scholarly journals 632 Diagnostic and prognostic performance of HFA-PEFF and H2FpEF scores in patients with cardiac amyloidosis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Daniela Tomasoni ◽  
Marco Merlo ◽  
Alberto Aimo ◽  
Aldostefano Porcari ◽  
Maria Grazia De Angelis ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Amyloidosis ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Prognostic Performance ◽  
Echocardiographic Parameters

Abstract Aims HFA-PEFF and H2FPEF scores were developed to aid the diagnosis of heart failure with preserved ejection fraction (HFpEF) and have been associated with outcomes. We aimed to investigate the diagnostic and prognostic significance of these scores in patients with a specific phenotype of HFpEF, cardiac amyloidosis (CA). Methods and results In a retrospective, double-centre, observational study we included 171 patients with either transthyretin (ATTR) (n = 89, 52%) or light-chain (AL) (n = 82, 48%) cardiac amyloidosis and preserved left ventricular ejection fraction (LVEF). Patients were divided into three groups according to HFA-PEFF score (low, 0–1; intermediate 2–4; high 5–6) and H2FPEF score (low, 0–1; intermediate 2–5; high 6–9). None of the patients had a HFA-PEFF score of 0 or 1 (n = 0, 0%); 57 (33.3%) patients had HFA-PEFF score 2–4 and the majority (n = 114, 66.7%) had a high HFA-PEFF score. Twenty-eight (16.4%), 104 (60.8%), 39 (22.8%) patients had low, intermediate, and high H2FPEF score, respectively. During a median follow-up of 14.5 (6.5–30.2) months after diagnosis, 61 (35.7%) patients died. Patients with a high HFA-PEFF score had higher mortality, compared to those with an intermediate score (47.4% vs. 12.3%, P < 0.001). After adjustment for several clinical variables, including age, sex, comorbidities, natriuretic peptides, troponin levels and echocardiographic parameters, a high HFA-PEFF score was independently associated with mortality (HR: 3.75; 95% CI: 1.61–8.70; P = 0.005). H2FPEF score was not significantly associated with outcomes. Conclusions Our results suggest that a low HFA-PEFF score successfully rules out CA diagnosis, whereas some CA patients present a low H2FPEF score, potentially misleading the diagnosis. HFA-PEFF but not H2FPEF score was associated with outcome in patients with CA.

scholarly journals P1348 Impact of left ventricular ejection fraction and aortic valve sclerosis on cardiovascular outcome in patients with acute ischemic stroke

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Kim ◽  
H L Kim ◽  
K T Park ◽  
W H Lim ◽  
J B Seo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Ventricular Ejection Fraction ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Echocardiographic Parameters ◽  
Composite Events

Abstract Background/Introduction Previous studies have focused on only 1 or 2 echocardiographic parameters as prognostic marker in patients with acute ischemic stroke (AIS). Purpose Various echocardiographic parameters in the same patient were systemically evaluated for their prognostic significance in AIS. Methods A total of 900 patients with AIS who underwent transthoracic echocardiography (TTE) (72.6 ± 12.0 years and 60% male) were retrospectively reviewed. Composite events including all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and coronary revascularization were assessed during clinical follow-up. Results During a median follow-up of 3.3 years (interquartile range, 0.6-5.1 years), there were 151 (16.8%) composite events. Univariable analyses showed that low left ventricular ejection fraction (LVEF) (< 60%), increased peak tricuspid regurgitation (TR) velocity (> 2.8 m/s) and aortic valve (AV) sclerosis were associated with composite events (P < 0.05 for each). In the multivariable analyses after controlling for potential confounders, LVEF < 60% (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.30-2.77; P = 0.001) and AV sclerosis (HR, 1.56; 95% CI, 1.10-2.21; P = 0.013) were independent prognostic factors associated with composite events. Multivariable analysis showed that HR for composite events gradually increased according to LVEF and AV sclerosis: HR was 2.8-fold higher in the highest-risk group than in the lowest group (P = 0.001). Conclusions In patients with AIS, LVEF < 60% and the presence of AV sclerosis predicts the future vascular events. Patients with AIS exhibiting reduced LVEF and AV sclerosis may benefit from aggressive secondary prevention Abstract P1348 Figure. COX plot for composite event

scholarly journals Study protocol for the PURSUIT-HFpEF study: a Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038294
Author(s):  
Shinichiro Suna ◽  
Shungo Hikoso ◽  
Takahisa Yamada ◽  
Masaaki Uematsu ◽  
Yoshio Yasumura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Observational Study ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

