scholarly journals Sex Differences in Characteristics and Outcomes in Elderly Heart Failure Patients With Preserved Ejection Fraction: A Post-hoc Analysis From TOPCAT

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiaxing Sun ◽  
Shi Tai ◽  
Yanan Guo ◽  
Liang Tang ◽  
Hui Yang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sex Differences ◽  
Elderly Patients ◽  
Cardiac Function ◽  
Patient Outcomes ◽  
Cox Regression ◽  
Preserved Ejection Fraction ◽  
All Cause Mortality ◽  
Baseline Characteristics ◽  
The Impact

Introduction: Although the impact of sex on patient outcomes for heart failure (HF) with preserved ejection fraction (HFpEF) has been reported, it is still unclear whether this impact is applicable for elderly patients with HFpEF. This study was conducted as a secondary analysis from a large randomized controlled trial—The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT)—to evaluate the impact of sex differences on the baseline characteristics and outcomes of HFpEF patients who were older than 70 years.Methods: Baseline characteristic of elderly patients were compared between men and women. Primary outcomes were cardiovascular (CV) mortality and HF-related hospitalization, whereas secondary outcomes were all-cause mortality and all-cause hospitalization. Cox regression models were used to determine the effect of sex differences on patient outcomes.Results: A total of 1,619 patients were included in the study: 898 (55.5%) women and 721 (44.5%) men. Age was similar between women and men. Women had fewer comorbidities but worse cardiac function than men. The rate of primary outcomes was lower in women than in men (18.4 vs. 27.5%; p < 0.001), including rate of CV mortality (8.9 vs. 14.8%; p < 0.001) and HF-related hospitalization (13.4 vs. 18.2%; p = 0.008). All-cause mortality was also lower in women than in men (15.6 vs. 25.4%; p < 0.001). After adjustment for baseline characteristics, Cox regression analysis showed that female sex was a protective factor for CV mortality [hazard ratio (HR): 0.53; 95% confidence interval (CI): 0.40–0.73], HF-related hospitalization (HR: 0.71; 95% CI: 0.55–0.93), and all-cause mortality (HR: 0.59; 95% CI: 0.47–0.75). Although spironolactone significantly reduced the rate of all-cause mortality in women even after adjusting for baseline characteristics (HR: 0.68; 95% CI: 0.48–0.96; p = 0.028), no significant multivariate association was noted between sex and treatment effects (p = 0.190).Conclusion: Among elderly patients with HFpEF, women had worse cardiac function but better survival and lower HF-related hospitalization rate than men.Clinical Trial Registration: NCT00094302 (TOPCAT). Registered October 15, 2004, https://www.clinicaltrials.gov/ct2/show/NCT00094302.

scholarly journals Sex Differences in the Outcomes of Elderly Patients With Heart Failure With Preserved Ejection Fraction 

2021 ◽  
Author(s):  
Jiaxing Sun ◽  
Shi Tai ◽  
Guo Yanan ◽  
Liang Tang ◽  
Hui Yang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sex Differences ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Primary Outcome ◽  
Cox Regression ◽  
Baseline Characteristic ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
All Cause Mortality

