Abstract 16056: The Prevalence, Risk Factors and Outcome of Cardiac Dysfunction in Hospitalized Patients With Covid-19

Objectives: We aimed to investigate the prevalence, risk factors and outcome of cardiac dysfunction, and explore the potential value of echocardiographic parameters in hospitalized patients with coronavirus disease 2019 (COVID-19). Background: Cardiac involvement is a prominent features in COVID-19. However, the prevalence and clinical significance of cardiac dysfunction in COVID-19 patients have not yet been well described. Methods: We studied 157 consecutive hospitalized COVID-19 patients, whose Left ventricular (LV) and right ventricular (RV) structure and function were evaluated by echocardiography. Results: RV dysfunction was found in 40 (25.5%) patients, and LV dysfunction in 28 (17.8%) patients consisting of 24 (15.3%) with heart failure with preserved ejection fraction and 4 (2.5%) with heart failure with reduced ejection fraction. Hypertension, acute respiratory distress syndrome (ARDS), high-sensitivity troponin I (hs-TNI) level and mechanical ventilation therapy was associated with cardiac dysfunction, which contributed to higher mortality (LV dysfunction: 28.6% vs 11.6%, P = 0.022; RV dysfunction: 37.5% vs 6.8%, P < 0.001, respectively). Moreover, LV and RV dysfunction were more frequent in patients with elevated hs-TNI than those without (37.5% vs 12.5 %, P = 0.001; 40.0 % vs 22.9%, P = 0.043, respectively). During hospitalization, 23 patients died. The mortality was 3.0% for patients without cardiac dysfunction and normal hs-TNI levels, 6.7% for those with cardiac dysfunction and normal hs-TNI levels, 13.3% for those without cardiac dysfunction but elevated hs-TNI levels, and 64.0% for those with cardiac dysfunction and elevated hs-TNI. In Cox analysis, RV dysfunction was independently predictor of higher mortality (hazard ratio=2.79; 95% CI: 1.10 to 7.06; P=0.031). HF, especially HFpEF, was not predictive of increased mortality. Conclusions: The prevalence of RV dysfunction was higher than that of HF. Moreover, HFpEF was more common than HFrEF. RV dysfunction is an independent predictor of higher mortality. Additionally, patients with cardiac dysfunction and elevated hs-TNI had the highest mortality, which may prompt physicians to pay attention not only to the hs-TNI level but also the cardiac dysfunction.

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Prognostic value of high-sensitivity cardiac troponin I in heart failure patients with mid-range and reduced ejection fraction

PLoS ONE ◽

10.1371/journal.pone.0255271 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255271

Author(s):

Petr Lokaj ◽

Jindrich Spinar ◽

Lenka Spinarova ◽

Filip Malek ◽

Ondrej Ludka ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Prognostic Value ◽

Troponin I ◽

High Sensitivity ◽

Left Ventricular ◽

Ventricular Assist ◽

Reduced Ejection Fraction ◽

Increased Risk ◽

Ctni Level

Background The identification of high-risk heart failure (HF) patients makes it possible to intensify their treatment. Our aim was to determine the prognostic value of a newly developed, high-sensitivity troponin I assay (Atellica®, Siemens Healthcare Diagnostics) for patients with HF with reduced ejection fraction (HFrEF; LVEF < 40%) and HF with mid-range EF (HFmrEF) (LVEF 40%–49%). Methods and results A total of 520 patients with HFrEF and HFmrEF were enrolled in this study. Two-year all-cause mortality, heart transplantation, and/or left ventricular assist device implantation were defined as the primary endpoints (EP). A logistic regression analysis was used for the identification of predictors and development of multivariable models. The EP occurred in 14% of the patients, and these patients had higher NT-proBNP (1,950 vs. 518 ng/l; p < 0.001) and hs-cTnI (34 vs. 17 ng/l, p < 0.001) levels. C-statistics demonstrated that the optimal cut-off value for the hs-cTnI level was 17 ng/l (AUC 0.658, p < 0.001). Described by the AUC, the discriminatory power of the multivariable model (NYHA > II, NT-proBNP, hs-cTnI and urea) was 0.823 (p < 0.001). Including heart failure hospitalization as the component of the combined secondary endpoint leads to a diminished predictive power of increased hs-cTnI. Conclusion hs-cTnI levels ≥ 17 ng/l represent an independent increased risk of an adverse prognosis for patients with HFrEF and HFmrEF. Determining a patient’s hs-cTnI level adds prognostic value to NT-proBNP and clinical parameters.

