE recommendations. Each group was further classified into 2 subgroups according to the absence or presence of dipstick proteinuria (proteinuria trace or more). The study endpoint was a composite of all-cause mortality and HF hospitalization. Results: Median age 83 years and 58% female. The number of pts with DD-: 336 pts (221 pts: proteinuria-[G1], 115 pts: proteinuria+[G2]); and DD+: 239 pts (125 pts: proteinuria-[G3], 114 pts: proteinuria+[G4]). G4 had higher NT-proBNP level than G3, but not observed between G1 and G2. Proteinuria+ were more hypertensive, diabetic with worse renal function than proteinuria- in both DD-/DD+. The composite endpoint occurred more often in G4 than G3 (HR: 1.75, 95%CI: 1.18-2.62, log-rank P=0.005), but was similar between G1 and G2 (HR: 1.21, 95%CI: 0.76-1.92, log-rank P=0.431). Multivariable Cox regression adjusting for NT-proBNP, eGFR and other major confounding factors revealed that proteinuria was associated with the composite endpoint in DD+ (HR:1.85, 95% CI:1.16-2.93, P=0.009), but not in DD- (HR:0.96, 95% CI:0.55-1.69, P=0.900). Conclusions: Proteinuria may be an additive risk factor in pts with DD but not in those without DD in HFpEF.

Abstract 14681: Uber Analysis of Cardiopulmonary Exercise Test Variables and Mortality in Patients with Heart Failure: the Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ali Shafiq ◽  
Clinton A Brawner ◽  
Heather E Aldred ◽  
Raakesh Hassan ◽  
Stepahanie Vasko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Test ◽  
Cox Regression ◽  
Composite Endpoint ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Cardiac Transplant ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

Introduction: Numerous metrics derived from the cardiopulmonary exercise test (CPX) are associated with outcomes among patients with heart failure with reduced ejection fraction (HFrEF). However few studies have examined the independent prognostic value of all variables assessed simultaneously. Purpose: Retrospective analysis to describe the relationship between all CPX measures and the composite outcome of mortality, left ventricular assist device (LVAD), or cardiac transplant (CT). Methods: Patients (n= 1,201; 33% female; age= 55 ± 13 y) with a CPX between 1997 and 2010 and confirmed HFrEF (ejection fraction [EF] < 40%) were identified. Death data through 2011 was obtained from the National Death Index. The association with the composite endpoint was evaluated separately for 30 CPX measures with adjustment for age, gender, EF, and beta-blocker therapy using Cox regression. Forward stepwise Cox regression was performed to identify which of the CPX variables contribute the most to outcome prediction. Results: During a median follow-up of 3.75 years there were 576 (48%) events. When tested separately, nearly all CPX variables (except heart rate reserve/metabolic reserve and peak respiratory exchange ratio) were associated (p<0.05) with the composite endpoint. The top 5 predictors are shown in the Table. Stepwise Cox regression revealed that only % predicted peak oxygen uptake (VO 2 , Wald= 76.1), ventilatory power (peak systolic blood pressure/V E -VCO 2 slope, Wald= 58.0), and EF (Wald= 27.0) independently predicted outcomes. Conclusion: When considering all variables measured during a CPX test, % predicted peak VO 2 was the variable with the strongest independent association to outcomes in this cohort of patients with HFrEF. The % predicted peak VO 2 may represent a key variable in determining when to consider a patient for an LVAD or CT.

Temporal trends in the contribution of Chagas cardiomyopathy to mortality among patients with heart failure

Heart ◽  
2018 ◽  
Vol 104 (18) ◽  
pp. 1522-1528 ◽  
Author(s):  
Wilson Nadruz ◽  
Luciana Gioli-Pereira ◽  
Sabrina Bernardez-Pereira ◽  
Fabiana G Marcondes-Braga ◽  
Miguel M Fernandes-Silva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Population Attributable Risk ◽  
Temporal Trends ◽  
University Hospital ◽  
Cox Regression Analysis ◽  
Chagas Cardiomyopathy ◽  
Risk Of Death ◽  
Patients With Heart Failure

