scholarly journals 46 A clinical and echocardiographic score to differentiate pulmonary hypertension due to heart failure with preserved ejection fraction from idiopathic pulmonary hypertension: the PH-HFpEF score

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesco Chietera ◽  
Fabio Dardi ◽  
Mariangela Rotunno ◽  
Massimiliano Palazzini ◽  
Daniele Guarino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical History ◽  
Pulmonary Vascular Disease ◽  
Preserved Ejection Fraction ◽  
Multivariate Logistic Regression

Abstract Aims One of the most challenging differential diagnoses in pulmonary hypertension clinical practice, is the discrimination between idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF). We elaborate a score (considering patient clinical history, demographics, and echocardiographic characteristics) that can predict, noninvasively, PH-HFpEF vs. IPAH diagnosis. Methods and results Data were prospectively collected on 466 consecutive patients with a final diagnosis of IPAH or PH-HFpEF referred to a single tertiary pulmonary vascular disease centre. Data included clinical history, demographics, and parameters of an electrocardiogram and a transthoracic echocardiogram. A multivariate regression model was developed to predict a PH-HFpEF diagnosis, and an integer risk score was generated using adjusted regression coefficients of the multivariate logistic regression analysis. At the multivariate logistic regression a high ratio between left and right ventricular dimensions, a history of atrial fibrillation (AF), a high body mass index (BMI), a reduced mitral deceleration time and a high E-wave at trans-mitral Doppler, an advanced age and a high right ventricular fractional area change (FAC) were predictors of PH-HFpEF. The derived PH-HFPEF score (Figure), with a cut-point ≥11, yielded a specificity/sensitivity, respectively, for the diagnosis of PH-HFpEF, of 100%/49% with an AUC of 0.987. ED, end-diastolic; LV, left ventricle; RV, right ventricle. Conclusions The PH-HFPEF score can predict PH-HFpEF vs. IPAH. The PH-HFPEF score may be used to potentially avoid an invasive diagnostic testing in almost half of PH-HFpEF patients.

P2610Increase in comfortable walking speed during hospitalization predicts the readmission due to decompensated heart failure in heart failure patients with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Tabata ◽  
M Kato ◽  
N Hamazaki ◽  
T Masuda
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Exercise Capacity ◽  
Walking Speed ◽  
Decompensated Heart Failure ◽  
Preserved Ejection Fraction ◽  
Functional Classification ◽  
Multivariate Logistic Regression ◽  
Heart Failure Patients

Abstract Background Heart failure patients with preserved ejection fraction (HFpEF) have reduced exercise capacity and poor prognosis as well as those with reduced ejection fraction (HFrEF). Both cardiac function and exercise capacity have been known as prognostic factors for patients with HFrEF. However, few reports documented the relations of comfortable walking speed (CWS) during hospitalization to exercise capacity and prognosis. is used as a clinical measure to assess their exercise capacity and prognosis. However, few reports documented the correlations of CWS with exercise capacity and prognosis in patients with HFpEF. Purpose This study aimed to investigate whether CWS at hospital discharge and the increase in CWS during hospitalization predicted the readmission due to decompensated heart failure in patients with HFpEF and HFrEF. Methods Patients who were hospitalized due to heart failure with New York Heart Association (NYHA) Functional Classification III or IV were prospectively followed up for 3 years after hospital discharge. Consequently, 264 patients, 173 males and 92 females, aged 73.2±6.8 years were studied. Patients were divided into 3 groups based on their ejection fraction (EF): HFpEF group (EF≥50%; n=98), HFrEF group (EF<40%; n=138) and heart failure with mid-range ejection fraction (HFmrEF) group (40%≤EF≤49%; n=28). We assessed clinical characteristics including age, gender, height, NYHA functional classification, etiology of CHF, plasma brain natriuretic peptide and left ventricular ejection fraction (LVEF) on admission, and measured CWS several days after admission and at discharge. We determined significant factors affecting the readmission and their cut-off values using univariate and multivariate logistic regression analyses and the area under the receiver operating characteristics curves in the three groups. Results Forty patients (40.8%), 54 (39.1%) and 6 (21.4%) were readmitted in the HFpEF, HFrEF and HFmrEF groups, respectively, within 3 years after the discharge. Univariate logistic regression analysis detected the age, LVEF, CWS at discharge and the CWS increase during hospitalization as significant limiting factors for readmission in the HFpEF and HFrEF groups (P<0.05, respectively). The multivariate logistic regression analysis detected the CWS increase during hospitalization as significant limiting factor for readmission in the HFpEF and HFrEF groups (P<0.001 and P<0.05, respectively). The odds ratios of readmission were 1.86 (P<0.01) and 1.44 (P<0.001) with each 5-meter decrease of CWS increase during hospitalization and predictive cut-off values of the CWS increase were 7.5 and 8.5 meters/min in the HFpEF and HFrEF groups, respectively. Conclusion This study demonstrated that the CWS increase during hospitalization was a strong predictor for readmission due to decompensated heart failure in patients not only with HFrEF but also with HFpEF and each predictive the cut-off value was 7.5 and 8.5 meters/min.