Abstract Background: It has been shown the impacts of sex on patients' outcomes with preserved ejection fraction (HFpEF), but little is known about the impacts of sex on elderly patients with HFpEF.Methods: A secondary analysis was conducted to evaluate the impacts of sex on outcomes of patients who were ≥70 years of age with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT). The primary outcome was composed of cardiovascular (CV) mortality, HF hospitalization. Secondary outcomes included all-cause mortality and all-cause hospitalization. Cox regression models were used to determine sex differences in outcomes.Results: A total of 1619 patients were included: 898 (55.5%) women and 721 (44.5%) men. Their age ranged from 70 to 94 years, similar between women and men. Women had fewer comorbidities than men. The rate of primary outcome was lower in women than in men (18.9% vs. 28.1%, p=0.002), including CV mortality (10.6% vs. 15.4%, p=0.039) and HF hospitalization (13.5% vs. 19.0%, p=0.033). After adjustment for baseline characteristic, the Cox regression analysis showed that woman was a protective factor for CV mortality (hazard ratio [HR] 0.53, 95% confidence interval [CI] 0.40-0.73), HF hospitalization (HR 0.71, 95% CI 0.55-0.93) and all-cause mortality (HR 0.59, 95% CI 0.47-0.75). Although a significant reduction in all-cause mortality associated with spironolactone in women was observed even after adjustment (HR: 0.68; 95% CI: 0.48-0.96; p=0.028), there is not a significant multivariate sex-treatment interaction (p interaction=0.190).Conclusion: Among elderly patients with HFpEF, women had fewer comorbidities and better outcomes. Clinical trial registration: NCT00094302 (TOPCAT). Registered 15 October 2004, https://www.clinicaltrials.gov/ct2/show/NCT00094302

Rehospitalization as a predictor of mortality in Polish population of heart failure patients-national registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Zaleska-Kociecka ◽  
K Witczak ◽  
K Bartolik ◽  
D Was ◽  
A Kleinork ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cox Regression ◽  
National Registry ◽  
Funding Source ◽  
Polish Population ◽  
The European Union ◽  
Related Factors ◽  
Comorbidity Burden ◽  
All Cause Mortality ◽  
The Impact

Abstract Background High mortality risk in heart failure (HF) is related to repeat HF hospitalizations but also individual patient characteristics. Purpose To evaluate the impact of HF re-/hospitalizations and patient-related factors (sex, HF etiology, age, comorbidity) on all-cause mortality. Methods Our study represents one of the most extensive retrospective cohort analyses consisting of 1,686,861 adult Polish HF patients who presented into public health system in years 2013–2018. It is a part of a nationwide National Health Fund registry covering out- and in-patient data for the entire Polish population (38,495,659 in 2013) since 2009. HF hospitalizations were extracted using ICD-10 coding, whereas the comorbidity was evaluated by means of Charlson Comorbidity Index (CCI). Results In years 2013–2018 the absolute number of HF hospitalizations in Poland grew by 33% to 264,808 in 2018, whereas the number of rehospitalizations increased 1.5-fold to reach 137,708 in 2018. In fact, nearly half of HF patients (n=817,432; 48.5%) experienced at least one hospitalization, while 15.4% (n=259,868) were rehospitalized during the study period. After initial hospitalization the readmission rate due to HF/all circulatory diseases at 30, 60, 180, 360, and 720 days was 10.4%/15.1%, 21.2%/28.3%, 43.9%/52.8%, 62%/70.4%, and 81%/87%, respectively. As compared to patients who were hospitalized just once, those who underwent at least one rehospitalization were more often female (p<0.001), slightly older (p<0.001), and with higher burden of comorbidities based on CCI (p<0.001). Patient survival was highly dependent on hospitalization frequency (Fig. 1). Mean survival rate at day 720 was 66.4%, 59.8%, 54.9%, 51%, and 43.9% for 1st, 2nd, 3rd, 4th, and ≥5th hospitalization, respectively. After adjusting for age, sex, etiology (ischemic/non-ischemic) and CCI using a multivariate stratified Cox regression model, the estimated hazard ratios (HR) for all-cause mortality amounted to 1.22 (95% CI: 1.21–1.23, p<0.001) for 2nd, 1.4 (95% CI: 1.39–1.42, p<0.001) for 3rd, 1.58 (95% CI: 1.56–1.6, p<0.001) for 4th, and 1.97 (95% CI: 1.95–1.98 p<0.001) for 5th and subsequent hospitalizations, as compared to the first hospitalization. Conclusions Hospitalization rate in Poland is alarmingly high. Repeat HF hospitalizations strongly predict mortality rate for HF patients even after adjustment for age, sex, etiology, and comorbidity burden. Figure 1. Kaplan-Meier for survival post hosp. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): The project is co-financed by the European Union from the European Social Fund under the Operational Programme Knowledge Education Development and it is being carried out by the Analyses and Strategies Department of the Polish Ministry of Health.