BackgroundChagas cardiomyopathy (ChC) prevalence is decreasing in Brazil and medical therapies for heart failure (HF) have improved in the last decade. Whether these changes modified the prognosis of ChC relative to non-Chagas cardiomyopathies (NChC) remains unknown. This study evaluated the temporal trends in population attributable risk (PAR) of ChC for 2-year mortality among patients with HF enrolled at years 2002–2004 (era 1) and 2012–2014 (era 2) in a Brazilian university hospital.MethodsWe prospectively studied 362 (15% with ChC) and 582 (18% with ChC) HF patients with ejection fraction ≤50% in eras 1 and 2, respectively and estimated the PAR of ChC for 2-year mortality.ResultsThere were 145 deaths (29 in ChC) in era 1 and 85 deaths (26 in ChC) in era 2. In multivariable Cox-regression analysis adjusted for age, sex, ejection fraction, heart rate, body mass index, hypertension, diabetes mellitus, systolic blood pressure and ischaemic/valvar aetiology, ChC was associated with higher risk of death in era 1 (HR (95% CI)=1.92 (1.00 to 3.71), p=0.05) and era 2 (HR (95% CI)=3.51 (1.94 to 6.36), p<0.001). In fully adjusted analysis, the PAR of ChC for mortality increased twofold from era 1 (PAR (95% CI)=11.0 (2.8 to 18.5)%) to era 2 (PAR (95% CI)=21.9 (16.5 to 26.9)%; p=0.023 versus era 1).ConclusionAlthough the absolute death rates decreased over time in the ChC and NChC groups, the PAR of ChC for mortality increased among patients with HF, driven by increases in the HR associated with ChC. Our results highlight the need for additional efforts aiming to prevent and treat ChC.

Abstract 14922: Prognostic Value of Baseline BNP and NT-ProBNP and its Interaction With Spironolactone in Patients With Heart Failure and Preserved Ejection Fraction in the TOPCAT Trial

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Inder S Anand ◽  
Scott D Solomon ◽  
Brian Claggett ◽  
Sanjiv J Shah ◽  
Eileen O’Meara ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
Cox Regression ◽  
Selection Criterion ◽  
Adverse Outcomes ◽  
Preserved Ejection Fraction ◽  
Patient Selection Criterion ◽  
Increased Risk ◽  
Patients With Heart Failure

Background: Plasma natriuretic peptides (NP) are helpful in the diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF) and predict adverse outcomes. Levels of NP beyond a certain cut-off level are often used as inclusion criteria in clinical trials to ensure that the patients have HF, and to select patients at higher risk. Whether treatments have a differential effect on outcomes across the spectrum of NP levels is unclear. In the I-Preserve trial a benefit of irbesartan on all outcomes was only seen in HFpEF patients with low but not high NP levels. We hypothesized that in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, spironolactone might have a greater benefit in patients with lower NP levels. Methods and Results: BNP (n=468) or NT-proBNP (n=400) levels were available at baseline in 868 patients with HFpEF enrolled in the natriuretic peptide stratum (BNP ≥100 pg/mL or an NT- proBNP ≥360 pg/mL) of the TOPCAT trial. In a multi-variable Cox regression model, that included age, gender, region (Americas vs. Russia/Georgia), atrial fibrillation, diabetes, eGFR, BMI and heart rate, higher BNP or NT-proBNP as a continuous, standardized log-transformed variable or grouped by terciles (see Figure for BNP & NT-proBNP tercile values) was independently associated with an increased risk of the primary endpoint of cardiovascular mortality, aborted cardiac arrest, or hospitalization for heart failure (Figure-1). There was a significant interaction between the effect of spironolactone and baseline BNP or NT-proBNP terciles for the primary outcome (P=0.02, Figure-2), with greater benefit of the drug in the lower compared to higher NP terciles. Conclusions: The benefit of spironolactone in lower risk HFpEF patients may indicate effects of the drug on early, but not late higher-risk stage of the disease. These findings question the strategy of using elevated NP as a patient selection criterion in HFpEF trials.

