Abstract 11242: Impact of Peripheral Artery Disease on Prognosis in Heart Failure Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yuichi Nakamura ◽  
Akiomi Yoshihisa ◽  
Hiroyuki Kunii ◽  
Mai Takiguchi ◽  
Takeshi Shimizu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Ischemic Heart Disease ◽  
Cardiac Death ◽  
Independent Predictor ◽  
Cardiac Mortality ◽  
Peripheral Artery ◽  
All Cause Mortality ◽  
Artery Disease

Background: A history of peripheral artery disease (PAD) is an independent predictor of cardiac mortality in patients with ischemic heart disease. However, it still remains unclear whether PAD predicts worsening heart failure (HF), cardiac and all-cause mortality in HF patients. Methods and Results: Consecutive 388 HF patients admitted to our hospital for the treatment of decompensated HF were divided into 2 groups based on the presence of PAD: HF with PAD (PAD group, n = 103) and HF without PAD (non-PAD group, n = 285). We compared echocardiographic and laboratory findings, and followed the event of worsening HF, cardiac death, non-cardiac death, and all-cause mortality between the two groups. The PAD group, as compared to non-PAD group, had 1) higher age (69.2 vs. 64.5 years old, P=0.001), 2) higher incidence of New York Heart Association functional class III or IV (56.3% vs. 37.2%, P = 0.001), 3) lower levels of hemoglobin (12.3 vs. 12.9 g/dl, P = 0.020), 4) higher levels of B-type natriuretic peptide (591.0 vs. 256.9 pg/ml, P = 0.017), 5) lower estimated glomerular filtration rate (GFR) (46.2 vs. 58.9 ml/min/1.73m 2 , P < 0.001), and 6) lower left ventricular ejection fraction (42.0 vs. 48.7%, P < 0.001). In the follow-up period (mean 765.6 days), Kaplan-Meier analyses (Figure) showed that the event-free survival from worsening HF, cardiac death, non-cardiac death and all-cause death was significantly higher in non-PAD group than in PAD group (P = 0.017, P < 0.001, P = 0.001 and P = 0.005, respectively, by a log-rank test). In the Cox proportional hazard analyses after adjusting for age, gender, ejection fraction, estimated GFR, and the presence of ischemic heart disease, PAD was an independent predictor of cardiac death (hazard ratio (HR) 2.09, P = 0.019) and all-cause mortality (HR 2.16, P = 0.002) in HF patients. Conclusions: PAD is an independent predictor of cardiac mortality and all-cause mortality in HF patients.

Abstract 12033: Impact of n-3 Polyunsaturated Fatty Acids on Mortality of Patients With Hospitalized Heart Failure Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shunsuke Watanabe ◽  
Akiomi Yoshihisa ◽  
Yuki Kanno ◽  
Mai Takiguchi ◽  
Shunsuke Miura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Fatty Acids ◽  
Heart Disease ◽  
Polyunsaturated Fatty Acids ◽  
Ischemic Heart Disease ◽  
Linolenic Acid ◽  
Independent Predictor ◽  
Ischemic Heart ◽  
Cardiac Mortality ◽  
All Cause Mortality

Background: Intake of n-3 polyunsaturated fatty acids (n-3 PUFA), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), lowers risk of atherosclerotic cardiovascular events, particularly ischemic heart disease. In addition, a ratio of EPA/arachidonic acid (AA) is recently recognized as a risk marker of ischemic heart disease. In contrast, prognostic impact of the EPA, DHA and EPA/AA ratio on patients with heart failure (HF) still remains unclear. Methods and Results: Consecutive 577 patients admitted for HF were divided into 2 groups based on median levels of EPA/AA ratio: low EPA/AA (EPA/AA ≤ 0.32 mg/dl, n=291) and high EPA/AA (0.32 < EPA/AA, n=286) groups. We compared laboratory data, echocardiographic findings and cardio-pulmonary exercise test results, and prospectively followed cardiac and all-cause mortality. The low EPA/AA group, as compared to the high EPA/AA group, had lower levels of EPA and DHA (EPA: 33.9 vs. 86.8 μg/ml, P<0.003; DHA: 107.0 vs. 150.5 μg/ml, P<0.001), and higher levels of AA and dihomosexual linolenic acid (AA: 174.0 vs. 156.5 μg/ml, P<0.001; dihomosexual linolenic acid: 32.4 vs. 29.5 μg/ml, P=0.010). In contrast, body mass index, blood pressure, B-type natriuretic peptide, hemoglobin, estimated GFR, total protein, albumin, sodium, C-reactive protein, left ventricular ejection fraction, peak VO 2 and VE/VCO 2 slope were similar between the two groups. Cardiac mortality (log-rank P=0.004) and all-cause mortality (P<0.001) were higher in the low EPA/AA group than in the high EPA/AA group. In the multivariable Cox proportional hazard analyses, the EPA/AA ratio was an independent predictor of cardiac mortality (HR 0.087, P=0.003) and all-cause mortality (HR 0.233, P=0.009) in HF patients. Conclusions: The EPA/AA ratio was an independent predictor of cardiac and all-cause mortality in HF patients. Thus, taking appropriate management to control EPA/AA balance may improve the prognosis of HF patients.