scholarly journals Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach

2020 ◽  
Vol 9 (4) ◽  
pp. 1110 ◽  
Author(s):  
Antoni Bayes-Genis ◽  
Felipe Bisbal ◽  
Julio Núñez ◽  
Enrique Santas ◽  
Josep Lupón ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Left Atrial ◽  
Interstitial Fibrosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

To better understand heart failure with preserved ejection fraction (HFpEF), we need to better characterize the transition from asymptomatic pre-HFpEF to symptomatic HFpEF. The current emphasis on left ventricular diastolic dysfunction must be redirected to microvascular inflammation and endothelial dysfunction that leads to cardiomyocyte remodeling and enhanced interstitial collagen deposition. A pre-HFpEF patient lacks signs or symptoms of heart failure (HF), has preserved left ventricular ejection fraction (LVEF) with incipient structural changes similar to HFpEF, and possesses elevated biomarkers of cardiac dysfunction. The transition from pre-HFpEF to symptomatic HFpEF also involves left atrial failure, pulmonary hypertension and right ventricular dysfunction, and renal failure. This review focuses on the non-left ventricular mechanisms in this transition, involving the atria, right heart cavities, kidneys, and ultimately the currently accepted driver—systemic inflammation. Impaired atrial function may decrease ventricular hemodynamics and significantly increase left atrial and pulmonary pressure, leading to HF symptoms, irrespective of left ventricle (LV) systolic function. Pulmonary hypertension and low right-ventricular function are associated with the incidence of HF. Interstitial fibrosis in the heart, large arteries, and kidneys is key to the pathophysiology of the cardiorenal syndrome continuum. By understanding each of these processes, we may be able to halt disease progression and eventually extend the time a patient remains in the asymptomatic pre-HFpEF stage.

scholarly journals Heart Failure Drug Class Effects on 30-Day Readmission Rates in Patients with Heart Failure with Preserved Ejection Fraction: A Retrospective Single Center Study

Medicines ◽  
2020 ◽  
Vol 7 (5) ◽  
pp. 30
Author(s):  
Priyanka Parajuli ◽  
Odalys Lara-Garcia ◽  
Manjari Regmi ◽  
Warren Skoza ◽  
Mukul Bhattarai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Hospital Readmission ◽  
Lower Risk ◽  
Loop Diuretics ◽  
Preserved Ejection Fraction ◽  
Day Hospital ◽  
Multivariate Logistic Regression ◽  
Early Readmission

Background: The pharmacologic management of heart failure with preserved ejection fraction (HFpEF) involves far fewer options with demonstrated additional benefit. Therefore, we examined the effect of combination of multiple classes of HF medication in the 30-day hospital readmission in patients with HFpEF. Methods: All adult patients discharged with a diagnosis of HFpEF and a left ventricular ejection fraction (LVEF) of ≥ 50% reported during the admission or within the previous six months from our institution were retrospectively studied for a 30-day hospital readmission risk. Individual as well as combination drug therapy at the time of hospital discharge were evaluated using Pearson chi2 test and multivariate logistic regression. Results: The overall 30-day readmission rate in this HFpEF cohort of 445 discharges was 29%. Therapy with loop diuretics (p = 0.011), loop diuretics and angiotensin receptor blocker (p = 0.043) and loop diuretics and beta blockers (p = 0.049) were associated with a lower risk of 30-day hospital readmission. Multivariate logistic regression revealed only loop diuretics to be associated with a lower risk of hospital readmission in patients with HFpEF (OR 0.59; 95% CI, 0.39-0.90; p = 0.013). Conclusions: Our study revealed that loop diuretics at discharge decreases early readmission in patients with HFpEF. Further, our study highlights the implication of a lack of guidelines and treatment challenges in HFpEF patients and emphasizes the importance of a conservative approach in preventing early readmission in patients with HFpEF.

scholarly journals Serum uric acid is associated with cardiac diastolic dysfunction among women with preserved ejection fraction

2015 ◽  
Vol 309 (5) ◽  
pp. H986-H994 ◽  
Author(s):  
Shinpei Nogi ◽  
Shu-ichi Fujita ◽  
Yusuke Okamoto ◽  
Shun Kizawa ◽  
Hideaki Morita ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Uric Acid ◽  
Regression Analysis ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Odds Ratio ◽  
Multivariate Logistic Regression Analysis ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Multivariate Logistic Regression

Serum uric acid (SUA) is associated with the severity and prognosis of systolic heart failure. We investigated the potential association between SUA and cardiac diastolic dysfunction among total of 744 cardiac patients (202 women and 542 men) who had preserved left ventricular ejection fraction. Presence of diastolic dysfunction was assessed by echocardiographic data, plasma B-type natriuretic peptide concentration, and left ventricular hypertrophy. Univariate analysis showed that the prevalence of diastolic dysfunction increased with increasing SUA value in women, but not in men. When sex-nonspecific SUA quartiles were used, multivariate logistic regression analysis, among female patients who were not taking uric acid lowering medication, showed that the third (SUA, 5.7–6.4 mg) and the fourth (SUA, ≥6.5 mg/dl) SUA quartiles were associated with diastolic dysfunction with an odds ratio of 3.25 ( P < 0.05) and 8.06 ( P < 0.001), respectively, when compared with the first SUA quartile (≤4.7 mg/dl). When sex-specific SUA quartiles were used among these population, multivariate logistic regression analysis showed that the fourth SUA quartile (≥5.7 mg/dl) was associated with diastolic dysfunction with an odds ratio of 5.34 ( P < 0.05) when compared with the first SUA quartile (≤4.1 mg/dl). By contrast, the relationship between SUA and diastolic dysfunction was not significant in men, irrespective of which of the sex-nonspecific or sex-specific SUA quartiles were used. These data indicated that among cardiac patients with preserved ejection fraction, SUA was significantly associated with diastolic dysfunction in women but not in men.