IntroductionNeither the pathophysiology nor an effective treatment for heart failure with preserved ejection fraction (HFpEF) has been elucidated to date. The purpose of this ongoing study is to elucidate the pathophysiology and prognostic factors for patients with HFpEF admitted to participating institutes. We also aim to obtain insights into the development of new diagnostic and treatment methods by analysing patient background factors, clinical data and follow-up information.Methods and analysisThis study is a prospective, multicentre, observational study of patients aged ≥20 years admitted due to acute decompensated heart failure with preserved left ventricular ejection fraction (≥50%) and elevated N-terminal-pro brain natriuretic peptide (NT-proBNP) (≥400 pg/mL). The study began in June 2016, with the participation of Osaka University Hospital and 31 affiliated facilities. We will collect data on history in detail, accompanying diseases, quality of life, frailty score, medication history, and laboratory and echocardiographic data. We will follow-up each patient for 5 years, and collect outcome data on mortality, cause of death, and the number and cause of hospitalisation. The target number of registered cases is 1500 cases in 5 years.Ethics and disseminationThe protocol was approved by the Institutional Review Board (IRB) of Osaka University Hospital on 24 February 2016 (ID: 15471), and by the IRBs of the all participating facilities. The findings will be disseminated through peer-reviewed publications and conference presentations.

Prognostic significance of longitudinal strain in dilated cardiomyopathy with recovered ejection fraction

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319504
Author(s):  
Marco Merlo ◽  
Marco Masè ◽  
Andrew Perry ◽  
Eluisa La Franca ◽  
Elena Deych ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death

ObjectivePatients with non-ischaemic dilated cardiomyopathy (NICM) may experience a normalisation in left ventricular ejection fraction (LVEF). Although this correlates with improved prognosis, it does not correspond to a normalisation in the risk of death during follow-up. Currently, there are no tools to risk stratify this population. We tested the hypothesis that absolute global longitudinal strain (aGLS) is associated with mortality in patients with NICM and recovered ejection fraction (LVEF).MethodsWe designed a retrospective, international, longitudinal cohort study enrolling patients with NICM with LVEF <40% improved to the normal range (>50%). We studied the relationship between aGLS measured at the time of the first recording of a normalised LVEF and all-cause mortality during follow-up. We considered aGLS >18% as normal and aGLS ≥16% as of potential prognostic value.Results206 patients met inclusion criteria. Median age was 53.5 years (IQR 44.3–62.8) and 56.6% were males. LVEF at diagnosis was 32.0% (IQR 24.0–38.8). LVEF at the time of recovery was 55.0% (IQR 51.7–60.0). aGLS at the time of LVEF recovery was 13.6%±3.9%. 166 (80%) and 141 (68%) patients had aGLS ≤18% and <16%, respectively. During a follow-up of 5.5±2.8 years, 35 patients (17%) died. aGLS at the time of first recording of a recovered LVEF correlated with mortality during follow-up (HR 0.90, 95% CI 0.91 to 0.99, p=0.048 in adjusted Cox model). No deaths were observed in patients with normal aGLS (>18%). In unadjusted Kaplan-Meier survival analysis, aGLS <16% was associated with higher mortality during follow-up (31 deaths (22%) in patients with GLS <16% vs 4 deaths (6.2%) in patients with GLS ≥16%, HR 3.2, 95% CI 1.1 to 9, p=0.03).ConclusionsIn patients with NICM and normalised LVEF, an impaired aGLS at the time of LVEF recovery is frequent and associated with worse outcomes.

scholarly journals Effect of systolic dysfunction and elevated left ventricular end diastolic pressure on 3-year clinical outcomes in patients with atrial fibrillation

2021 ◽  
Author(s):  
YU HYEYON ◽  
JIHUN AHN
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Systolic Dysfunction ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diastolic Filling ◽  
Ventricular Ejection Fraction

