Abstract MP091: Hypertension is Associated With Increased Risk of Adverse Clinical Outcomes in Women With Peripartum Cardiomyopathy

Background: Peripartum cardiomyopathy (PPCM) is a rare condition that carries a high morbidity and mortality among young women. Studies examining the association of modifiable risk factors such as hypertension with outcomes in this population are sparse. Methods: We conducted a multi-center retrospective study across three major centers (BWH, BIDMC, MGH) to identify subjects with PPCM using the following criteria: ejection fraction < 40%, development of heart failure within the last month of pregnancy or within 5 months of delivery and no other identifiable cause of heart failure with reduced ejection fraction. We defined adverse clinical outcome as a composite of heart failure hospitalizations, need for extra-corporeal membrane oxygenation, ejection fraction <35%, cardiac transplantation or death during the follow-up period. Results: In all, 237 women met criteria for PPCM across the three centers between April 1995 and November 2015. Participants had a median age of 33.1 years (IQR: 28.6-38.0), gravida 2.0, para 2.0, mean left ventricular ejection fraction at diagnosis of 30%; 25% had chronic hypertension and 14% had preeclampsia. After a median follow-up of 3.2 years (IQR: 1.0-7.8), 59 events occurred. In a logistic regression model adjusting for age, number of prior pregnancies and number of deliveries, women with preeclampsia had an OR of 1.34 (95% CI: 1.05-1.72), p=0.02 as compared to those without preeclampsia. A similar association was observed for hypertension (Table). In sensitivity analysis, the association between preeclampsia and adverse outcomes persisted for blacks and other races, but not for whites. Conclusion: Our study suggests that hypertension or preeclampsia at diagnosis is associated with increased risk of heart failure hospitalizations, need for extra-corporeal membrane oxygenation, poor left ventricular function recovery, cardiac transplantation and death on follow-up in women with PPCM. Clinicians should consider aggressive treatment of hypertension in women of childbearing age.

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Clinical Outcomes in Patients with Ischemic versus Non-Ischemic Cardiomyopathy after Angiotensin-Neprilysin Inhibition Therapy

Journal of Clinical Medicine ◽

10.3390/jcm10214989 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4989

Author(s):

Mohammad Abumayyaleh ◽

Christina Pilsinger ◽

Ibrahim El-Battrawy ◽

Marvin Kummer ◽

Jürgen Kuschyk ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Ischemic Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Tachyarrhythmias ◽

Ventricular Ejection Fraction ◽

One Year ◽

The Impact

Background: The angiotensin receptor-neprilysin inhibitor (ARNI) decreases cardiovascular mortality in patients with chronic heart failure with a reduced ejection fraction (HFrEF). Data regarding the impact of ARNI on the outcome in HFrEF patients according to heart failure etiology are limited. Methods and results: One hundred twenty-one consecutive patients with HFrEF from the years 2016 to 2017 were included at the Medical Centre Mannheim Heidelberg University and treated with ARNI according to the current guidelines. Left ventricular ejection fraction (LVEF) was numerically improved during the treatment with ARNI in both patient groups, that with ischemic cardiomyopathy (n = 61) (ICMP), and that with non-ischemic cardiomyopathy (n = 60) (NICMP); p = 0.25. Consistent with this data, the NT-proBNP decreased in both groups, more commonly in the NICMP patient group. In addition, the glomerular filtration rate (GFR) and creatinine changed before and after the treatment with ARNI in both groups. In a one-year follow-up, the rate of ventricular tachyarrhythmias (ventricular tachycardia and ventricular fibrillation) tended to be higher in the ICMP group compared with the NICMP group (ICMP 38.71% vs. NICMP 17.24%; p = 0.07). The rate of one-year all-cause mortality was similar in both groups (ICMP 6.5% vs. NICMP 6.6%; log-rank = 0.9947). Conclusions: This study shows that, although the treatment with ARNI improves the LVEF in ICMP and NICMP patients, the risk of ventricular tachyarrhythmias remains higher in ICMP patients in comparison with NICMP patients. Renal function is improved in the NICMP group after the treatment. Long-term mortality is similar over a one-year follow-up.