scholarly journals Calcium Channel Autoantibodies Predicted Sudden Cardiac Death and All-Cause Mortality in Patients with Ischemic and Nonischemic Chronic Heart Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Haiyun Yu ◽  
Juanhui Pei ◽  
Xiaoyan Liu ◽  
Jingzhou Chen ◽  
Xian Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariate Analysis ◽  
Sudden Cardiac Death ◽  
Chronic Heart Failure ◽  
Cardiac Death ◽  
Independent Predictor ◽  
All Cause Mortality ◽  
Patient Prognosis ◽  
The Relationship

The purpose of this study was to evaluate whether CC-AAbs levels could predict prognosis in CHF patients. A total of 2096 patients with CHF (841 DCM patients and 1255 ICM patients) and 834 control subjects were recruited. CC-AAbs were detected and the relationship between CC-AAbs and patient prognosis was analyzed. During a median follow-up time of 52 months, there were 578 deaths. Of these, sudden cardiac death (SCD) occurred in 102 cases of DCM and 121 cases of ICM. The presence of CC-AAbs in patients was significantly higher than that of controls (bothP<0.001). Multivariate analysis revealed that positive CC-AAbs could predict SCD (HR 3.191, 95% CI 1.598–6.369 for DCM; HR 2.805, 95% CI 1.488–5.288 for ICM) and all-cause mortality (HR 1.733, 95% CI 1.042–2.883 for DCM; HR 2.219, 95% CI 1.461–3.371 for ICM) in CHF patients. A significant association between CC-AAbs and non-SCD (NSCD) was found in ICM patients (HR = 1.887, 95% CI 1.081–3.293). Our results demonstrated that the presence of CC-AAbs was higher in CHF patients versus controls and corresponds to a higher incidence of all-cause death and SCD. Positive CC-AAbs may serve as an independent predictor for SCD and all-cause death in these patients.

scholarly journals Left Ventricular Function and Myocardial Triglyceride Content on 3T Cardiac MR Predict Major Cardiovascular Adverse Events and Readmission in Patients Hospitalized with Acute Heart Failure

2020 ◽  
Vol 9 (1) ◽  
pp. 169
Author(s):  
Kuang-Fu Chang ◽  
Gigin Lin ◽  
Pei-Ching Huang ◽  
Yu-Hsiang Juan ◽  
Chao-Hung Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Magnetic Resonance ◽  
Adverse Events ◽  
Ischemic Heart Disease ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Imaging Biomarkers ◽  
Myocardial Mass ◽  
End Diastolic Volume