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Abstract P169: Difference of Risk Factors for Controlled Blood Pressure in Three Types of Heart Failure

Hypertension ◽

10.1161/hyp.70.suppl_1.p169 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Hong Seok Lee ◽

Nunez Belen ◽

Hans Cativo ◽

Amrut Savadkar ◽

Visco Ferdinand ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Ejection Fraction ◽

Ventricular Hypertrophy ◽

Multiple Logistic Regression Analysis ◽

Left Ventricular ◽

Reduced Ejection Fraction ◽

Different Types ◽

Artery Disease ◽

The Relationship

Background: Hypertension is the most important modifiable risk factor for worsening heart failure (HF) because hypertension increases cardiac work, which results in worsening left ventricular hypertrophy and development of coronary artery disease. We will determine risk fctors of BP control in different types of heart failure according to JNC 8 guideline. Method: Based on ACC/AHA guidelines, heart failure is classified as a reduced ejection fraction(HFrEF, EF <40), preserved ejection fraction (HFpEF, EF>50) and heart failure with an improved ejection fraction(HFpEF(i),EF≥40). 732 patients enrolled in our heart failure program were analyzed retrospectively. And 672 patients who had been followed from Jan 1 st ,2013 to June 30st 2015 were included. Multiple logistic regression analysis was performed to determine the relationship between hypertension and heart failure after adjusting for potential confounders. Results: Patients with three types of heart failure had different BP control rate. It was 67.5% (308/456) ,76.5%(104/136), 77.5%(62/80) in HFrEF, HFrEF, and HFpEF(i) based on JNC 8 guideline, respectively. Mean systolic BP was 127.1±17 mmHg in HFrEF, 129.0±21 mmHg in HFpEF and 124.4±18 mmHg in HFpEF(i). Obesity [Odds ratio (OR): 0.12,95% Confidence Interval(CI): 0.048-0.284] , ACE inhibitor or ARB [OR: 2.66, CI: 1.50-3.42] and lasix [OR: 1.90,CI: 1.07-3.40] and aspirin [OR 0.53, CI: 0.37-0.96] were noted to be related to controlled BP in HFrEF. Aspirin [OR 0.17, CI: 0.05-0.60] was significantly associated with controlled BP in HFpEF. And beta-blocker [OR: 0.07, CI: 0.01-0.62] and anti-lipid medication [OR: 4.76, CI: 1.73-5.89] were associated with BP control in HFpEF(i). Conclusion: In each type of heart failure, there was difference of risk factors related to BP control. Different medications were associated with control of BP in different types of heart failure. Patients may need to modify risk factors including types of medication to control BP according to types of heart failure. It might be leading to better heart failure management.

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The association of high-sensitivity cardiac troponin I and T with echocardiographic stages of heart failure with preserved ejection fraction

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563219841644 ◽

2019 ◽

Vol 56 (4) ◽

pp. 431-441

Author(s):

Julia Hoffmann ◽

Michael Behnes ◽

Uzair Ansari ◽

Kathrin Weidner ◽

Philip Kuche ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Diastolic Dysfunction ◽

Troponin I ◽

High Sensitivity ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Preserved Ejection Fraction ◽

Ventricular Ejection Fraction ◽

Grade Iii

Background This study evaluates the associations between high-sensitivity troponin I and T (hs-TnI/hs-TnT) and the stages of heart failure with preserved ejection fraction (HFpEF)/diastolic dysfunction. Methods Blood samples for biomarker measurements (hs-TnI/hs-TnT/NT-proBNP) were collected within 24 h of routine echocardiographic examination. Patients with left ventricular ejection fraction <50%, right ventricular dysfunction and moderate-to-severe valvular heart disease were excluded. Graduation of diastolic dysfunction was determined according to current guidelines. Results A total of 70 patients were included. Hs-TnT concentrations increased significantly according to the progression of diastolic dysfunction ( P = 0.024). Hs-TnT was able to discriminate patients with diastolic dysfunction grade III (AUC = 0.737; P = 0.013), while NT-proBNP revealed a greater AUC (AUC 0.798; P = 0.002). Concentrations of hs-TnI increased only numerically according to the increasing stages of diastolic dysfunction ( P = 0.353). In multivariable logistic regression models, hs-TnT concentrations > 28 ng/L were associated with diastolic dysfunction grade III (OR = 4.7, P = 0.024), even after adjusting for NT-proBNP. Conclusion Increasing concentrations of hs-TnT may reflect the stages of diastolic dysfunction being assessed by echocardiography, whereas hs-TnI does not show any association with diastolic dysfunction.