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Prognostic value of atrial fibrillation in patients with heart failure and different left ventricular ejection fraction: results of the multicenter RIF-CHF register

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4200 ◽

2021 ◽

Vol 26 (1) ◽

pp. 4200

Author(s):

I. V. Zhirov ◽

N. V. Safronova ◽

Yu. F. Osmolovskaya ◽

S. N. Тereschenko

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Cardiovascular Mortality ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Number Of Patients ◽

Increased Risk

Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with HF and AF is increasing every year.Aim. To analyze the effect of clinical course and management of HF and AF on the outcomes.Material and methods. The data of 1,003 patients from the first Russian register of patients with HF and AF (RIF-CHF) were analyzed. The endpoints included hospitalization due to decompensated HF, cardiovascular mortality, thromboembolic events, and major bleeding. Predictors of unfavorable outcomes were analyzed separately for patients with HF with preserved ejection fraction (AF+HFpEF), mid-range ejection fraction (AF+HFmrEF), and reduced ejection fraction (AF+HFrEF).Results. Among all patients with HF, 39% had HFpEF, 15% — HFmrEF, and 46% — HFrEF. A total of 57,2% of patients were rehospitalized due to decompensated HF within one year. Hospitalization risk was the highest for HFmrEF patients (66%, p=0,017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15,5% vs 5,4% in other groups, p<0,001) but not ischemic stroke (2,4% vs 3%, p=0,776). Patients with HFpEF had lower risk to achieve the composite endpoint (stroke+MI+cardiovascular death) as compared to patients with HFmrEF and HFrEF (12,7% vs 22% and 25,5%, p<0,001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and selected therapy had different effects on the risk of unfavorable outcomes depending on ejection fraction group.Conclusion. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with unfavorable outcomes. The demographic and clinical characteristics of patients with mid-range ejection fraction demonstrate that these patients need to be studied as a separate cohort.

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Abstract P232: Screening Past B-Type Natriuretic Peptide (BNP) Values to Identify Candidates for Treatment of Systolic Dysfunction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap232 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Parisa Gholami ◽

Shoutzu Lin ◽

Paul Heidenreich

Keyword(s):

Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Significant Difference ◽

The Mean

Background: BNP testing is now common though it is not clear if the test results are used to improve patient care. A high BNP may be an indicator that the left ventricular ejection fraction (LVEF) is low (<40%) such that the patient will benefit from life-prolonging therapy. Objective: To determine how often clinicians obtained a measure of LVEF (echocardiography, nuclear) following a high BNP value when the left ventricular ejection fraction (LVEF) was not known to be low (<40%). Methods and Results: We reviewed the medical records of 296 consecutive patients (inpatient or outpatient) with a BNP values of at least 200 pg/ml at a single medical center (tertiary hospital with 8 community clinics). A prior diagnosis of heart failure was made in 65%, while 42% had diabetes, 79% had hypertension, 59% had ischemic heart disease and 31% had chronic lung disease. The mean age was 73 ± 12 years, 75% were white, 10% black, 15% other and the mean BNP was 810 ± 814 pg/ml. The LVEF was known to be < 40% in 84 patients (28%, mean BNP value of 1094 ± 969 pg/ml). Of the remaining 212 patients without a known low LVEF, 161 (76%) had a prior LVEF >=40% ( mean BNP value of 673 ± 635 pg/ml), and 51 (24%) had no prior LVEF documented (mean BNP 775 ± 926 pg/ml). Following the high BNP, a measure of LVEF was obtained (including outside studies documented by the primary care provider) within 6 months in only 53% (113 of 212) of those with an LVEF not known to be low. Of those with a follow-up echocardiogram, the LVEF was <40% in 18/113 (16%) and >=40% in 95/113 (84%). There was no significant difference in mean initial BNP values between those with a follow-up LVEF <40% (872 ± 940pg/ml), >=40% (704 ± 737 pg/ml), or not done (661 ± 649 pg/ml, p=0.5). Conclusions: Follow-up measures of LVEF did not occur in almost 50% of patients with a high BNP where the information may have led to institution of life-prolonging therapy. Of those that did have a follow-up study a new diagnosis of depressesd LVEF was noted in 16%. Screening of existing BNP and LVEF data and may be an efficient strategy to identify patients that may benefit from life-prolonging therapy for heart failure.