scholarly journals Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension

Heart ◽  
2017 ◽  
Vol 104 (6) ◽  
pp. 487-493 ◽  
Author(s):  
Ekrem Yasa ◽  
Fabrizio Ricci ◽  
Martin Magnusson ◽  
Richard Sutton ◽  
Sabina Gallina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Orthostatic Hypotension ◽  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Cox Regression ◽  
All Cause Mortality ◽  
Unexplained Syncope ◽  
The Impact

ObjectiveTo investigate the relationship of hospital admissions due to unexplained syncope and orthostatic hypotension (OH) with subsequent cardiovascular events and mortality.MethodsWe analysed a population-based prospective cohort of 30 528 middle-aged individuals (age 58±8 years; males, 40%). Adjusted Cox regression models were applied to assess the impact of unexplained syncope/OH hospitalisations on cardiovascular events and mortality, excluding subjects with prevalent cardiovascular disease.ResultsAfter a median follow-up of 15±4 years, 524 (1.7%) and 504 (1.7%) participants were hospitalised for syncope or OH, respectively, yielding 1.2 hospital admissions per 1000 person-years for each diagnosis. Syncope hospitalisations increased with age (HR, per 1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01 to 1.12), antihypertensive treatment (HR: 1.26, 95% CI 1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31 to 2.38) and prevalent cardiovascular disease (HR: 1.59, 95% CI 1.14 to 2.23), whereas OH hospitalisations increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After exclusion of 1399 patients with prevalent cardiovascular disease, a total of 473/464 patients were hospitalised for unexplained syncope/OH before any cardiovascular event. Hospitalisation for unexplained syncope predicted coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation (HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis (HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR: 1.22, 95% CI 1.09 to 1.37) and cardiovascular death (HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation (HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality (HR: 1.14, 95% CI 1.01 to 1.30).ConclusionsPatients discharged with the diagnosis of unexplained syncope or OH show higher incidence of cardiovascular disease and mortality with only partial overlap between these two conditions.

scholarly journals Spironolactone Treatment and Effect on Survival in Chronic Heart Failure Patients with Reduced Renal Function: A Propensity-Matched Study

2017 ◽  
Vol 7 (2) ◽  
pp. 128-136 ◽  
Author(s):  
Viera Stubnova ◽  
Ingrid Os ◽  
Morten Grundtvig ◽  
Dan Atar ◽  
Bård Waldum-Grevbo
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Propensity Score ◽  
Renal Dysfunction ◽  
Cox Regression ◽  
Independent Effect ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Baseline Characteristics ◽  
Matched Study

Background/Aims: Spironolactone may be hazardous in heart failure (HF) patients with renal dysfunction due to risk of hyperkalemia and worsened renal function. We aimed to evaluate the effect of spironolactone on all-cause mortality in HF outpatients with renal dysfunction in a propensity-score-matched study. Methods: A total of 2,077 patients from the Norwegian Heart Failure Registry with renal dysfunction (eGFR <60 mL/min/1.73 m2) not treated with spironolactone at the first visit at the HF clinic were eligible for the study. Patients started on spironolactone at the outpatient HF clinics (n = 206) were propensity-score-matched 1:1 with patients not started on spironolactone, based on 16 measured baseline characteristics. Kaplan-Meier and Cox regression analyses were used to investigate the independent effect of spironolactone on 2-year all-cause mortality. Results: Propensity score matching identified 170 pairs of patients, one group receiving spironolactone and the other not. The two groups were well matched (mean age 76.7 ± 8.1 years, 66.4% males, and eGFR 46.2 ± 10.2 mL/min/1.73 m2). Treatment with spironolactone was associated with increased potassium (delta potassium 0.31 ± 0.55 vs. 0.05 ± 0.41 mmol/L, p < 0.001) and decreased eGFR (delta eGFR -4.12 ± 12.2 vs. -0.98 ± 7.88 mL/min/1.73 m2, p = 0.006) compared to the non-spironolactone group. After 2 years, 84% of patients were alive in the spironolactone group and 73% of patients in the non-spironolactone group (HR 0.59, 95% CI 0.37-0.92, p = 0.020). Conclusion: In HF outpatients with renal dysfunction, treatment with spironolactone was associated with improved 2-year survival compared to well-matched patients not treated with spironolactone. Favorable survival was observed despite worsened renal function and increased potassium in the spironolactone group.