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Additive Value of Biomarkers and Echocardiography to Stratify the Risk of Death in Heart Failure Patients with Reduced Ejection Fraction

Cardiology Research and Practice ◽

10.1155/2019/1824816 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Calogero Falletta ◽

Francesco Clemenza ◽

Catherine Klersy ◽

Valentina Agnese ◽

Diego Bellavia ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Troponin I ◽

Cox Model ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Systolic Pulmonary Artery Pressure ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Risk Of Death

Background. Risk stratification is a crucial issue in heart failure. Clinicians seek useful tools to tailor therapies according to patient risk. Methods. A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF). Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected. Association with death for any cause was analyzed. Results. Four hundred thirty-one (431) consecutive patients were enrolled in the study. Fifty deaths occurred over a median follow-up of 32 months. On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death. Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio <0.36 group. The risk of death increased linearly by 1.6 for each additional positive biomarker and by almost two for women compared with men. Conclusions. In a HFrEF outpatient cohort, the evaluation of plasma levels of both NPs and hsTnI can contribute significantly to identifying patients who have a worse prognosis, in addition to the echocardiographic assessment of right ventricular-arterial coupling.

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Characteristics and outcomes of hospitalized patients with cardiovascular complications of COVID-19

Journal of Cardiovascular and Thoracic Research ◽

10.34172/jcvtr.2021.53 ◽

2021 ◽

Vol 13 (4) ◽

pp. 355-363

Author(s):

Farzad Jalali ◽

Farbod Hatami ◽

Mehrdad Saravi ◽

Iraj Jafaripour ◽

Mohammad Taghi Hedayati ◽

...

Keyword(s):

Heart Failure ◽

Troponin I ◽

High Sensitivity ◽

Cardiovascular Complications ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Hospitalized Patients ◽

Vein Thrombosis ◽

All Cause Mortality ◽

Ventricular Diastolic Dysfunction

Introduction: To address cardiovascular (CV) complications and their relationship to clinical outcomes in hospitalized patients with COVID-19. Methods: A total of 196 hospitalized patients with COVID-19 were enrolled in this retrospective single-center cohort study from September 10, 2020, to December 10, 2020, with a median age of 65 years (IQR, 52-77). Follow-up continued for 3 months after hospital discharge. Results: CV complication was observed in 54 (27.6%) patients, with arrhythmia being the most prevalent (14.8%) followed by myocarditis, acute coronary syndromes, ST-elevation myocardial infarction, cerebrovascular accident, and deep vein thrombosis in 15 (7.7%), 12 (6.1%), 10(5.1%), 8 (4.1%), and 4 (2%) patients, respectively. The proportion of patients with elevated high-sensitivity troponin I, N-terminal pro-B-type natriuretic peptide, left ventricular diastolic dysfunction, and heart failure with preserved ejection fraction was greater in the CV complication group. Severe forms of COVID-19 comprised nearly two-thirds (64.3%) of our study population and constituted a significantly higher share of the CV complication group members (75.9%vs 59.9%; P=0.036). Intensive care unit admission (64.8% vs 44.4%; P=0.011) and stay (5.5days vs 0 day; P=0.032) were notably higher in patients with CV complications. Among 196patients, 50 died during hospitalization and 10 died after discharge, yielding all-cause mortality of 30.8%. However, there were no between-group differences concerning mortality. Age, heart failure, cancer/autoimmune disease, disease severity, interferon beta-1a, and arrhythmia were the independent predictors of all-cause mortality during and after hospitalization. Conclusion: CV complications occurred widely among COVID-19 patients. Moreover,arrhythmia, as the most common complication, was associated with increased mortality.