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Predicting mortality for patients with heart failure beyond oxygen consumption: a prognostic risk score

Journal of Applied Physiology ◽

10.1152/japplphysiol.00326.2021 ◽

2021 ◽

Author(s):

Hanaa Shafiek ◽

Andres Grau ◽

Jaume Pons ◽

Pere Pericas ◽

Xavier Rossello ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Risk Score ◽

Cardiac Transplantation ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Functional Evaluation ◽

Cardiac Events ◽

Ventricular Ejection Fraction

Background: Cardiopulmonary exercise test (CPET) is a crucial tool for the functional evaluation of cardiac patients. We hypothesized that VO2 max and VE/VCO2 slope are not the only parameters of CPET able to predict major cardiac events (mortality or cardiac transplantation urgently or elective). Objectives: We aimed to identify the best CPET predictors of major cardiac events in patients with severe chronic heart failure and to propose an integrated score that could be applied for their prognostic evaluation. Methods: We evaluated 140 patients with chronic heart failure who underwent CPET between 2011 and 2019. Major cardiac events were evaluated during follow-up. Univariate and multivariate logistic regression analysis were applied to study the predictive value of different clinical, echocardiographic and CPET parameters in relation to the major cardiac events. A score was generated and c-statistic was used for the comparisons. Results: Thirty-nine patients (27.9%) died or underwent cardiac transplantation over a median follow-up of 48 months. Five parameters (maximal workload, breathing reserve, left ventricular ejection fraction, diastolic dysfunction and non-idiopathic cardiomyopathy) were used to generate a risk score that had better risk discrimination than NYHA dyspnea scale, VO2 max, VE/VCO2 slope > 35 alone, and combined VO2 max and VE/VCO2 slope (p= 0.009, 0.004, < 0.001 and 0.005 respectively) in predicting major cardiac events. Conclusions: A composite score of CPET and clinical/echocardiographic data is more reliable than the single use of VO2max or combined with VE/VCO2 slope to predict major cardiac events.

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Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Cardiology ◽

10.1159/000505148 ◽

2020 ◽

Vol 145 (5) ◽

pp. 275-282 ◽

Cited By ~ 2

Author(s):

Pablo Díez-Villanueva ◽

Lourdes Vicent ◽

Francisco de la Cuerda ◽

Alberto Esteban-Fernández ◽

Manuel Gómez-Bueno ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Ventricular ◽

Functional Class ◽

Ventricular Ejection ◽

Cardiac Resynchronization ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Background: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. Methods: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). Results: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13–0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). Conclusions: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.

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Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation

Journal of Clinical Medicine ◽

10.3390/jcm9092932 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2932

Author(s):

Mauro Feola ◽

Arianna Rossi ◽

Marzia Testa ◽

Cinzia Ferreri ◽

Alberto Palazzuoli ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Acute Decompensated Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Heart Failure Patients ◽

Acute Decompensation ◽

Diuretic Response

Background. The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure patients. The objectives of this clinical research are to analyze two different formulas (diuretic response (DR) or response to diuretic (R-to-D)) in predicting 6-month clinical outcomes. Methods: Consecutive patients discharged alive after an acute decompensated heart failure (ADHF) were enrolled. All patients underwent N-terminal-pro hormone BNP (NT-proBNP) and an echocardiogram together with DR and R-to-D calculation during diuretic administration. Death by any cause, cardiac transplantation and worsening heart failure (HF) requiring readmission to hospital were considered cardiovascular events. Results: 263 patients (62% male, age 78 years) were analyzed at 6-month follow-up. During the follow-up 58 (22.05%) events were scheduled. Patients who experienced CV-event had a worse renal function (p = 0.001), a higher NT-proBNP (p = 0.001), a lower left ventricular ejection fraction (p = 0.01), DR (p = 0.02) and R-to-D (p = 0.03). Spearman rho’s correlation coefficient showed a strong direct correlation between DR and R to D in all patients (r = 0.93; p < 0.001) and both in heart failure with reduced ejection fraction (HFrEF) (r = 0.94; p < 0.001) and HF preserved ejection fraction (HFpEF) (r = 0.91; p < 0.001). At multivariate analysis, a value of R-to-D <1.69 kg/40 mg, but only <0.67 kg/40 mg for DR were significantly related to poor 6-month outcome (p = 0.04 and p = 0.05, respectively). Receiver operating characteristic (ROC) curve analyses demonstrated that DR and R-to-D are equivalent in predicting prognosis (area under curve (AUC): 0.39 and 0.40, respectively). Only R-to-D was inversely related to in-hospital stay (r = −0.23; p = 0.01). Conclusion: Adding diuresis to DR seemed to provide a better risk assessment in alive HF patients discharged after an acute decompensation.

