scholarly journals Prognostic value of secondary hyperaldosteronism in patients with chronic heart failure with preserved ejection fraction

2021 ◽  
Vol 12 (2) ◽  
pp. 81-91
Author(s):  
A. N. Shevelok
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Functional Class ◽  
Plasma Aldosterone ◽  
Preserved Ejection Fraction ◽  
Aldosterone Level ◽  
Patients With Heart Failure ◽  
Secondary Hyperaldosteronism ◽  
Plasma Aldosterone Level

Purpose: to investigate the prognostic value of secondary hyperaldosteronism patients with heart failure with preserved ejection fraction. Materials and methods: prospective cohort study included 158 patients with hyperaldosteronism and heart failure with preserved ejection fraction. Baseline blood aldosterone levels were determined in all patients. Hyperaldosteronemia was diagnosed when the plasma aldosterone level was > 160 pg/ml. The primary endpoint was all-cause mortality. Results: at baseline, hyperaldosteronemia was detected in 59 of 158 patients (37.3%). Hyperaldosteronemic patients were younger, had higher functional class and NT-proBNP level, and a higher rate of comorbidity (all Ps <0.05). Over a median follow‐up of 32 (28-38) months, a total of 50 (37.6%) patients died. Cardiovascular death occurred in 32 (20.3%) cases, non-cardiovascular – in 18 (11.4%) cases. A total of 65 (41.1%) patients were hospitalized for HF. High aldosterone levels were associated with a significant (p <0.05) increase in the risk of hospitalization for HF (adjusted odds ratio (OR) 2.14, 95% confidence interval (CI) 1.34-9.68), all-cause death (OR 1.64; 95% CI 1.23-7.65, P = 0.033) and HF death (OR 1.56; 95 % CI 1.14-11.3, P = 0.021). Conclusion: Hyperaldosteronism in patients with heart failure with preserved ejection fraction secondary hyperaldosteronism is an independent predictor of hospitalization for heart failure, all-cause, and cardiovascular mortality. The inclusion of plasma aldosterone level in the existing prognosis models of heart failure with preserved ejection fraction will help improve their predictive value and optimize the management of high-risk patients.

scholarly journals Association Between Hyperaldosteronemia and Electrophysiological Myocardial Activity in Heart Failure with Preserved Ejection Fraction

2020 ◽  
Vol 10 (5) ◽  
pp. 382-389
Author(s):  
A. N. Shevelok
Keyword(s):  
Heart Failure ◽  
Plasma Level ◽  
Confidence Interval ◽  
Ejection Fraction ◽  
Ventricular Arrhythmias ◽  
Plasma Aldosterone ◽  
Preserved Ejection Fraction ◽  
Qtc Prolongation ◽  
Aldosterone Level ◽  
Plasma Aldosterone Level

Background. Sudden cardiac death, one of the most common types of cardiac death, is most often triggered by ventricular arrhythmia. Plasma aldosterone level has been shown to be an independent risk factor of life-threatening ventricular arrhythmia in patients with left ventricular systolic dysfunction following acute myocardial infarction. Whether either effect also occurs in patients with heart failure and preserved ejection fraction is currently unknown. Purpose. The study aims to investigate the relationship between plasma aldosterone level and ventricular arrhythmias in longterm heart failure with preserved ejection fraction. Methods. A cross-sectional study included 158 patients (58 men and 100 women, mean age 62.3±7.4 years) with heart failure with preserved ejection fraction (> 50%). Patients had no history of primary aldosteronism and did not use the mineralocorticoid receptor antagonists during the last 6 weeks. Aldosterone plasma level was measured and 24-hour electrocardiographic monitoring was performed. Results. According to laboratory results 99 patients (62.7%, 95% confidence interval 55.0-70.0%) had normal (40-160 pg/ml) aldosterone plasma level (nAld) and 59 patients (37.3%, 95% CI 30.0-45.0%) had high (> 160 pg/ml) aldosterone level (hAld). hAld patients more often had QTc prolongation (44.1% versus 18.2%) and ventricular arrhythmias (83.1% vs 61.6%) compared to nAld patients (all Ps <0.001). The number of ventricular premature complexes in 24 hours were higher in hAld group (median 214, range 64-758) compared to nAld (median 52, range 16-198, P < 0.003). hAld patients more often occurred bigemy, couple ventricular ectopy and nonsustained ventricular tachycardia (39.0% vs 19.0%, р=0.01). In Cox regression model’s high aldosterone plasma level was the independent risk factors of QTc prolongation (odds ratio 1.6, 95% confidence interval 1.1-5.7, p=0.034) and prognostically unfavorable ventricular arrhythmias (odds ratio 1.8, 95% confidence interval 1.2-6.8, p=0.024). Conclusion. In long-term HFpEF plasma aldosterone level is significantly related to QTc prolongation as well as ventricular arrhythmias.

