scholarly journals Rest Cardiac Power Predicts All-cause Death and Heart Failure Hospitalization in Heart Failure Patients With Preserved Ejection Fraction

2021 ◽  
Author(s):  
Jianqiao Chen ◽  
Huiying Li ◽  
Benchuan Hao ◽  
Yulun Cai ◽  
Shiqi Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Community Dwelling ◽  
Rank Test ◽  
Preserved Ejection Fraction ◽  
Cardiac Power

Abstract Background: Cardiac power as an integrated indicator of cardiac performance that incorporates both pressure and volume factors. It has been studied in patients with reduced left ventricular (LV) ejection fraction (EF), and in the present study we aimed to explore its significance and role in predicting adverse outcome in patients with heart failure with preserved ejection fraction (HFpEF).Methods: This retrospective cohort study included 2089 community-dwelling patients with HFpEF and without significant valve diseases or right ventricular dysfunction. We normalized cardiac power to LV mass and expressed it in W/100 g of LV myocardium. Univariate analysis with log-rank test and multivariate analysis with Cox regression model were used to evaluate the association between rest cardiac power/mass and all-cause death and heart failure (HF) hospitalization. Results: After a median follow-up of 4.4 (0.5–10.1) years, 331 (15.84%) experienced all-cause death and 391 (18.72%) experienced HF hospitalization. Patients with the lower rest power/mass were older and had higher New York Heart Association class, N-terminal pro-brain natriuretic peptide (NT-proBNP) level and more comorbidities. After adjusting for multiple covariates, rest power/mass ≤0.7 W/m2 was independently associated with all-cause death and HF hospitalization, with the hazard ratio (HR) of 1.753 [95% confidence interval (CI) 1.394–2.203, P<0.001] and 1.266 (95% CI 1.033–1.551, P=0.023), respectively. The C statistic increased significantly when the rest cardiac power/mass were incorporated into a model with established risk factors. For all-cause death, the continuous net reclassification index (NRI) after adding rest cardiac power/mass in the model with established risk factors and NT-proBNP was 17.0% (95% CI 11.4–28.3, P=0.04), and the integrated discrimination index (IDI) was 2.3% (95% CI 0.7–8.7, P=0.02); for HF hospitalization, the corresponding continuous NRI and IDI were 6.0% (95% CI 4.7–15.2, P=0.026) and 1.7% (95% CI 1.2–4.3, P=0.007), respectively.Conclusion: Rest cardiac power by non-invasive echocardiography is independently associated with risks of adverse outcomes in patients with HFpEF and provides incremental prognostic information.

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

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.

Abstract 2284: Non-invasively Determined Ventricular Elastance as a predictor of cardiovascular mortality in Patients With acute myocardial infarction and Preserved ejection fraction: Data from Infarction Prognosis Study (IPS) registry

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sung Ai Kim ◽  
Jong-Won Ha ◽  
Hyeon Chang Kim ◽  
Sungha Park ◽  
Eui-Young Choi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Left Ventricular ◽  
Volume Index ◽  
Rank Test ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Acute Mi

Background : Previous studies of the prognosis of myocardial infarction (MI) have focused primarily on patients with left ventricular (LV) systolic dysfunction. Little is known about the prognosis of patients with MI and preserved ejection fraction (EF), which is increasing. Since the ratio of mitral inflow (E) and annular velocity (E′) to stroke volume (E/E′/SV) has been reported as an index of diastolic elastance (Ed), we hypothesized that Ed has prognostic implication in patients with acute MI and preserved EF. Method : Between May 2005 and January 2007, a total of 421 patients with acute MI were prospectively enrolled in Infarction Prognosis Study (IPS) registry. Among 358 patients who had comprehensive echocardiographic study, 42 patients with significant valvular heart disease or coexisted cardiomyopathy and 50 patients with decreased EF (<40%) were excluded. This left a total of 266 patients, who constituted the study population. The primary end-point was cardiovascular mortality. Results : Median follow-up duration was 12 months. Of 266 patients, cardiovascular death occurred in 11 (4.1%) patients. Age (p< 0.001), LA volume index (p=0.001), the severity of diastolic dysfunction (grade ≥ 2, p=0.04), Ed (p=0.003) were univariate predictors of cardiovascular mortality. However, in multivariate Cox regression analysis, age (p=0.008, HR; 1.14, 95% CI; 1.03–1.25) and Ed (p=0.009, HR; 1.72, 95% CI; 1.14 –2.58) were found to be independent predictors for cardiovascular mortality in patients with acute MI and preserved EF. Cut-off value of Ed for cardiovascular mortality determined by Kaplan-Meier method (p<0.001 by log-rank test) and ROC curve (AUC 0.87, sensitivity 90%, specificity 74%) was 0.25. Conclusion : Non-invasively determined ventricular diastolic elastance is a novel and powerful independent predictor of cardiovascular mortality in patients with acute MI and preserved EF.