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Sacubitril/Valsartan Improves Autonomic Function and Cardiopulmonary Parameters in Patients with Heart Failure with Reduced Ejection Fraction

Journal of Clinical Medicine ◽

10.3390/jcm9061897 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1897 ◽

Cited By ~ 1

Author(s):

Francesco Giallauria ◽

Giuseppe Vitale ◽

Mario Pacileo ◽

Anna Di Lorenzo ◽

Alessandro Oliviero ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Autonomic Function ◽

Left Ventricular ◽

Exercise Stress ◽

Left Ventricular Ejection ◽

Peak Exercise ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction

Background: Heart rate recovery (HRR) is a marker of vagal tone, which is a powerful predictor of mortality in patients with cardiovascular disease. Sacubitril/valsartan (S/V) is a treatment for heart failure with reduced ejection fraction (HFrEF), which impressively impacts cardiovascular outcome. This study aims at evaluating the effects of S/V on HRR and its correlation with cardiopulmonary indexes in HFrEF patients. Methods: Patients with HFrEF admitted to outpatients’ services were screened out for study inclusion. S/V was administered according to guidelines. Up-titration was performed every 4 weeks when tolerated. All patients underwent laboratory measurements, Doppler-echocardiography, and cardiopulmonary exercise stress testing (CPET) at baseline and at 12-month follow-up. Results: Study population consisted of 134 HFrEF patients (87% male, mean age 57.9 ± 9.6 years). At 12-month follow-up, significant improvement in left ventricular ejection fraction (from 28% ± 5.8% to 31.8% ± 7.3%, p < 0.0001), peak exercise oxygen consumption (VO2peak) (from 15.3 ± 3.7 to 17.8 ± 4.2 mL/kg/min, p < 0.0001), the slope of increase in ventilation over carbon dioxide output (VE/VCO2 slope )(from 33.4 ± 6.2 to 30.3 ± 6.5, p < 0.0001), and HRR (from 11.4 ± 9.5 to 17.4 ± 15.1 bpm, p = 0.004) was observed. Changes in HRR were significantly correlated to changes in VE/VCO2slope (r = −0.330; p = 0.003). After adjusting for potential confounding factors, multivariate analysis showed that changes in HRR were significantly associated to changes in VE/VCO2slope (Beta (B) = −0.975, standard error (SE) = 0.364, standardized Beta coefficient (Bstd) = −0.304, p = 0.009). S/V showed significant reduction in exercise oscillatory ventilation (EOV) detection at CPET (28 EOV detected at baseline CPET vs. 9 EOV detected at 12-month follow-up, p < 0.001). HRR at baseline CPET was a significant predictor of EOV at 12-month follow-up (B = −2.065, SE = 0.354, p < 0.001). Conclusions: In HFrEF patients, S/V therapy improves autonomic function, functional capacity, and ventilation. Whether these findings might translate into beneficial effects on prognosis and outcome remains to be elucidated.

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NT-ProBNP and hsTnI: A Multistate Survival Analysis in Outpatients with Reduced Left-Ventricular Ejection Fraction

Cardiology ◽

10.1159/000488640 ◽

2019 ◽

Vol 142 (1) ◽

pp. 7-13

Author(s):

Gabriele Di Gesaro ◽

Giuseppa Caccamo ◽

Diego Bellavia ◽

Calogero Falletta ◽

Chiara Minà ◽

...