scholarly journals Left atrial pressure overload and prognosis in elderly patients with heart failure and preserved ejection fraction: a prospective multicenter observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e044605
Author(s):  
Shiro Hoshida ◽  
Koichi Tachibana ◽  
Yukinori Shinoda ◽  
Tomoko Minamisaka ◽  
Takahisa Yamada ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Pressure Overload ◽  
Volume Index ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

ObjectivesThe severity of diastolic dysfunction is assessed using a combination of several indices of left atrial (LA) volume overload and LA pressure overload. We aimed to clarify which overload is more associated with the prognosis in patients with heart failure and preserved ejection fraction (HFpEF).SettingA prospective, multicenter observational registry of collaborating hospitals in Osaka, Japan.ParticipantsWe enrolled hospitalised patients with HFpEF showing sinus rhythm (men, 79; women, 113). Blood tests and transthoracic echocardiography were performed before discharge. The ratio of diastolic elastance (Ed) to arterial elastance (Ea) was used as a relative index of LA pressure overload.Primary outcome measuresAll-cause mortality and admission for heart failure were evaluated at >1 year after discharge.ResultsIn the multivariable Cox regression analysis, Ed/Ea, but not LA volume index, was significantly associated with all-cause mortality or admission for heart failure (HR 2.034, 95% CI 1.059 to 3.907, p=0.032), independent of age, sex, and the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level. In patients with a higher NT-proBNP level, the effect of higher Ed/Ea on prognosis was prominent (p=0.015).ConclusionsEd/Ea, an index of LA pressure overload, was significantly associated with the prognosis in elderly patients with HFpEF showing sinus rhythm.Trial registration numberUMIN000021831.

scholarly journals Predictive Value of HFA-PEFF Score in Patients With Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuxi Sun ◽  
Jinping Si ◽  
Jiaxin Li ◽  
Mengyuan Dai ◽  
Emma King ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Ejection Fraction ◽  
Roc Analysis ◽  
Cox Regression ◽  
Nyha Class ◽  
Area Under The Curve ◽  
Heart Association ◽  
Preserved Ejection Fraction ◽  
All Cause Mortality