scholarly journals Right ventricular-vascular coupling in heart failure with preserved ejection fraction and pre- vs. post-capillary pulmonary hypertension

2017 ◽  
Vol 19 (4) ◽  
pp. 425-432 ◽  
Author(s):  
Thomas M Gorter ◽  
Dirk J van Veldhuisen ◽  
Adriaan A Voors ◽  
Yoran M Hummel ◽  
Carolyn S P Lam ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Preserved Ejection Fraction

scholarly journals Readmission Rates and Medication Selection for Patients with Heart Failure Preserved Ejection Fraction

2020 ◽  
Author(s):  
Troy Kramer ◽  
Carrie Vogler ◽  
Robert Robinson ◽  
Mukul Bhattarai
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Prescribing Patterns ◽  
Preserved Ejection Fraction ◽  
Multivariate Logistic Regression ◽  
Readmission Rates

Purpose Heart failure with preserved ejection fraction (HFpEF) has less guideline driven treatment options due to a lack of trials demonstrating medications with improved clinical outcomes for this patient population. The primary objective of this study is to determine which medications and dosages are related to high readmission rates for HFpEF patients. Methods A retrospective, single center, chart review was performed on patients with HFpEF at an academic medical center. Heart failure patients ages between 18-89 with an ejection fraction ≥45% from a transthoracic echocardiogram (TTE) were included. Primary outcomes include 30-day all cause readmission rates, prescribing patterns, and avoidance of potentially harmful medications. Descriptive statistics and multivariate logistic regression were used to assess potential risk factors. Results This study analyzed 455 patient admissions. Univariate analysis shows patients who were not readmitted were more likely to be on furosemide (54% vs 42%; p = 0.019). Conversely, readmitted patients were more likely to be taking bumetanide (4% vs 1%; p = 0.039). Lisinopril was the only angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) associated with lower readmission rates (p = 0.036). Multivariate logistic regression showed bumetanide on admission (OR 14.6, p = 0.001), discharged on rosuvastatin (OR 6.29, p = 0.003) and meloxicam therapy (OR 6.33, p = 0.003) to be independent predictors of hospital readmission. Conclusion Three independent pharmacologic predictors for 30-day readmissions for patients with HFpEF were therapy with bumetanide, meloxicam, or rosuvastatin. Further research is needed to clarify the significance of these results.

scholarly journals Natriuretic peptide receptor C contributes to disproportionate right ventricular hypertrophy in a rodent model of obesity-induced heart failure with preserved ejection fraction with pulmonary hypertension

2019 ◽  
Vol 9 (4) ◽  
pp. 204589401987859 ◽  
Author(s):  
Vineet Agrawal ◽  
Niki Fortune ◽  
Sheeline Yu ◽  
Julio Fuentes ◽  
Fubiao Shi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Natriuretic Peptide ◽  
Ventricular Dysfunction ◽  
Control Diet ◽  
Right Ventricular Dysfunction ◽  
Cardiomyocyte Hypertrophy ◽  
Preserved Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) currently has no therapies that improve mortality. Right ventricular dysfunction and pulmonary hypertension are common in HFpEF, and thought to be driven by obesity and metabolic syndrome. Thus, we hypothesized that an animal model of obesity-induced HFpEF with pulmonary hypertension would provide insight into the pathogenesis of right ventricular failure in HFpEF. Two strains of mice, one susceptible (AKR) and one resistant (C3H) to obesity-induced HFpEF, were fed high fat (60% fat) or control diet for 0, 2, or 20 weeks and evaluated by cardiac catheterization and echocardiography for development of right ventricular dysfunction, pulmonary hypertension, and HFpEF. AKR, but not C3H, mice developed right ventricular dysfunction, pulmonary hypertension, and HFpEF. NPRC, which antagonizes beneficial natriuretic peptide signaling, was found in RNA sequencing to be the most differentially upregulated gene in the right ventricle, but not left ventricle or lung, of AKR mice that developed pulmonary hypertension and HFpEF. Overexpression of NPRC in H9C2 cells increased basal cell size and increased expression of hypertrophic genes, MYH7 and NPPA. In conclusion, we have shown that NPRC contributes to right ventricular modeling in obesity-induced pulmonary hypertension-HFpEF by increasing cardiomyocyte hypertrophy. NPRC may represent a promising therapeutic target for right ventricular dysfunction in pulmonary hypertension-HFpEF.

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