Abstract 13497: Prognostic Value of the Combination of the Echocardiographic Derived Pulmonary Artery Wedge Pressure and Body Mass Index in Patients With Heart Failure With Preserved Ejection Fraction: Insights From PURSUIT-HFpEF Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kumpei Ueda ◽  
Shungo Hikoso ◽  
Daisaku D Nakatani ◽  
Shunsuke Tamaki ◽  
Masamichi Yano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Pulmonary Artery Wedge Pressure ◽  
Patients With Heart Failure ◽  
Wedge Pressure

Background: An elevated pulmonary artery wedge pressure (PAWP), a surrogate of left ventricular filling pressure, is associated with poor outcomes in patients with heart failure (HF). In addition, obesity paradox is well recognized in HF patients and body mass index (BMI) also provides a prognostic information. However, there is little information available on the prognostic value of the combination of the echocardiographic derived PAWP and BMI in patients with HF with preserved ejection fraction (HFpEF). Methods and Results: Patients data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for acute decompensated heart failure (ADHF) patients with HFpEF. We analyzed 548 patients after exclusion of patients undergoing hemodialysis, patients with in-hospital death, missing follow-up data, or missing data to calculate PAWP or BMI. Body weight measurement and echocardiography were performed just before discharge. PAWP was calculated using the Nagueh formula [PAWP = 1.24* (E/e’) + 1.9] with e’ = [(e’ septal + e’ lateral ) /2]. During a mean follow up period of 1.5±0.8 years, 86 patients had all-cause death (ACD). Multivariate Cox analysis showed that both PAWP (p=0.020) and BMI (p=0.0001) were significantly associated with ACD, independently of age and previous history of HF hospitalization, after the adjustment with gender, left ventricular ejection fraction, NT-proBNP and estimated glomerular filtration rate. Kaplan-Meier curve analysis revealed that there was a significant difference in the risk of ACD when patients were stratified into 3 groups based on the median values of PAWP (17.3) and BMI (21.4). Conclusions: The combination of the echocardiographic derived PAWP and BMI might be useful for stratifying ADHF patients with HFpEF at risk for the total mortality.

scholarly journals Patients with Heart Failure and Preserved Ejection Fraction Are at Risk of Gastrointestinal Bleeding

2019 ◽  
Vol 8 (8) ◽  
pp. 1240 ◽  
Author(s):  
Lore Schrutka ◽  
Benjamin Seirer ◽  
Franz Duca ◽  
Christina Binder ◽  
Daniel Dalos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Vitamin K ◽  
Prognostic Value ◽  
Vitamin K Antagonists ◽  
Right Atrial ◽  
Preserved Ejection Fraction ◽  
Gi Bleeding ◽  
Bleeding Events ◽  
Patients With Heart Failure

Aims. Two thirds of patients with heart failure and preserved ejection fraction (HFpEF) have an indication for oral anticoagulation (OAC) to prevent thromboembolic events. However, evidence regarding the safety of OAC in HFpEF is limited. Therefore, our aim was to describe bleeding events and to find predictors of bleeding in a large HFpEF cohort. Methods and Results. We recorded bleeding events in a prospective HFpEF cohort. Out of 328 patients (median age 71 years (interquartile range (IQR) 67–77)), 64.6% (n = 212) were treated with OAC. Of those, 65.1% (n = 138) received vitamin-K-antagonists (VKA) and 34.9% (n = 72) non-vitamin K oral anticoagulants (NOACs). During a median follow-up time of 42 (IQR 17–63) months, a total of 54 bleeding events occurred. Patients on OAC experienced more bleeding events (n = 49 (23.1%) versus n = 5 (4.3%), p < 0.001). Major drivers of events were gastrointestinal (GI) bleeding (n = 18 (36.7%)]. HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score (hazard ratios (HR) of 2.15 (95% confidence interval (CI) 1.65–2.79, p < 0.001)) was the strongest independent predictor for overall bleeding. In the subgroup of GI bleeding, mean right atrial pressure (mRAP: HR of 1.13 (95% CI 1.03–1.25, p = 0.013)) and HAS-BLED score (HR of 1.74 (95% CI 1.15–2.64, p = 0.009)] remained significantly associatiated with bleeding events after adjustment. mRAP provided additional prognostic value beyond the HAS-BLED score with an improvement from 0.63 to 0.71 (95% CI 0.58–0.84, p for comparison 0.032), by C-statistic. This additional prognostic value was confirmed by significant improvements in net reclassification index (61.3%, p = 0.019) and integrated discrimination improvement (3.4%, p = 0.015). Conclusion. OAC-treated HFpEF patients are at high risk of GI bleeding. High mRAP as an indicator of advanced stage of disease was predictive for GI bleeding events and provided additional risk stratification information beyond that obtained by HAS-BLED score.