Objectives: Systolic and diastolic dysfunctions are related to adverse clinical outcomes in patients with sinus rhythm. The aim of this study was to clarify the prognostic significance of systolic and diastolic dysfunctions in patients with chronic persistent atrial fibrillation (AF). Methods: We evaluated data for 114 consecutive patients with chronic AF who underwent measurement of LVEDP at our hospital between 1 March 2011 and 31 December 2014. In total, 114 consecutive patients with chronic AF were divided into two groups according to the left ventricular ejection fraction (LVEF): LVEF < 50 (reduced ejection fraction, REF group) and LVEF ≥50 (preserved EF, PEF group). The PEF group was further divided into two subgroups according to the left ventricular end-diastolic filling pressure (LVEDP): LVEDP >15 mmHg and LVEDP ≤ 15 mmHg. The 3-year clinical outcomes were compared between the PEF and REF groups and the LVEDP ≥15 mmHg and LVEDP <15 mmHg groups. Results: During the 3-year follow-up period, the rate of heart failure (HF) hospitalisation and incidence of AF with rapid ventricular rhythm (RVR) were higher in the REF group than in the PEF group. Multivariate analysis revealed that REF was the only significant predictor of HF hospitalisation (hazard ratio, 4.71; 95% confidence interval, 1.48–15.02; p=0.009). Conclusions: Our observations during a mid-term follow-up period revealed that systolic dysfunction could be an important predictor of HF hospitalisation in patients with AF. However, elevated LVEDP may not be associated with mid-term adverse clinical outcomes in patients without systolic dysfunction.

P1775Outcomes in patients with left ventricular non-compaction phenotype and normal left ventricular ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rebellius ◽  
R Berzins Schoenenberger ◽  
S Anwer ◽  
S Rogler ◽  
N Kuzo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Echocardiographic Parameters ◽  
Normal Lvef

Abstract Introduction Left ventricular non-compaction (LVNC) is a rare cardiomyopathy with a progressive clinical course, resulting in symptoms such as heart failure, cardiac arrhythmias, or thrombo-embolic events. Little is known about the natural course of disease, in particular in individuals with normal LV ejection fraction (EF) at diagnosis. In this study, we aim to evaluate the outcome of this group of patients. Methods 48 LVNC patients with normal LV EF at diagnosis (defined as ≥50% by Simpson) were retrospectively analysed followed-up for median duration of 3656 days (2017–4965). All outcome data and conventional echocardiographic parameters were obtained; and in 27 patients, LV and right ventricular (RV) global longitudinal strain (GLS) were also determined using TomTec Image Arena (v.4.6). Results Mean age was 25.5 years. Median LVEF was 58.5% [IQR: 52.75 - 65.25]). The localization of non-compacted segments displayed a typical distribution with apical and inferolateral midventricular segments most frequently involved. Although LVEF was normal at baseline, median LV GLS was 16.8% (IQR: 20.0 - 14.2) and RV GLS was 18.7% (23.3–15.6). Furthermore, only 30 patients (73.2%) had a normal diastolic function, while others showed impaired relaxation (19.5%; n=8) or restrictive filling pattern (7.3%; n=3). During follow-up, LVEF decreased slightly from the initial visit (59%, [53.3–65.0]) to last follow-up (56%, [53.0–61.8], p=0.0009), and LV end-systolic and end-diastolic volumes increased (p=0.009 and 0.001, respectively). The other echocardiographic parameters did not show any significant changes. During follow-up, 3 patients (7.7%) died, 5 (12.8%) were hospitalized for heart failure, 3 (7.7%) had a thromboembolic event, 5 (12.8%) a syncope, 3 (8.1%) a non-sustained ventricular tachycardia, 9 (22.5%) a supraventricular tachycardia, and 14 (35.9%) suffered other complications during follow-up. The change in LVEF and LV volumes during follow-up was not significantly associated with outcome. Conclusion Patients presenting with a LVNC phenotype and normal LVEF did not display a completely normal LV function as revealed by LV strain and LV diastolic function. LVEF decreased slightly during follow-up, but was surprisingly stable in most patients. Nevertheless, a significant number of individuals experienced a clinically relevant event. Hence, a LVNC phenotype is important even in individuals with normal LVEF and such patients should be followed-up regularly.