P5261Feature tracking by CMR: left ventricular dysfunction predicts outcome in heart failure with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kammerlander ◽  
J Kraiger ◽  
C Nitsche ◽  
C Dona ◽  
F Duca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Feature Tracking ◽  
Tissue Characterization ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Walking Distance ◽  
Preserved Ejection Fraction ◽  
Prognostic Relevance

Abstract Objectives To investigate the association between global longitudinal strain (GLS) using feature tracking (FT) cardiovascular magnetic resonance imaging (CMR) and prognosis in patients with heart failure and preserved ejection fraction (HFpEF). Background Echocardiography-based studies have demonstrated that in HFpEF left ventricular (LV) strain analyses can detect impaired systolic function despite preserved ejection fraction and might also predict outcome. CMR also allows strain analysis using FT and is furthermore the gold standard for assessment of ventricular volumes and ejection fractions. In addition, T1-mapping allows non-invasive tissue characterization. However, the prognostic relevance of FT-CMR is unknown. In addition right ventricular (RV) FT-CMR is poorly investigated. Methods Consecutive patients with confirmed diagnosis of HFpEF underwent CMR on a 1.5T scanner. We used dedicated software (cvi42, Circle Cardiovascular Imaging Inc.) for global longitudinal left ventricular strain (LV-GLS) in a 3D and global longitudinal RV strain (RV-GLS) in a 2D model using feature tracking (FT). In addition, we performed uni- and multivariable Cox regression using a combined endpoint of heart failure hospitalizations, and cardiovascular death to determine the prognostic relevance of FT-CMR. Results We included a total of 131 HFpEF patients (70.4±8.6 years old, 70.2% female). Median LV-GLS by FT-CMR was −8% [IQR: −10% to 5%] and median RV-GLS was −11.9% [IQR: −16.57% to −12.23%]. LV and RV GLS values were significantly correlated with LV and RV ejection fractions (r=−0.463, p<0.001 for LV, and r=−0.306, p=0.001 and RV, respectively). 77 (58.8%) events were recorded during a follow-up of 42.0±31.4 months. Patients with an LV-GLS worse than the median (−8%) showed a significantly reduced event-free survival rate (log-rank, p=0.009).In a multivariable Cox-regression model correcting for the strongest clinical variables, including age (HR 1.018 [0.985–1.052], p=0.290), GFR (HR 0.987 [0.975–1.000], p=0.055), diabetes (HR 1.696 [1.028–2.799], p=0.039), and 6-min-walking distance (HR 0.997 [0.995–0.999)], p=0.014), LV-GLS remained significantly associated with outcome (HR 1.093 [1.039–1.150], p=0.001) while RV-GLS had no effect on outcome (p>0.05). Conclusions In patients with HFpEF, LV-GLS but not RV-GLS by FT-CMR is significantly associated with cardiovascular events.

scholarly journals A study of association between heart failure with preserved ejection fraction with hypertension and diabetes mellitus

2021 ◽  
Vol 12 (12) ◽  
pp. 58-61
Author(s):  
Swapan Sarkar ◽  
Joydeep Biswas ◽  
Suprotim Ghosh
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Pressure ◽  
Strong Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

Background: Heart failure is a common clinical entity which we come across in our daily practice and accounts for significant mortality and morbidity. The basic pathophysiology lies in the inability of the heart to pump adequate blood (output) to meet the demands of circulation/tissue or can do so only at the expense of elevated left ventricular filling pressure. Among various types of heart failure, heart failure with preserved ejection fraction (HFpEF) is still a poorly understood entity and several comorbidities such as hypertension, diabetes, coronary artery disease, obesity, and CKD are common association of HFpEF. Diabetes causes heart failure by increasing the risk of CAD and by direct injury to myocardium (cardiomyopathy). Hence, in this cross-sectional observational study, we assess the cardiovascular risk factors such as hypertension and diabetes mellitus in association with HFpEF. Aims and Objectives: This study aims to establish the hypothesis that hypertension and diabetes mellitus are associated with a predictor of HFpEF. Materials and Methods: Ninety patients were selected. NTproBNP, HbA1C, FBS, PPBS level, and blood pressure was measured and echocardiogram was performed to assess ratio of transmitral flow velocity and annular velocity (E/E’); left ventricular end-diastolic pressure; and left ventricular ejection fraction (LVEF). Results: The mean age was 64±7. Forty-two (46.67%) were men and 48 (53.33%) were female. Hypertension was present in 73 (81.11%) and diabetes in 44 (48.89%). E/E´, a parameter of LV diastolic function, showed positive correlation to both risk factors in study (r=0.653, p<0.001). Linear regression indicated that E/E’ (β-coefficient=0.845, p<0.001) was significantly associated with the presence of risk factors. Conclusion: The data show that the prevalence of HTN and DM is significantly higher in patients with HFpEF and establishes a strong association between duration of HTN and DM with symptomatic HFpEF.

