scholarly journals Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction

2017 ◽  
Vol 22 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kavita B Khaira ◽  
Ellen Brinza ◽  
Gagan D Singh ◽  
Ezra A Amsterdam ◽  
Stephen W Waldo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Left Ventricular ◽  
Term Survival ◽  
Long Term Survival ◽  
Reduced Ejection Fraction ◽  
History Of

The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) ( p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups ( p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction.

scholarly journals Cardiac contractility modulation improves long‐term survival and hospitalizations in heart failure with reduced ejection fraction

2019 ◽  
Vol 21 (9) ◽  
pp. 1103-1113 ◽  
Author(s):  
Stefan D. Anker ◽  
Martin Borggrefe ◽  
Hans Neuser ◽  
Marc‐Alexander Ohlow ◽  
Susanne Röger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Contractility ◽  
Term Survival ◽  
Cardiac Contractility Modulation ◽  
Long Term Survival ◽  
Reduced Ejection Fraction

Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Long-Term Cardiac Mortality in Heart Failure with Reduced Ejection Fraction

Angiology ◽  
2021 ◽  
pp. 000331972110473
Author(s):  
Umut Karabulut ◽  
Kudret Keskin ◽  
Dilay Karabulut ◽  
Ece Yiğit ◽  
Zerrin Yiğit
Keyword(s):  
Heart Failure ◽  
Combination Therapy ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Mortality ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor

The angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II–IV symptoms and ejection fraction ≤40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16–3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) ( P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10–.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85–.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.

5951The impact of regulatory T lymphocytes on long-term survival in patients with ischemic heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Sulzgruber ◽  
L Koller ◽  
S Blum ◽  
A Hammer ◽  
N Kazem ◽  
...  
Keyword(s):  
Heart Failure ◽  
T Lymphocytes ◽  
Ejection Fraction ◽  
Cellular Immunity ◽  
Cardiovascular Mortality ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Long Term Survival ◽  
Regulatory T Lymphocytes

Abstract Background Heart failure with reduce ejection fraction (HFrEF) constitutes a global health issue representing a prevalent clinical syndrome. While pro-inflammatory cytokines proved to have a pivotal role in the development and progression of HFrEF, less attention has been paid to the cellular immunity. Regulatory T lymphocytes (Tregs) seem to have an important role in the induction and maintenance of immune homeostasis especially in patients after acute coronary syndrome and coronary vessel disease. Therefore, we aimed to investigate the impact of Tregs on the outcome of patients presenting with ischemic HFrEF. Methods We prospectively enrolled 112 patients with HFrEF defined by New York Heart Association (NYHA) functional class >II and left ventricular ejection fraction (LVEF) <40%. Patients were stratified in ischemic (iHFrEF, n=57) and dilated etiology (dHFrEF, n=55). Cells from fresh heparinized blood were stained and analyzed using BD FACS Canto II flow cytometry. Cox regression hazard analysis was used to assess the influence of Tregs on survival. The multivariate model was adjusted forage and gender. Results Comparing patients with iHFrEF to dHFrEF we found a significantly lower fraction of Tregs within lymphocytes in the ischemic subgroup (0.42% vs. 0.56%; p=0.009). After a mean follow-up time of 4.5 years 32 (28.6%) patients died due to cardiovascular causes. We found that Tregs were significantly associated with cardiovascular survival in the entire study cohort with an adjusted HR per one standard deviation (1-SD) of 0.60 (95% CI 0.39–0.92; p=0.017). Interestingly while there was no association with cardiovascular survival independently in the dHFrEFsubgroup (adj. HR per 1-SD of 0.62 (95% CI 0.17–2.31); p=0.486), we found a significant inverse association of Tregs and cardiovascular survival in patients with iHFrEFwith an adj. HR per 1-SD of 0.59 (95% CI 0.36–0.96; p=0.034). Figure 1. Survival Curves of Cardiovascular Mortality. Kaplan-Meier plots showing survival free of cardiovascular mortality in the total study collective (A) and patients stratified in ischemic CMP (B) as well dilative CMP (C) according to tertiles of frequencies of regulatory T cells. Tertile 1 = high; Tertile 2 = mid; Tertile 3 = low. Conclusion Our results indicate a potential influence of Tregs in the pathogenesis and progression of iHFrEF, fostering the implication of cellular immunity in iHFrEF pathophysiology and proving Tregs as a predictor for long-term survival among iHFrEF -patients.

scholarly journals P6071Behind guidelines: long term survival of critical limb ischemia patients treated with iloprost

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
R. Di Stefano ◽  
M. Nuti ◽  
A. Farina ◽  
S. Meini ◽  
E. Melillo
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Epidemiology and long-term outcome in outpatients with chronic heart failure in Northwestern Europe

Heart ◽  
2019 ◽  
Vol 105 (16) ◽  
pp. 1252-1259 ◽  
Author(s):  
Hanna Fröhlich ◽  
Niklas Rosenfeld ◽  
Tobias Täger ◽  
Kevin Goode ◽  
Syed Kazmi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Period 2 ◽  
Wide Range ◽  
Ambulatory Patients

