Abstract 13304: Liver Dispersion Predicts Adverse Outcomes in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yu Hotsuki ◽  
Akiomi Yoshihisa ◽  
Koichiro Watanabe ◽  
Yu Sato ◽  
Yusuke Kimishima ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Death ◽  
Cardiac Event ◽  
Liver Stiffness ◽  
Adverse Outcomes ◽  
Right Atrial ◽  
Gamma Glutamyl Transferase ◽  
Abdominal Ultrasonography ◽  
Patients With Heart Failure ◽  
Glutamyl Transferase

Background: It has been recently reported that liver stiffness assessed by transient elastography reflects right atrial pressure (RAP), and is associated with worse outcome in patients with heart failure (HF). However, the relationship between liver dispersion (LD, a novel indicator of liver viscosity) determined by abdominal ultrasonography and RAP, and prognostic impacts of LD on HF patients have not been fully examined. We aimed to clarify associations of LD with parameters of liver functional test (LFT) and right-heart catheterization (RHC), and cardiac event such as cardiac death and worsening HF in patients with HF. Methods and Results: We performed abdominal ultrasonography, LFT, RHC, and followed up cardiac events including cardiac death and unplanned hospitalization due to HF in patients with HF (n=157). We examined associations of LD with parameters of LFT and RHC. There were significant correlations between LD and circulating levels of gamma-glutamyl transferase (R=0.197, P=0.018), cholinesterase (R=-0.301, P=0.001), and 7S domain of collagen type IV (P4NP 7S, a marker of fibrosis, R=0.334, P<0.001), but not with RAP (R=0.067, P=0.514) or cardiac index (R=-0.038, P=0.667). During the follow up period (median 305 days), 6 cardiac deaths and 18 unplanned hospitalization due to HF occurred. In the Kaplan-Meier analysis ( Figure ), cardiac event rate was significantly higher in the high LD group (LD ≥10.0 (m/s)/kHz, n=79) than in the low LD group (LD < 10.0 (m/s)/kHz, n=78; log-rank, P=0.007). In the multivariable Cox proportional hazard analysis, high LD was found to be an independent predictor of cardiac event (hazard ratio 3.274, 95% confidence interval 1.203-8.912, P=0.020). Conclusions: LD assessed by abdominal ultrasonography reflects liver fibrosis rather than liver congestion, and is associated with adverse prognosis in HF patients.

scholarly journals Shear Wave Dispersion Predicts Liver Fibrosis and Adverse Outcomes in Patients with Heart Failure

2020 ◽  
Vol 9 (12) ◽  
pp. 3953
Author(s):  
Himika Ohara ◽  
Akiomi Yoshihisa ◽  
Shinji Ishibashi ◽  
Mitsuko Matsuda ◽  
Yukio Yamadera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Fibrosis ◽  
Shear Wave ◽  
Cardiac Event ◽  
Wave Dispersion ◽  
Right Atrial ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Abdominal Ultrasonography ◽  
Patients With Heart Failure

Background: It has been recently reported that liver stiffness assessed by transient elastography reflects right atrial pressure (RAP) and is associated with worse outcomes in patients with heart failure (HF). However, the relationship between shear wave dispersion (SWD, a novel indicator of liver viscosity) determined by abdominal ultrasonography and RAP, and the prognostic impact of SWD on HF patients have not been fully examined. We aimed to clarify the associations of SWD with parameters of liver function test (LFT) and right heart catheterization (RHC), as well as with cardiac events such as cardiac death and worsening HF, in patients with HF. Methods: We performed abdominal ultrasonography, LFT and RHC in HF patients (n = 195), and followed up for cardiac events. We examined associations between SWD and parameters of LFT and RHC. Results: There were significant correlations between SWD and circulating levels of direct bilirubin (R = 0.222, p = 0.002), alkaline phosphatase (R = 0.219, p = 0.002), cholinesterase (R = −0.184, p = 0.011), and 7S domain of collagen type IV (R = 0.177, p = 0.014), but not with RAP (R = 0.054, p = 0.567) or cardiac index (R = −0.015, p = 0.872). In the Kaplan–Meier analysis, cardiac event rate was significantly higher in the high SWD group (SWD ≥ 10.0 (m/s)/kHz, n = 103) than in the low SWD group (SWD < 10.0 (m/s)/kHz, n = 92; log-rank, p = 0.010). In the Cox proportional hazard analysis, high SWD was associated with high cardiac event rates (hazard ratio, 2.841; 95% confidence interval, 1.234–6.541, p = 0.014). In addition, there were no interactions between SWD and all subgroups, according to the subgroup analysis. Conclusions: SWD assessed by abdominal ultrasonography reflects liver fibrosis rather than liver congestion, and is associated with adverse prognosis in HF patients.