P1663The impact of highest doses of ACEi/ARB therapy on mortality of patients suffering from heart failure with reduced ejection fraction: a long-term follow-up, propensity-matched cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Muk ◽  
M Vamos ◽  
P Bogyi ◽  
Z S Majoros ◽  
D Vagany ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Nearest Neighbor ◽  
Cox Regression ◽  
Converting Enzyme Inhibitors ◽  
Mortality And Morbidity ◽  
Cox Regression Analysis ◽  
Reduced Ejection Fraction ◽  
Total Cohort

Abstract The angiotensin-converting enzyme inhibitors (ACEi) as cornerstone of neurohormonal drug regime reduce mortality and morbidity in heart failure with reduced ejection fraction (HFrEF) hence these drugs are recommended for every HFrEF patients without presence of contraindication or intolerance. However, there are controversial results regarding the incremental survival benefit of higher doses of these drugs used in HFrEF. In addition, achieving the highest doses (TD1) (20 mg < enalapril daily dose≤40 mg, or dose equivalent ACEi/ARB), of these drugs often accompanies side effects related to the uptitration, which may make it impossible to start other therapies proven to result in undoubtful mortality benefit (i.e. sacubitril/valsartan). Aim To assess the effect of TD1 of ACEi/ARB on mortality of HFrEF patients followed at a heart failure outpatient clinic (HFOC). Methods Data of 579 consecutive HFrEF patients, who hadn't been treated with an ACEi/ARB or were receiving ≤50% of doses equivalent with 20mg enalapril daily (TD2) at the time of initiation of care (NYHA: 3.1±0.8; LVEF: 27.5±6.6%; age: 61.1±13.0 years; male: 76.1%; ischemic: 46.8%; atrial fibrillation: 27.6%; diabetes: 34.9%; hypertension: 72.5%), followed at our HFOC was analysed. After therapy optimization (TO) ACEis/ARBs were applied in 96.5% and at least TD2 was reached in 55.9% of the total cohort, while TD1 of an ACEi/ARB was applied in 111 patients (19.2% of total cohort). BBs in 88.4%, target doses of BBs in 46.8%, MRAs in 57.0% of total cohort were used. To adjust for possible confounders, patients were matched based on the ACEi/ARB doses reached during TO applying propensity score matching (PSM) using the nearest neighbor matching (caliper: 0.2). All-cause mortality (ACM) was assessed using the Kaplan-Meier method and compared with the Cox proportional hazard model. Results After 7.1±4.7 years follow-up ACM of patients treated with TD1 of ACEis/ARBs was significantly lower than those treated with lower doses in the total cohort (HR=0.67; 95% CI=0.50–0.89; p=0.005). Applying multivariate Cox regression analysis the use of TD1 of an ACEi/ARB didn't remain independent predictor of survival; creatinine, NYHA f.c., age, sex, ischemic etiology were proved to be significant predictor of mortality. After PSM the survival of patients receiving TD1 of an ACEi/ARB didn't differ from those treated with lower doses (HR=0.84; 95% CI=0.61–1.14; p=0.27). Conclusions The current ESC guidelines recommend the use of target doses or maximal tolerated doses of ACEis or ARBs in HFrEF. In a real-world patient cohort whom all the effort was made to reach the target doses, ACM of patients treated with TD1 of an ACEi/ARB was significantly lower than those treated with lower doses, however this result wasn't independent from the patient characteristics. Beside that, after PSM the survival of patients treated with TD1 or with lower doses of an ACEi/ARB did not differ significantly.

P5261Feature tracking by CMR: left ventricular dysfunction predicts outcome in heart failure with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kammerlander ◽  
J Kraiger ◽  
C Nitsche ◽  
C Dona ◽  
F Duca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Feature Tracking ◽  
Tissue Characterization ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Walking Distance ◽  
Preserved Ejection Fraction ◽  
Prognostic Relevance