ObjectiveTo describe the epidemiology, long-term outcomes and temporal trends in mortality in ambulatory patients with chronic heart failure (HF) with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) from three European countries.MethodsWe identified 10 312 patients from the Norwegian HF Registry and the HF registries of the universities of Heidelberg, Germany, and Hull, UK. Patients were classified according to baseline left ventricular ejection fraction (LVEF) and time of enrolment (period 1: 1995–2005 vs period 2: 2006–2015). Predictors of mortality were analysed by use of univariable and multivariable Cox regression analyses.ResultsAmong 10 312 patients with stable HF, 7080 (68.7%), 2086 (20.2%) and 1146 (11.1%) were classified as having HFrEF, HFmrEF or HFpEF, respectively. A total of 4617 (44.8%) patients were included in period 1, and 5695 (55.2%) patients were included in period 2. Baseline characteristics significantly differed with respect to type of HF and time of enrolment. During a median follow-up of 66 (33–105) months, 5297 patients (51.4%) died. In multivariable analyses, survival was independent of LVEF category (p>0.05), while mortality was lower in period 2 as compared with period 1 (HR 0.81, 95% CI 0.72 to 0.91, p<0.001). Significant predictors of all-cause mortality regardless of HF category were increasing age, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide and use of loop diuretics.ConclusionAmbulatory patients with HF stratified by LVEF represent different phenotypes. However, after adjusting for a wide range of covariates, long-term survival is independent of LVEF category. Outcome significantly improved during the last two decades irrespective from type of HF.

Abstract 17335: Cluster Analysis of Cardiac Resynchronization Response Parameters Predicts Long-Term Survival With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kenneth C Bilchick ◽  
Xu Gao ◽  
Derek Bivona ◽  
Rohit Malhotra ◽  
Michael Mangrum ◽  
...  
Keyword(s):  
Machine Learning ◽  
Heart Failure ◽  
Cluster Analysis ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Term Survival ◽  
Long Term Survival ◽  
Systolic Volume

Introduction: Machine learning methods such as cluster analysis can identify commonality in patterns of short-term response measures after cardiac resynchronization therapy (CRT) to predict classes of patients with distinct long-term prognoses. Hypothesis: Distinct response clusters identified within 6 months of CRT implantation would provide independent prognostic value relative to known pre-CRT patient characteristics. Methods: Patients with heart failure (HF) undergoing CRT had assessments of left ventricular end-systolic volume fractional change (LVESV-FC), peak VO 2 , and B-type natriuretic peptide (BNP) based on cardiac magnetic resonance (CMR), echocardiography, exercise testing, and blood tests before and 6 months after CRT. Statistical methods included multivariate multiple linear regression, cluster analysis based on a mixture model, survival analysis, and receiver operating characteristic (ROC) analysis. Results: During a median of 5.0 years of follow-up after CRT, the cohort of 146 patients (age 66.0 ± 11.3 years, 34.9% female) had a death rate of 28.1%. A significant correlation was observed for BNP response and LVESV-FC (r=0.42, p>0.01), but not for the other response comparisons. Three clusters of patients (1: n=27; 2: n=82; 3: n=37) were identified. Kaplan-Meier analysis (Figure) demonstrated the best long-term survival in cluster 2, intermediate survival in cluster 3, and the worst survival in cluster 1 (p<0.0001). ROC curve comparisons for 4-year survival based on pre-CRT findings with or without the 6-month response cluster showed that the cluster increased the AUC from 0.818 to 0.870 (p=0.069). Conclusions: Response clusters based on 6-month parameters were strongly associated with long-term survival and improved prognostication compared with just pre-CRT predictors alone. This response clustering approach based on machine learning promises to be very useful for clinical risk stratification in heart failure after CRT.

scholarly journals Clinical Characteristics and Outcomes of Adults With a History of Heart Failure Hospitalized for COVID-19

2021 ◽  
Author(s):  
Parag Goyal ◽  
Evgeniya Reshetnyak ◽  
Sadiya Khan ◽  
Mahad Musse ◽  
Babak B. Navi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Relative Risk ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
History Of ◽  
Adjusted Model

Background: It is important to understand the risk for in-hospital mortality of adults hospitalized with acute coronavirus disease 2019 (COVID-19) infection with a history of heart failure (HF). Methods: We examined patients hospitalized with COVID-19 infection from January 1, 2020 to July 22, 2020, from 88 centers across the US participating in the American Heart Association’s COVID-19 Cardiovascular Disease registry. The primary exposure was history of HF and the primary outcome was in-hospital mortality. To examine the association between history of HF and in-hospital mortality, we conducted multivariable modified Poisson regression models that included sociodemographics and comorbid conditions. We also examined HF subtypes based on left ventricular ejection fraction in the prior year, when available. Results: Among 8920 patients hospitalized with COVID-19, mean age was 61.4±17.5 years and 55.5% were men. History of HF was present in 979 (11%) patients. In-hospital mortality occurred in 31.6% of patients with history of HF, and 16.9% in patients without a history of HF. In a fully adjusted model, history of HF was associated with increased risk for in-hospital mortality (relative risk: 1.16 [95% CI, 1.03–1.30]). Among 335 patients with left ventricular ejection fraction, heart failure with reduced ejection fraction was significantly associated with in-hospital mortality in a fully adjusted model (heart failure with reduced ejection fraction relative risk: 1.40 [95% CI, 1.10–1.79]; heart failure with mid-range ejection fraction relative risk: 1.06 [95% CI, 0.65–1.73]; heart failure with preserved ejection fraction relative risk, 1.06 [95% CI, 0.84–1.33]). Conclusions: Risk for in-hospital mortality was substantial among adults with history of HF, in large part due to age and comorbid conditions. History of heart failure with reduced ejection fraction may confer especially elevated risk. This population thus merits prioritization for the COVID-19 vaccine.

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