Abstract 13301: Clinical Implications of Hepatic Hemodynamic Evaluation by Abdominal Ultrasonographic Imaging in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yu Hotsuki ◽  
Akiomi YOSHIHISA ◽  
Yasuhiro Ichijo ◽  
Koichiro Watanabe ◽  
Yu Sato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Stiffness ◽  
Stable Condition ◽  
Right Atrial ◽  
Clinical Implications ◽  
Cardiac Events ◽  
Abdominal Ultrasonography ◽  
Hemodynamic Evaluation ◽  
Patients With Heart Failure ◽  
Hepatic Hemodynamic

Background: It has been reported that liver stiffness assessed by transient elastography is correlated with right atrial pressure (RAP), which is an important hemodynamic parameter in patients with heart failure (HF). We aimed to clarify clinical implications of hepatic hemodynamic evaluation (liver congestion and hypoperfusion) by abdominal ultrasonography in patients admitted for the treatment of decompensated HF. Methods and Results: We performed abdominal ultrasonography, right-heart catheterization (RHC), and echocardiography in HF patients (n=342) at stable condition after treatment, then followed up for cardiac events such as cardiac death and re-hospitalization due to worsening HF. Regarding liver congestion, liver stiffness assessed by shear wave elastography of the liver (SWE) was significantly correlated with RAP determined by RHC (R=0.343, P<0.01) and right atrial end systolic area determined by echocardiography (R=0.293, P<0.01). With regard to liver hypoperfusion, peak systolic velocity (PSV) of the celiac artery was correlated with cardiac index determined by RHC (R=0.291, P<0.001) and tricuspid annular plane systolic excursion determined by echocardiography (R=0.251, P=0.004). Importantly, cardiac event rate was highest in HF patients with high SWE and low PSV ( Figure , subset 4). In the Cox proportional hazard analysis, the combination of high SWE and low PSV was a strong predictor of cardiac events (HR 4.811, 95% CI 1.562-14.818). Conclusions: Abdominal ultrasonography based evaluations of intrahepatic congestion and hypoperfusion predict adverse prognosis in HF patients.

scholarly journals Liver Stiffness Reflecting Right-Sided Filling Pressure Can Predict Adverse Outcomes in Patients With Heart Failure

2019 ◽  
Vol 12 (6) ◽  
pp. 955-964 ◽  
Author(s):  
Tatsunori Taniguchi ◽  
Tomohito Ohtani ◽  
Hidetaka Kioka ◽  
Yasumasa Tsukamoto ◽  
Toshinari Onishi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Stiffness ◽  
Filling Pressure ◽  
Adverse Outcomes ◽  
Patients With Heart Failure

Abstract 13330: Intrarenal Doppler Ultrasonography Reflects Hemodynamics and Predicts Prognosis in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Koichiro Watanabe ◽  
Akiomi YOSHIHISA ◽  
Yu Sato ◽  
Yu Hotsuki ◽  
Yasuhiro Ichijo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Event ◽  
Doppler Ultrasonography ◽  
Event Rate ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Cardiac Event Rate ◽  
Patients With Heart Failure

Introduction: We aimed to clarify clinical implications of intrarenal hemodynamics (congestion and hypoperfusion) assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in patients with heart failure (HF). Methods and Results: We performed IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n=341). These patients were categorized based on 1) VTI: high VTI (VTI ≥ 14.0 cm, n=231) or low VTI (VTI < 14.0 cm, n=103); and 2) IRVF: monophasic (n=36) or non-monophasic (n=305) pattern. We performed right-heart catheterization, and examined post-discharge cardiac event rate such as cardiac death and rehospitalization due to worsening HF. Regarding renal perfusion, cardiac index was positively correlated with VTI (R=0.270, P=0.040). Concerning renal congestion, levels of right atrial pressure were higher in monophasic pattern than in non-monophasic pattern (9.0 vs. 7.2 mmHg, P=0.029). Importantly, HF patients with low VTI and a monophasic IRVF pattern (subset 4) had the highest cardiac event rate ( Figure ). In the Cox proportional hazard analysis, the combination of low VTI and a monophasic IRVF pattern was found to be a strong predictor of cardiac events (HR 8.357, 95% CI 3.365-20.752). Conclusion: Intrarenal hypoperfusion and congestion assessed by IRD imaging reflected cardiac output and right atrial pressure, and was useful to risk-stratify HF patients.

