Abstract 14608: Prognostic Value of Diuretic Resistance in Patients Admitted for Acute Decompensated Heart Failure With Reduced, Mid-range, or Preserved Left Ventricular Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takanari Kimura ◽  
Takahisa Yamada ◽  
Tetsuya Watanabe ◽  
Takashi Morita ◽  
Yoshio Furukawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Clinical Outcome ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Poor Clinical Outcome ◽  
Ventricular Ejection Fraction ◽  
Diuretic Resistance

Background: Diuretic resistance is associated with poor clinical outcome in patients with acute decompensated heart failure (ADHF). However, little information is available on the prognostic significance of diuretic resistance in ADHF patients, relating to reduced, mid-range, or preserved left ventricular ejection fraction (LVEF). Methods: We studied 400 consecutive patients who were admitted for ADHF and survived to discharge. Diuretic resistance (DR) was defined by furosemide dose per body weight (BW) at discharge. Patients were classified by DR, and high dose group (higher DR) was defined by furosemide dose of > median value of DR (0.580). The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure. Results: There were 139 patients with heart failure with reduced LVEF (HFrEF, LVEF<40%), 86 with mid-range LVEF (HFmrEF, 40%≤LVEF<50%) and 175 with preserved LVEF (HFpEF, LVEF≥50%). There was no significant difference in DR among the three groups (HFrEF; median 0.541 [IQR 0.360-0.786] mg/kg vs HFmrEF; 0.606 [0.398-0.820] mg/kg vs HFpEF; 0.624 [0.380-0.935] mg/kg, p=NS). During follow-up of 2.4±1.6 years, 195 patients reached the endpoint (HFrEF, n=67, HFmrEF, n=44, and HFpEF, n=84). In multivariate Cox analysis, DR was significantly associated with the endpoint independently of age, estimated glomerular filtration rate, plasma brain natriuretic peptide level and LVEF only in HFpEF patients (p<0.0001). Kaplan-Meier analysis showed that the risk of the endpoint was significantly higher in the patients with higher DR in HFpEF patients, but not in HFrEF or HFmrEF patients (Figure). Conclusions: In this study, higher DR was shown to be associated with poor clinical outcome in HFpEF patients admitted with ADHF.

scholarly journals Prognostic significance of cardiac I-123-metaiodobenzylguanidine imaging in patients with reduced, mid-range, and preserved left ventricular ejection fraction admitted for acute decompensated heart failure: a prospective study in Osaka Prefectural Acute Heart Failure Registry (OPAR)

2020 ◽  
Vol 22 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Masahiro Seo ◽  
Takahisa Yamada ◽  
Shunsuke Tamaki ◽  
Tetsuya Watanabe ◽  
Takashi Morita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Mibg Imaging ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction

Abstract Aims Cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging provides prognostic information in patients with chronic heart failure (HF). However, there is little information available on the prognostic role of cardiac 123I-MIBG imaging in patients admitted for acute decompensated heart failure (ADHF), especially relating to reduced ejection fraction [HFrEF; left ventricular ejection fraction (LVEF) &lt; 40%], mid-range ejection fraction (HFmrEF; 40% ≤ LVEF &lt; 50%) and preserved ejection fraction (HFpEF; LVEF ≥ 50%). Methods and results We studied 349 patients admitted for ADHF and discharged with survival. Cardiac 123I-MIBG imaging, echocardiography, and venous blood sampling were performed just before discharge. The cardiac 123I-MIBG heart-to-mediastinum ratio (late H/M) was measured on the chest anterior view images obtained at 200 min after the isotope injection. The endpoint was cardiac events defined as unplanned HF hospitalization and cardiac death. During a follow-up period of 2.1 ± 1.4 years, 128 patients had cardiac events (45/127 in HFrEF, 28/78 in HFmrEF, and 55/144 in HFpEF). On multivariable Cox analysis, late H/M was significantly associated with cardiac events in overall cohort (P = 0.0038), and in subgroup analysis of each LVEF subgroup (P = 0.0235 in HFrEF, P = 0.0119 in HFmEF and P = 0.0311 in HFpEF). Kaplan–Meier analysis showed that patients with low late H/M (defined by median) had significantly greater risk of cardiac events in overall cohort (49% vs. 25% P &lt; 0.0001) and in each LVEF subgroup (HFrEF: 48% vs. 23% P = 0.0061, HFmrEF: 51% vs. 21% P = 0.0068 and HFpEF: 50% vs. 26% P = 0.0026). Conclusion Cardiac sympathetic nerve dysfunction was associated with poor outcome in ADHF patients irrespective of HFrEF, HFmrEF, or HFpEF.

Abstract 12859: Prognostic Value of Neutrophil to Lymphocyte Ratio in Acute Decompensated Heart Failure With Reduced or Preserved Left Ventricular Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Takahisa Yamada ◽  
Takashi Morita ◽  
Yoshio Furukawa ◽  
Shunsuke Tamaki ◽  
Yusuke Iwasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Prognostic Value ◽  
Independent Predictor ◽  
Acute Decompensated Heart Failure ◽  
Prognostic Significance ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Backgrounds: Neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a measure of inflammation and as a prognosticating biomarker in various medical conditions ranging from infectious disease to cardiovascular disease. The prognostic significance of NLR in patients admitted with acute decompensated heart failure (ADHF) is not established. The aim of this study was to investigate the prognostic impact of NLR in ADHF patients, relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF). Methods and Results: We studied 264 patients admitted with ADHF and discharged with survival (HFrEF(LVEF<50%); n=144, HFpEF(LVEF≥50%;n=120). There was no significant difference in NLR at the discharge between patients with HFrEF (2.1±1.1) and HFpEF (2.1±1.0). During a follow up period of 4.2±3.2 yrs, 87 pts died. NLR was significantly associated with mortality in patients with HFrEF (p<0.0001) and HFpEF (p=0.006) at univariate Cox analysis. All cause-death was significantly frequently observed in patients with the highest tertile of NLR (>2.2) than those with the middle or lowest tertile of NLR(<1.5) in patients with HFrEF (60% vs 36% vs 20%, p<0.0001, respectively) and HFpEF (43% vs 20% vs 14%, p=0.004, respectively). After adjustment for baseline characteristics, echocardiographical findings, and blood tests such as hemoglobin, sodium level and estimated glomerular filtration rate, NLR remained a significant independent predictor for mortality in patients with HFrEF (hazard ratio: 1.23 [95%CI 1.04-1.54], p=0.017), while NLR tended to be a independent predictor in those with HFpEF (hazard ratio:1.29 [95%CI 0.98-1.71], p=0.07). Conclusion: NLR at the discharge provides a prognostic value for the prediction of total mortality in ADHF patients with HFrEF and HFpEF, although the prognostic significance of NLR in patients with HFpEF was weakened by adjustment for relevant covariates.

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