Abstract 15017: Early Post-discharge Follow-up Delay After Hospitalization for Heart Failure With Preserved Ejection Fraction Reduces Readmission for Heart Failure in the Following Year

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Patrick Prudhomme ◽  
Brault Gabriel ◽  
Pusca Laurence ◽  
Coderre Roxanne ◽  
Tétrault-Langlois Marianne ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Hospital Readmission ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Confounding Variables

Introduction: Early physician follow-up after hospital discharge for acute decompensated heart failure (ADHF) is recommended by the AHA to prevent early hospital readmission. This recommendation has not been specifically evaluated for heart failure with preserved ejection fraction (HFpEF). Hypothesis: Earlier follow-up should lead to decrease in readmissions for ADHF in the HFpEF population even when adjusting for confounding factors. Methods: Consecutive ADHF hospitalisation that occurred inclusively between 2015 and 2018 were reviewed. Main inclusion criterion was left ventricular ejection fraction ≥45%. The major exclusion criteria were: severe valvulopathy, hypertrophic cardiomyopathy, acute coronary syndrome 3 months before hospitalisation, chronic kidney failure (eGFR <30 ml/min), severe chronic respiratory disease and death before discharge. Follow-up delay after discharge was dichotomized (early vs late/no follow up) by using the median delay. Main outcome was hospital readmission in the year following discharge. Multivariate logistic regression was performed for main outcome according to follow-up delay and adjusted for age, sex, medication at discharge and major comorbid conditions. Results: A total of 163 heart failure readmission (37% of patients) occurred in 438 patients in the year following the first hospitalisation. Median readmission delay was of 62 days. Median dedicated follow-up delay was 30 days and was arranged in 68% of cases. After adjusting for confounding variables, early follow-up was significantly associated with fewer readmission (adjusted odds ratio 0.57, 95% CI; 0.34-0.97). Conclusions: Early dedicated follow-up after discharge for HFpEF was associated with fewer readmission over the year following discharge even when adjusting for major confounding variables.

Peak Oxygen Consumption and Resting Left Ventricular Ejection Fraction Changes After Cardiomyoplasty at 6-Month Follow-up

Circulation ◽  
1995 ◽  
Vol 92 (9) ◽  
pp. 216-222 ◽  
Author(s):  
Edimar Alcides Bocchi ◽  
Guilherme Veiga Guimarães ◽  
Luiz Felipe P. Moreira ◽  
Fernando Bacal ◽  
Alvaro Vilela de Moraes ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

scholarly journals Natural Progression of Low-Gradient Severe Aortic Stenosis with Preserved Ejection Fraction

2014 ◽  
Vol 41 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Antony Leslie Innasimuthu ◽  
Sanjay Kumar ◽  
Jason Lazar ◽  
William E. Katz
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Mild Stenosis ◽  
Natural Progression

Because the natural progression of low-gradient aortic stenosis (LGAS) has not been well defined, we performed a retrospective study of 116 consecutive patients with aortic stenosis who had undergone follow-up echocardiography at a median interval of 698 days (range, 371–1,020 d). All patients had preserved left ventricular ejection fraction (&gt;0.50) during and after follow-up. At baseline, patients were classified by aortic valve area (AVA) as having mild stenosis (≥1.5 cm2), moderate stenosis (≥1 to &lt;1.5 cm2), or severe stenosis (&lt;1 cm2). Severe aortic stenosis was further classified by mean gradient (LGAS, mean &lt;40 mmHg; high-gradient aortic stenosis [HGAS], mean ≥40 mmHg). We compared baseline and follow-up values among 4 groups: patients with mild stenosis, moderate stenosis, LGAS, and HGAS. At baseline, 30 patients had mild stenosis, 54 had moderate stenosis, 24 had LGAS, and 8 had HGAS. Compared with the moderate group, the LGAS group had lower AVA but similar mean gradient. Yet the actuarial curves for progressing to HGAS were significantly different: 25% of patients in LGAS reached HGAS status significantly earlier than did 25% of patients in the moderate-AS group (713 vs 881 d; P=0.035). Because LGAS has a high propensity to progress to HGAS, we propose that low-gradient aortic stenosis patients be closely monitored as a distinct subgroup that warrants more frequent echocardiographic follow-up.

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