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.

scholarly journals Clinical Significance of Mean and Pulse Pressure in Patients With Heart Failure With Preserved Ejection Fraction

Hypertension ◽  
2021 ◽  
Author(s):  
Fang-Fei Wei ◽  
Yuzhong Wu ◽  
Ruicong Xue ◽  
Xiao Liu ◽  
Xin He ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Pulse Pressure ◽  
Total Mortality ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Sensitivity Analyses ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

It remains debated whether pulse pressure is associated with left ventricular traits and adverse outcomes over and beyond mean arterial pressure (MAP) in patients with heart failure (HF) with preserved ejection fraction. We investigated these associations in 3428 patients with HF with preserved ejection fraction (51.5% women; mean age, 68.6 years) enrolled in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). We computed association sizes and hazards ratios with 1-SD increase in MAP and pulse pressure. In multivariable-adjusted analyses, association sizes ( P ≤0.039) for MAP were 0.016 cm and 0.014 cm for septal and posterior wall thickness, −0.15 for E/A ratio, −0.66 for E/e′, and −0.64% for ejection fraction, independent of pulse pressure. With adjustment additionally applied for MAP, E/A ratio and longitudinal strain increased with higher pulse pressure with association sizes amounting to 0.067 ( P =0.026) and 0.40% ( P =0.023). In multivariable-adjusted analyses of both placebo and spironolactone groups, lower MAP and higher pulse pressure predicted the primary composite end point ( P ≤0.028) and hospitalized HF ( P ≤0.002), whereas MAP was also significantly associated with total mortality ( P ≤0.007). Sensitivity analyses stratified by sex, median age, and region generated confirmatory results with exception for the association of adverse outcomes with pulse pressure in patients with age ≥69 years. In conclusion, the clinical application of MAP and pulse pressure may refine risk estimates in patients with HF with preserved ejection fraction. This finding may help further investigation for the development of HF with preserved ejection fraction preventive strategies targeting pulsatility and blood pressure control.

Racial differences in dietary antioxidant intake and cardiac event-free survival in patients with heart failure

2018 ◽  
Vol 17 (4) ◽  
pp. 305-313 ◽  
Author(s):  
Jia-Rong Wu ◽  
Eun Kyeung Song ◽  
Debra K Moser ◽  
Terry A Lennie
Keyword(s):  
Heart Failure ◽  
African American ◽  
African Americans ◽  
Cardiac Event ◽  
Event Free Survival ◽  
Free Survival ◽  
Dietary Antioxidant ◽  
Patients With Heart Failure ◽  
Antioxidant Intake ◽  
Carotene Beta

Background: Heart failure is a chronic, burdensome condition with higher re-hospitalization rates in African Americans than Whites. Higher dietary antioxidant intake is associated with lower oxidative stress and improved endothelial function. Lower dietary antioxidant intake in African Americans may play a role in the re-hospitalization disparity between African American and White patients with heart failure. Objective: The objective of this study was to examine the associations among race, dietary antioxidant intake, and cardiac event-free survival in patients with heart failure. Methods: In a secondary analysis of 247 patients with heart failure who completed a four-day food diary, intake of alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, zeaxanthin, lycopene, vitamins C and E, zinc, and selenium were assessed. Antioxidant deficiency was defined as intake below the estimated average requirement for antioxidants with an established estimated average requirement, or lower than the sample median for antioxidants without an established estimated average requirement. Patients were followed for a median of one year to determine time to first cardiac event (hospitalization or death). Survival analysis was used for data analysis. Results: African American patients had more dietary antioxidant deficiencies and a shorter cardiac event-free survival compared with Whites ( p = .007 and p = .028, respectively). In Cox regression, race and antioxidant deficiency were associated with cardiac event-free survival before and after adjusting for covariates. Conclusion: African Americans with heart failure had more dietary antioxidant deficiencies and shorter cardiac event-free survival than Whites. This suggests that encouraging African American patients with heart failure to consume an antioxidant-rich diet may be beneficial in lengthening cardiac event-free survival.