scholarly journals Screening for asymptomatic heart failure with preserved ejection fraction in mongolian population at high risk

Kardiologiia ◽  
2020 ◽  
Vol 60 (4) ◽  
pp. 86-90
Author(s):  
Ts. Unurjargal ◽  
Ch. Khorloo ◽  
G. Ulziisaikhan ◽  
N. Sodovsuren ◽  
A. Khasag
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
High Risk ◽  
Ejection Fraction ◽  
Clinical Symptoms ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Cross Sectional ◽  
High Prevalence

Objective The goals of the present study were to assess the prevalence of asymptomatic heart failure with preserved ejection fraction (HFpEF) in subjects at high risk of developing HF and to define the diagnostic accuracy of NT-pro BNP assay compared with echocardiography in this setting.Material and methods This cross-sectional study included subjects aged from 35 to 64 years, with high risk of HF, who had no clinical symptoms of HF. Risk factors of HF were detected by clinical examinations. NT-pro BNP determination was performed using immunoassay analyzer (FIA8000, Getein Bio Medical Inc, China),. The cut-off point for NT-pro BNP was 125 pg/ml. Diagnosis of HFpEF was based on criteria recommended by 2016 ESC heart failure guidelines. Diastolic dysfunction was assessed according to the algorithm proposed in the joint recommendations of the ASE/EACVI.Results 602 patients with risk factors of HF were included in the study, of which 256 (42.5 %) were males and 346 (57.5 %) females. The mean age was 51.71±8.07 years. 83 patients (13.8 %) showed elevated NT-pro BNP levels of ≥125 pg / ml. Our study has shown that NT-pro BNP concentration was positively correlating with age, both systolic and diastolic blood pressure, left ventricular mass and E / e’ ratio and negatively correlating with waist circumference, body mass index, left ventricular EF and E / A ratio in asymptomatic population. The likelihood of positive NT-pro BNP test was independently (p<0.05) associated with age, hypertension and diabetes. The diagnosis of asymptomatic HFpEF was confirmed in 12.3 % of studied population. A cutoff value of 125 pg / ml for NT-proBNP concentration showed the following diagnostic re-abilities in identifying asymptomatic HFpEF: sensitivity 85.0 %, specificity 88.6 % and area under curve 0.92 (95 % CI 0.86–0.98).Conclusion Subjects with raised NT-pro BNP level (≥125 pg/ml) were more likely to have a confirmed diagnosis of asymptomatic HFpEF after screening. In summary, in at-risk population, natriuretic peptide based screening combined with echocardiography identifies high prevalence of asymptomatic HFpEF.

scholarly journals Sex and Heart Failure with Preserved Ejection Fraction: From Pathophysiology to Clinical Studies

2019 ◽  
Vol 8 (6) ◽  
pp. 792 ◽  
Author(s):  
Marijana Tadic ◽  
Cesare Cuspidi ◽  
Sven Plein ◽  
Evgeny Belyavskiy ◽  
Frank Heinzel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Cardiac Phenotype ◽  
Hospitalization Rates ◽  
Ventricular Diastolic Dysfunction ◽  
Artery Disease

Heart failure with preserved ejection fraction (HFpEF) represents the most frequent form of heart failure in women, with almost two-fold higher prevalence than in men. Studies have revealed sex-specific HFpEF pathophysiology, and suggested the possibility of a sex-specific therapeutic approach in these patients. Some cardiovascular risk factors, such as arterial hypertension, obesity, diabetes mellitus, coronary artery disease, atrial fibrillation, and race, show specific features that might be responsible for the development of HFpEF in women. These risk factors are related to specific cardiovascular changes—left ventricular diastolic dysfunction and hypertrophy, ventricular–vascular coupling, and impaired functional capacity—that are related to specific cardiac phenotype and HFpEF development. However, there is no agreement regarding outcomes in women with HFpEF. For HFpEF, most studies have found higher hospitalization rates for women than for men. Mortality rates are usually not different. Pharmacological treatment in HFpEF is challenging, along with many unresolved issues and questions raised. Available data on medical therapy in patients with HFpEF show no difference in outcomes between the sexes. Further investigations are necessary to better understand the pathophysiology and mechanisms of HFpEF, as well as to improve and eventually develop sex-specific therapy for HFpEF.

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