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Interleukin 6 and Development of Heart Failure With Preserved Ejection Fraction in the General Population

Journal of the American Heart Association ◽

10.1161/jaha.120.018549 ◽

2021 ◽

Vol 10 (11) ◽

Author(s):

Yook Chin Chia ◽

Lyanne M. Kieneker ◽

Gaston van Hassel ◽

S. Heleen Binnenmars ◽

Ilja M. Nolte ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Ejection Fraction ◽

Left Ventricular ◽

Community Dwelling ◽

Left Ventricular Ejection ◽

Preserved Ejection Fraction ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

New Onset

Background The cause of heart failure with preserved ejection fraction (HFpEF) is poorly understood, and specific therapies are lacking. Previous studies suggested that inflammation plays a role in the development of HFpEF. Herein, we aimed to investigate in community‐dwelling individuals whether a higher plasma interleukin 6 (IL‐6) level is associated with an increased risk of developing new‐onset heart failure (HF) over time, and specifically HFpEF. Methods and Results We performed a case‐cohort study based on the PREVEND (Prevention of Renal and Vascular End‐Stage Disease) study, a prospective general population‐based cohort study. We included 961 participants, comprising 200 participants who developed HF and a random group of 761 controls. HF with reduced ejection fraction or HFpEF was defined on the basis of the left ventricular ejection fraction of ≤40% or >40%, respectively. In Cox proportional hazard regression analyses, IL‐6 levels were statistically significantly associated with the development of HF (hazard ratio [HR], 1.28; 95% CI, 1.02–1.61; P =0.03) after adjustment for key risk factors. Specifically, IL‐6 levels were significantly associated with the development of HFpEF (HR, 1.59; 95% CI, 1.16–2.19; P =0.004), whereas the association with HF with reduced ejection fraction was nonsignificant (HR, 1.05; 95% CI, 0.75–1.47; P =0.77). In sensitivity analyses, defining HFpEF as left ventricular ejection fraction ≥50%, IL‐6 levels were also significantly associated with the development of HFpEF (HR, 1.47; 95% CI, 1.04–2.06; P =0.03) after adjustment for key risk factors. Conclusions IL‐6 is associated with new‐onset HFpEF in community‐dwelling individuals, independent of potential confounders. Our findings warrant further research to investigate whether IL‐6 might be a novel treatment target to prevent HFpEF.

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Heart Failure with Preserved Ejection Fraction – A Review

US Cardiology Review ◽

10.15420/usc.2012.9.2.90 ◽

2012 ◽

Vol 9 (1) ◽

pp. 90-95 ◽

Cited By ~ 1

Author(s):

Otto A Smiseth ◽

Anders Opdahl ◽

Espen Boe ◽

Helge Skulstad

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Diastolic Heart Failure ◽

The Elderly ◽

Left Ventricular ◽

Filling Pressure ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Objective Evidence

Heart failure with preserved left ventricular ejection fraction (HF-PEF), sometimes named diastolic heart failure, is a common condition most frequently seen in the elderly and is associated with arterial hypertension and left ventricular (LV) hypertrophy. Symptoms are attributed to a stiff left ventricle with compensatory elevation of filling pressure and reduced ability to increase stroke volume by the Frank-Starling mechanism. LV interaction with stiff arteries aggravates these problems. Prognosis is almost as severe as for heart failure with reduced ejection fraction (HF-REF), in part reflecting co-morbidities. Before the diagnosis of HF-PEF is made, non-cardiac etiologies must be excluded. Due to the non-specific nature of heart failure symptoms, it is essential to search for objective evidence of diastolic dysfunction which, in the absence of invasive data, is done by echocardiography and demonstration of signs of elevated LV filling pressure, impaired LV relaxation, or increased LV diastolic stiffness. Antihypertensive treatment can effectively prevent HF-PEF. Treatment of HF-PEF is symptomatic, with similar drugs as in HF-REF.