Abstract P041: Cumulative Exposure to Air Pollution, Socioeconomic Status and Post-Myocardial Infarction Outcomes in Central Israel. A Cohort Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Noa Molshatzki ◽  
David Broday ◽  
Silvia Koton ◽  
Yuval . ◽  
Vicki Myers ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Socioeconomic Status ◽  
Cardiac Death ◽  
Fine Particles ◽  
Adverse Outcomes ◽  
Cumulative Exposure ◽  
Exposure Misclassification ◽  
Cox Models ◽  
Clinical Variables

Objective: In a community-based cohort of myocardial infarction (MI) survivors, we examined whether cumulative residential exposure to air pollutants constitutes a risk factor for adverse outcomes. Methods: Patients aged ≤65 years (n=1,428), admitted with first MI in 1992-1993 to the 8 hospitals serving the population of central Israel, were followed up through 2005. Extensive data were collected on socio-demographic, clinical, and environmental factors. Daily measures of nitrogen dioxide (NO 2 ), nitric oxide (NO) and fine particles (PM 2.5 ) recorded at air quality monitoring stations were summarized and cumulative exposure was estimated for each patient based on geo-coded residential location at study entry. Cox models were used to assess the hazard ratios (HRs) for all-cause death, cardiac death, recurrent MI, heart failure and stroke associated with a 10 μ g/m 3 increase in pollutant exposure. Results: Patients residing in more polluted areas had better socioeconomic status at both the individual and neighborhood levels. Exposure to pollutants was inversely associated with outcomes. However, these associations were either removed or reversed upon multivariable adjustment for socioeconomic and clinical variables (HRs [95% CIs] of PM 2.5 are reported in the Table). Conclusions: In this unique setting and in contrast to other reports, better socioeconomic status was associated with higher exposure to pollution. In multivariable models accounting for socioeconomic and clinical variables, we observed a weak positive association between PM 2.5 exposure and post-MI outcomes, consistent with findings in the general population. Considering exposure misclassification, the true association is likely stronger. Unadjusted Multivariable-Adjusted All-Cause Death 0.93 (0.53-1.62) 1.51 (0.85-2.67) Cardiac Death 0.74 (0.38-1.44) 1.37 (0.70-2.68) Recurrent MI 1.06 (0.62-1.81) 1.67 (0.96-2.92) Heart Failure 0.60 (0.32-1.12) 1.39 (0.73-2.62) Stroke 0.64 (0.29-1.40) 1.04 (0.46-2.33)

Abstract 13678: Serum Hepatokine Selenoprotein P is Upregulated by Hepatic Hypoperfusion and Predicts Adverse Prognosis in Heart Failure Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tomofumi Misaka ◽  
Yasuhiro Ichijo ◽  
Akiomi YOSHIHISA ◽  
Yu Hotsuki ◽  
Watanabe Koichiro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Peak Systolic Velocity ◽  
Shear Wave Elastography ◽  
Left Ventricular ◽  
Right Atrial ◽  
Enzyme Linked Immunosorbent Assay ◽  
Selenoprotein P ◽  
Abdominal Ultrasonography ◽  
Peripheral Tissues ◽  
Hepatic Congestion

Introduction: Cardiac and multiple organ network is involved in the pathophysiology of heart failure (HF). Hepatokines, which are produced and secreted from the liver, have regulatory functions in the peripheral tissues. However, the interaction between the heart and liver or clinical relevance of hepakokines in HF remains poorly understood. The present study aimed to elucidate the clinical significance of hepatokine selenoprotein P in HF. Methods and Results: We enrolled 250 participants including 171 hospitalized patients with HF and 79 control subjects. The serum concentration of selenoprotein P was measured by an enzyme-linked immunosorbent assay. We found that the serum selenoprotein P levels in HF patients were significantly higher than those in controls (14.8 ± 7.5 vs. 8.4 ± 4.6 mg/L, P<0.01). Next, the HF patients were categorized into 4 groups based on the hepatic hemodynamics assessed by abdominal-ultrasonography, which determined liver congestion by shear wave elastography (liver-SWE, >1.33 m/s) and liver hypoperfusion by peak systolic velocity of the celiac artery (celiac-PSV, <62.4 cm/s). Selenoprotein P levels were significantly upregulated in patients with liver hypoperfusion compared to patients with liver congestion ( Figure A ). Selenoprotein P was negatively correlated with celiac-PSV (P<0.01), cardiac output (P<0.01), and left ventricular stroke volume (P=0.03), whereas no correlations were observed between selenoprotein P and indices of congestion such as liver-SWE and right atrial pressure. Kaplan-Meier analysis demonstrated that a higher selenoprotein P group showed a lower event-free rate from re-hospitalization due to worsening HF ( Figure B ). Conclusion: Upregulation of liver-derived selenoprotein P was associated with hepatic hypoperfusion, not hepatic congestion, and related to the adverse prognosis in HF. Selenoprotein P may be a novel molecule involved in the cardio-hepatic interaction.

Sign in / Sign up

Export Citation Format

Share Document