Keyword(s):

Ejection Fraction ◽

Troponin I ◽

Serum Levels ◽

Left Ventricular ◽

Clinical Event ◽

Left Ventricular Ejection ◽

Baseline Serum ◽

Ventricular Ejection Fraction ◽

Increased Risk

Heart failure (HF) with reduced ejection fraction (HFrEF) has a well-known epidemic relevance in western countries. It affects up to 1–2% of patients > 60 years and reaches a prevalence of 12% in octogenarian patients. The role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin I (hsTnI) in risk stratifying HFrEF patients has been established; at present, evidence is exclusively based on one-time assessments, and the prognostic usefulness of serial biochemical assessments in this population still remains to be determined. We prospectively recruited 226 patients with chronic HFrEF, who were all referred to the Outpatient Clinic of our institution from November 2011 through September 2014. Recruited patients underwent full clinical evaluation with complete history taking and physical examination as well as ECG, biochemical assessment, and standard 2D and Doppler flow echocardiography at the first visit, and then again at each visit during the follow-up, repeated every 6 months. During the follow-up period, cardiovascular (CV) death, which occurred in 16 patients, was not statistically correlated with gender (p = 0.088) or age (p = 0.1636); however, baseline serum levels of NT-proBNP, which were 3 times higher in deceased patients, were significantly related to this clinical event (p = 0.001). We found that NT-proBNP represents a strong and independent predictor of CV outcome; serum levels of hsTnI, which are significantly related to an increased risk of hospitalization, cannot properly predict the relative risk of CV mortality. Our study validates, eventually, the multimarker strategy, which reflects the complexity of the HF pathophysiology.

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Improvement in Left Ventricular Ejection Fraction in Outpatients With Heart Failure With Reduced Ejection Fraction

Circulation Heart Failure ◽

10.1161/circheartfailure.119.006833 ◽

2020 ◽

Vol 13 (7) ◽

Cited By ~ 1

Author(s):

Adam D. DeVore ◽

Anne S. Hellkamp ◽

Laine Thomas ◽

Nancy M. Albert ◽

Javed Butler ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Clinical Decision Making ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Factors Associated ◽

Patients With Heart Failure

Background: Among patients with heart failure (HF) with reduced ejection fraction (EF), improvements in left ventricular EF (LVEF) are associated with better outcomes and remain an important treatment goal. Patient factors associated with LVEF improvement in routine clinical practice have not been clearly defined. Methods: CHAMP-HF (Change the Management of Patients with Heart Failure) is a prospective registry of outpatients with HF with reduced EF. Assessments of LVEF are recorded when performed for routine care. We analyzed patients with both baseline and ≥1 follow-up LVEF assessments to describe factors associated with LVEF improvement. Results: In CHAMP-HF, 2623 patients had a baseline and follow-up LVEF assessment. The median age was 67 (interquartile range, 58–75) years, 40% had an ischemic cardiomyopathy, and median HF duration was 2.8 years (0.7–6.8). Median LVEF was 30% (23–35), and median change on follow-up was 4% (−2 to −13); 19% of patients had a decrease in LVEF, 31% had no change, 49% had a ≥5% increase, and 34% had a ≥10% increase. In a multivariable model, the following factors were associated with ≥5% LVEF increase: shorter HF duration (odds ratio [OR], 1.21 [95% CI, 1.17–1.25]), no implantable cardioverter defibrillator (OR, 1.46 [95% CI, 1.34–1.55]), lower LVEF (OR, 1.15 [95% CI, 1.10–1.19]), nonischemic cardiomyopathy (OR, 1.24 [95% CI, 1.09–1.36]), and no coronary disease (OR, 1.20 [95% CI, 1.03–1.35]). Conclusions: In a large cohort of outpatients with chronic HF with reduced EF, improvements in LVEF were common. Common baseline cardiac characteristics identified a population that was more likely to respond over time. These data may inform clinical decision making and should be the basis for future research on myocardial recovery.

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

BMJ Open ◽

10.1136/bmjopen-2020-038294 ◽

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.

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