Effect of atorvastatin on the lipid profile, markers of immune inflammation and symptomatic severity of heart failure in patients with myocarditis

2020 ◽  
Vol 22 (3) ◽  
pp. 76-81
Author(s):  
N. N. Ryzhman ◽  
S. L. Grishaev ◽  
D. V. Cherkashin ◽  
E. V. Gladysheva ◽  
V. Yu. Filippov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Course ◽  
Systolic Function ◽  
Functional Class ◽  
Pleiotropic Effects ◽  
Preserved Ejection Fraction ◽  
Chronic Myocarditis ◽  
Patients With Heart Failure ◽  
Positive Effect

Abstract. The effect of atorvastatin on the immune system and lipid metabolism after 24-week treatment of patients with chronic myocarditis is considered. Statins have been found to improve the clinical course of heart failure with a preserved ejection fraction in patients with myocarditis: they reduce the functional class of heart failure, improve the systolic function of the heart and its arrhythmogenic potential. Despite the large amount of conflicting data in the field of statin use in heart failure, one can think about the possible influence of molecular differences in statins on their pharmacological and pleiotropic effects. In particular, atorvastatin, which has lipophilic properties, is able to penetrate cardiomyocytes in contrast to hydrophilic rosuvastatin, which may partially explain the positive cardiac effects of atorvastatin in patients with heart failure with a preserved ejection fraction. The probable basis for the positive effect of atorvastatin on morphofunctional parameters in heart failure is its positive pleiotropic effects associated with a decrease in рro-inflammatory immune markers and subsequent leveling of negative neurohumoral activation. An additional mechanism that caused the positive effect of atorvastatin on the clinical course of heart failure can be considered a factor of preservation of systolic function of the left ventricle.

Abstract 14213: Different Prognostic Value of Proteinuria According to the Severity of Heart Failure in Patients With Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bolrathanak Oeun ◽  
Shungo Hikoso ◽  
Daisaku Nakatani ◽  
Hiroya Mizuno ◽  
Tetsuhisa Kitamura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Cox Regression ◽  
Composite Endpoint ◽  
Study Endpoint ◽  
Prognostic Impact ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
Additive Risk

Introduction: Proteinuria reflects systemic inflammation and endothelial dysfunction, and is a prognosticator in heart failure with preserved ejection fraction (HFpEF). However, it remains elusive whether the prognostic impact of proteinuria is different according to the severity of HFpEF. Recently, we and other groups reported that echocardiographic diastolic dysfunction (DD) is a worse prognostic factor in HFpEF. Objectives: We aimed to clarify the prognostic value of proteinuria in HFpEF according to the severity of HFpEF. We used the evidence of DD as criteria of the severity of HFpEF. Methods: We assessed 575 discharged-alive patients (pts) in the PURSUIT-HFpEF registry. Pts were divided into 2 groups according to the absence (DD-) or presence of DD (DD+). DD was defined using the 2016 ASE recommendations. Each group was further classified into 2 subgroups according to the absence or presence of dipstick proteinuria (proteinuria trace or more). The study endpoint was a composite of all-cause mortality and HF hospitalization. Results: Median age 83 years and 58% female. The number of pts with DD-: 336 pts (221 pts: proteinuria-[G1], 115 pts: proteinuria+[G2]); and DD+: 239 pts (125 pts: proteinuria-[G3], 114 pts: proteinuria+[G4]). G4 had higher NT-proBNP level than G3, but not observed between G1 and G2. Proteinuria+ were more hypertensive, diabetic with worse renal function than proteinuria- in both DD-/DD+. The composite endpoint occurred more often in G4 than G3 (HR: 1.75, 95%CI: 1.18-2.62, log-rank P=0.005), but was similar between G1 and G2 (HR: 1.21, 95%CI: 0.76-1.92, log-rank P=0.431). Multivariable Cox regression adjusting for NT-proBNP, eGFR and other major confounding factors revealed that proteinuria was associated with the composite endpoint in DD+ (HR:1.85, 95% CI:1.16-2.93, P=0.009), but not in DD- (HR:0.96, 95% CI:0.55-1.69, P=0.900). Conclusions: Proteinuria may be an additive risk factor in pts with DD but not in those without DD in HFpEF.

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