Background: This prospective study was designed to investigate whether myocardial triglyceride (TG) content from proton magnetic resonance spectroscopy (MRS) and left ventricular (LV) function parameters from cardiovascular magnetic resonance imaging (CMR) can serve as imaging biomarkers in predicting future major cardiovascular adverse events (MACE) and readmission in patients who had been hospitalized for acute heart failure (HF). Methods: Patients who were discharged after hospitalization for acute HF were prospectively enrolled. On a 3.0 T MR scanner, myocardial TG contents were measured using MRS, and LV parameters (function and mass) were evaluated using cine. The occurrence of MACE and the HF-related readmission served as the endpoints. Independent predictors were identified using univariate and multivariable Cox proportional hazard regression analyses. Results: A total of 133 patients (mean age, 52.4 years) were enrolled. The mean duration of follow-up in surviving patients was 775 days. Baseline LV functional parameters—including ejection fraction, LV end-diastolic volume, LV end-diastolic volume index (LVEDVI), and LV end-systolic volume (p < 0.0001 for all), and myocardial mass (p = 0.010)—were significantly associated with MACE. Multivariable analysis revealed that LVEDVI was the independent predictor for MACE, while myocardial mass was the independent predictor for 3- and 12-month readmission. Myocardial TG content (lipid resonances δ 1.6 ppm) was significantly associated with readmission in patients with ischemic heart disease. Conclusions: LVEDVI and myocardial mass are potential imaging biomarkers that independently predict MACE and readmission, respectively, in patients discharged after hospitalization for acute HF. Myocardial TG predicts readmission in patients with a history of ischemic heart disease.

P3544Role of cardiovascular comorbidities in heart failure across the ejection fraction spectrum

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Settergren ◽  
G Savarese ◽  
T Thorvaldsen ◽  
A Meyers ◽  
S Fazeli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Ischemic Heart Disease ◽  
Cox Regression ◽  
Nyha Class ◽  
Ischemic Heart ◽  
Similar Distribution ◽  
Reduced Ejection Fraction ◽  
Cardiovascular Comorbidities

Abstract Background Comorbidities are associated with heart failure (HF) development, severity and outcomes, but may play different roles in HF with preserved (HFpEF) vs. mid-range (HFmrEF) vs. reduced ejection fraction (HFrEF). A detailed characterization of HF patients according to EF and comorbidities may improve prognostication and facilitate trial design. Purpose To investigate characteristics and outcomes in a large and unselected cohort of HF patients according to EF strata and presence/absence of concomitant type 2 diabetes (T2DM), atrial fibrillation (AF) and chronic kidney disease (CKD). Methods Patients enrolled in the Swedish HF registry between 2000–2012 were considered. Kaplan Meier curves and multivariable Cox regression models were fitted to assess risk and predictors of outcomes (HF and all-cause hospitalization; composite of cardiovascular (CV) death and HF hospitalization). Results Of 42,583 patients (23% HFpEF, 21% HFmrEF, 56% HFrEF), 24% had T2DM, 49% CKD defined as eGFR&lt;60 ml/min/1.73m2, and 56% AF. T2DM, AF and CKD coexisted in 8% of the population with similar distribution across all EF strata. AF and CKD were the most likely to coexist. Prevalence of AF and/or CKD was highest in HFpEF and lowest in HFrEF, whereas prevalence of T2DM was similar across the EF spectrum (Figure). Compared to patients without T2DM and/or AF and/or CKD, those with any of them were more likely to suffer from other comorbidities (i.e. hypertension, anemia, COPD), to be inpatients, have more severe HF (higher NYHA class, NT-proBNP levels and use of diuretics, longer HF duration) but less likely to be followed-up in specialty vs. primary care. Concomitant history of ischemic heart disease was more likely in patients with vs. without CKD and/or T2DM but less likely in those with vs without AF. Patients with vs. without T2DM and/or CKD and/or AF had worse prognosis. In particular, risk of HF hospitalization and composite of HF hospitalization/CV death was highest in patients with HFrEF and concomitant comorbidities, whereas the risk of all-cause hospitalization was highest in those with HFpEF or HFmrEF and concomitant comorbidities. Prognostic predictors of CV death/HF hospitalization were consistent in patients with T2DM, CKD or AF, regardless of EF (e.g. male sex, older age, lower EF category, more severe HF, ischemic heart disease, anemia, COPD). Comorbidities burden Conclusion HF patients show a high burden of concomitant diseases, specifically T2DM, CKD and AF. CKD and AF are more prevalent in HFpEF vs. HFmrEF vs. HFrEF, whereas T2DM prevalence is consistent across the EF spectrum. Presence of comorbidities identifies patients with more severe HF regardless of EF category. Presence of comorbidities may identify patients at higher risk of CV outcomes in HFrEF and those at higher risk of non-CV events in HFpEF. Acknowledgement/Funding This study has been supported by funding from Boehringer Ingelheim

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