Abstract Objectives To investigate the association between global longitudinal strain (GLS) using feature tracking (FT) cardiovascular magnetic resonance imaging (CMR) and prognosis in patients with heart failure and preserved ejection fraction (HFpEF). Background Echocardiography-based studies have demonstrated that in HFpEF left ventricular (LV) strain analyses can detect impaired systolic function despite preserved ejection fraction and might also predict outcome. CMR also allows strain analysis using FT and is furthermore the gold standard for assessment of ventricular volumes and ejection fractions. In addition, T1-mapping allows non-invasive tissue characterization. However, the prognostic relevance of FT-CMR is unknown. In addition right ventricular (RV) FT-CMR is poorly investigated. Methods Consecutive patients with confirmed diagnosis of HFpEF underwent CMR on a 1.5T scanner. We used dedicated software (cvi42, Circle Cardiovascular Imaging Inc.) for global longitudinal left ventricular strain (LV-GLS) in a 3D and global longitudinal RV strain (RV-GLS) in a 2D model using feature tracking (FT). In addition, we performed uni- and multivariable Cox regression using a combined endpoint of heart failure hospitalizations, and cardiovascular death to determine the prognostic relevance of FT-CMR. Results We included a total of 131 HFpEF patients (70.4±8.6 years old, 70.2% female). Median LV-GLS by FT-CMR was −8% [IQR: −10% to 5%] and median RV-GLS was −11.9% [IQR: −16.57% to −12.23%]. LV and RV GLS values were significantly correlated with LV and RV ejection fractions (r=−0.463, p<0.001 for LV, and r=−0.306, p=0.001 and RV, respectively). 77 (58.8%) events were recorded during a follow-up of 42.0±31.4 months. Patients with an LV-GLS worse than the median (−8%) showed a significantly reduced event-free survival rate (log-rank, p=0.009).In a multivariable Cox-regression model correcting for the strongest clinical variables, including age (HR 1.018 [0.985–1.052], p=0.290), GFR (HR 0.987 [0.975–1.000], p=0.055), diabetes (HR 1.696 [1.028–2.799], p=0.039), and 6-min-walking distance (HR 0.997 [0.995–0.999)], p=0.014), LV-GLS remained significantly associated with outcome (HR 1.093 [1.039–1.150], p=0.001) while RV-GLS had no effect on outcome (p>0.05). Conclusions In patients with HFpEF, LV-GLS but not RV-GLS by FT-CMR is significantly associated with cardiovascular events.

P5329Montreal score and coronary artery calcification in the prediction of cardiovascular event in patients with familial hypercholesterolemia

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Miname ◽  
M S B Bittencourt ◽  
C E J Jannes ◽  
A C P Pereira ◽  
J E K Krieger ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Family History ◽  
Familial Hypercholesterolemia ◽  
Coronary Disease ◽  
Roc Curve ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
History Of

Abstract Introduction Familial hypercholesterolemia (FH) is characterized by elevated levels of LDL-C and early cardiovascular disease (CVD). However, the risk of CVD in HF is variable. The Montreal score was designed to stratify cardiovascular risk in the FH population. Coronary calcium score (CAC) is a tool that can be used to optimize CVD risk assessment in FH. Purpose The objective of this study is to evaluate whether CAC is superior to the Montreal score in cardiovascular risk discrimination in FH. Methods We Included 206 patients with molecular diagnosis of FH (36.4% men, mean age 45±14 years, mean baseline LDL-C: 269±70 mg/dL). All patients underwent CAC and were treated with maximum tolerated statin therapy. We evaluated cardiovascular risk factors and calculated Montreal score as prior publication. Cox regression analysis was performed to test the association of CAC with the incidence of cardiovascular events. CAC was transformed into LogCAC + 1 to optimize the distribution of the CAC as previously described. Area under the ROC curve was calculated for Montreal score and CAC. Results Patients were followed by a median of 3.7 years (interquartile range: 2.7 to 6.8 years). Mean Montreal score was 22±8, median of 22. CAC was positive in 105 individuals (51%) and 15 CVD events (7.2%) had occurred. Montreal score above the median was associated with CAC (OR: 8.36, 95% CI: 4.47–15.62, p<0.001), and there was a gradient of increase in the Montreal score with CAC increase (mean Montreal score for CAC = 0, CAC 1–100, CAC>100: 17±7, 23±7, 30±4, p<0.001). Univariate analysis showed that the following variables were associated with CVD occurrence: male gender, family history of early coronary disease, corneal arcus, HDL-c (protective), logCAC + 1 and Montreal score. Multivariate analysis was performed: model 1 with Montreal score and logCAC + 1, only logCAC + 1 was associated with the occurrence of CVD (RR: 3.886; 95% CI: 2.112–7.148, p<0.001). Model 2 with family history of early coronary disease, corneal arcus, logCAC + 1 and Montreal score, only the latter was not associated with the occurrence of CVD. CAC presents greater area under the ROC curve for CVD event discrimination compared to the Montreal score: 0.839 versus 0.685, p=0.0074. Conclusion The Montreal score is associated with CAC in FH, however CAC is superior than this clinical score in predicting the occurrence of CVD in FH.

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.

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