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Heart Failure and Diabetes Mellitus: Biomarkers in Risk Stratification and Prognostication

Applied Sciences ◽

10.3390/app11104397 ◽

2021 ◽

Vol 11 (10) ◽

pp. 4397

Author(s):

Michael Lichtenauer ◽

Peter Jirak ◽

Vera Paar ◽

Brigitte Sipos ◽

Kristen Kopp ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Ejection Fraction ◽

Risk Stratification ◽

Natriuretic Peptides ◽

Predictive Ability ◽

High Sensitivity ◽

Routine Practice ◽

Reduced Ejection Fraction ◽

Novel Biomarkers

Heart failure (HF) and type 2 diabetes mellitus (T2DM) have a synergistic effect on cardiovascular (CV) morbidity and mortality in patients with established CV disease (CVD). The aim of this review is to summarize the knowledge regarding the discriminative abilities of conventional and novel biomarkers in T2DM patients with established HF or at higher risk of developing HF. While conventional biomarkers, such as natriuretic peptides and high-sensitivity troponins demonstrate high predictive ability in HF with reduced ejection fraction (HFrEF), this is not the case for HF with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous disease with a high variability of CVD and conventional risk factors including T2DM, hypertension, renal disease, older age, and female sex; therefore, the extrapolation of predictive abilities of traditional biomarkers on this population is constrained. New biomarker-based approaches are disputed to be sufficient for improving risk stratification and the prediction of poor clinical outcomes in patients with HFpEF. Novel biomarkers of biomechanical stress, fibrosis, inflammation, oxidative stress, and collagen turn-over have shown potential benefits in determining prognosis in T2DM patients with HF regardless of natriuretic peptides, but their role in point-to-care and in routine practice requires elucidation in large clinical trials.

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Prognostic value of global longitudinal layer specific strain for patients with heart failure with reduced ejection fraction

European Heart Journal ◽

10.1093/ehjci/ehaa946.0117 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Johnsen ◽

M Sengeloev ◽

P Joergensen ◽

N Bruun ◽

D Modin ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Prognostic Value ◽

Left Ventricular ◽

Volume Index ◽

Funding Source ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Echocardiographic Parameters

Abstract Background Novel echocardiographic software allows for layer-specific evaluation of myocardial deformation by 2-dimensional speckle tracking echocardiography. Endocardial, epicardial- and whole wall global longitudinal strain (GLS) may be superior to conventional echocardiographic parameters in predicting all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Purpose The purpose of this study was to investigate the prognostic value of endocardial-, epicardial- and whole wall GLS in patients with HFrEF in relation to all-cause mortality. Methods We included and analyzed transthoracic echocardiographic examinations from 1,015 patients with HFrEF. The echocardiographic images were analyzed, and conventional and novel echocardiographic parameters were obtained. A p value in a 2-sided test <0.05 was considered statistically significant. Cox proportional hazards regression models were constructed, and both univariable and multivariable hazard ratios (HRs) were calculated. Results During a median follow-up time of 40 months, 171 patients (16.8%) died. A lower endocardial (HR 1.17; 95% CI (1.11–1.23), per 1% decrease, p<0.001), epicardial (HR 1.20; 95% CI (1.13–1.27), per 1% decrease, p<0.001), and whole wall (HR 1.20; 95% CI (1.14–1.27), per 1% decrease, p<0.001) GLS were all associated with higher risk of death (Figure 1). Both endocardial (HR 1.12; 95% CI (1.01–1.23), p=0.027), epicardial (HR 1.13; 95% CI (1.01–1.26), p=0.040) and whole wall (HR 1.13; 95% CI (1.01–1.27), p=0.030) GLS remained independent predictors of mortality in the multivariable models after adjusting for significant clinical parameters (age, sex, total cholesterol, mean arterial pressure, heart rate, ischemic cardiomyopathy, percutaneous transluminal coronary angioplasty and diabetes) and conventional echocardiographic parameters (left ventricular (LV) ejection fraction, LV mass index, left atrial volume index, deceleration time, E/e', E-velocity, E/A ratio and tricuspid annular plane systolic excursion). No other echocardiographic parameters remained an independent predictors after adjusting. Furthermore, endocardial, epicardial and whole wall GLS had the highest C-statistics of all the echocardiographic parameters. Conclusion Endocardial, epicardial and whole wall GLS are independent predictors of all-cause mortality in patients with HFrEF. Furthermore, endocardial, epicardial and whole wall GLS were superior prognosticators of all-cause mortality compared with all other echocardiographic parameters. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Herlev and Gentofte Hospital

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