Aims: HFA-PEFF score has been proposed for diagnosing heart failure with preserved ejection fraction (HFpEF). Currently, there are only a limited number of tools for predicting the prognosis. In this study, we evaluated whether the HFA-PEFF score can predict mortality in patients with HFpEF.Methods: This single-center, retrospective observational study enrolled patients diagnosed with HFpEF at the First Affiliated Hospital of Dalian Medical University between January 1, 2015, and April 30, 2018. The subjects were divided according to their HFA-PEFF score into low (0–2 points), intermediate (3–4 points), and high (5–6 points) score groups. The primary outcome was all-cause mortality.Results: A total of 358 patients (mean age: 70.21 ± 8.64 years, 58.1% female) were included. Of these, 63 (17.6%), 156 (43.6%), and 139 (38.8%) were classified into the low, intermediate, and high score groups, respectively. Over a mean follow-up of 26.9 months, 46 patients (12.8%) died. The percentage of patients who died in the low, intermediate, and high score groups were 1 (1.6%), 18 (11.5%), and 27 (19.4%), respectively. A multivariate Cox regression identified HFA-PEFF score as an independent predictor of all-cause mortality [hazard ratio (HR):1.314, 95% CI: 1.013–1.705, P = 0.039]. A Cox analysis demonstrated a significantly higher rate of mortality in the intermediate (HR: 4.912, 95% CI 1.154–20.907, P = 0.031) and high score groups (HR: 5.291, 95% CI: 1.239–22.593, P = 0.024) than the low score group. A receiver operating characteristic (ROC) analysis indicated that the HFA-PEFF score can effectively predict all-cause mortality after adjusting for age and New York Heart Association (NYHA) class [area under the curve (AUC) 0.726, 95% CI 0.651–0.800, P = 0.000]. With an HFA-PEFF score cut-off value of 3.5, the sensitivity and specificity were 78.3 and 54.8%, respectively. The AUC on ROC analysis for the biomarker component of the score was similar to that of the total score.Conclusions: The HFA-PEFF score can be used both to diagnose HFpEF and predict the prognosis. The higher scores are associated with higher all-cause mortality.

scholarly journals High Plasma Docosahexaenoic Acid Associated to Better Prognoses of Patients with Acute Decompensated Heart Failure with Preserved Ejection Fraction

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 371
Author(s):  
Naoaki Matsuo ◽  
Toru Miyoshi ◽  
Atsushi Takaishi ◽  
Takao Kishinoue ◽  
Kentaro Yasuhara ◽  
...  
Keyword(s):  
Heart Failure ◽  
Docosahexaenoic Acid ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
Cox Regression ◽  
Risk Index ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Nutritional Risk Index ◽  
All Cause Mortality

The clinical relevance of polyunsaturated fatty acids (PUFAs) in heart failure remains unclear. The aim of this study was to investigate the association between PUFA levels and the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). This retrospective study included 140 hospitalized patients with acute decompensated HFpEF (median age 84.0 years, 42.9% men). The patients’ nutritional status was assessed, using the geriatric nutritional risk index (GNRI), and their plasma levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), and dihomo-gamma-linolenic acid (DGLA) were measured before discharge. The primary outcome was all-cause mortality. During a median follow-up of 23.3 months, the primary outcome occurred in 37 patients (26.4%). A Kaplan–Meier analysis showed that lower DHA and DGLA levels, but not EPA or AA levels, were significantly associated with an increase in all-cause death (log-rank; p < 0.001 and p = 0.040, respectively). A multivariate Cox regression analysis also revealed that DHA levels were significantly associated with the incidence of all-cause death (HR: 0.16, 95% CI: 0.06–0.44, p = 0.001), independent of the GNRI. Our results suggest that low plasma DHA levels may be a useful predictor of all-cause mortality and potential therapeutic target in patients with acute decompensated HFpEF.

scholarly journals Relationship of hyperuricemia with mortality in heart failure patients with preserved ejection fraction

2015 ◽  
Vol 309 (7) ◽  
pp. H1123-H1129 ◽  
Author(s):  
Takeshi Shimizu ◽  
Akiomi Yoshihisa ◽  
Yuki Kanno ◽  
Mai Takiguchi ◽  
Akihiko Sato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Ejection Fraction ◽  
Serum Uric Acid ◽  
Decompensated Heart Failure ◽  
Cardiopulmonary Exercise Test ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
All Cause Mortality ◽  
The Impact

Serum uric acid is a predictor of cardiovascular mortality in heart failure with reduced ejection fraction. However, the impact of uric acid on heart failure with preserved ejection fraction (HFpEF) remains unclear. Here, we investigated the association between hyperuricemia and mortality in HFpEF patients. Consecutive 424 patients, who were admitted to our hospital for decompensated heart failure and diagnosed as having HFpEF, were divided into two groups based on presence of hyperuricemia (serum uric acid ≥7 mg/dl or taking antihyperuricemic agents). We compared patient characteristics, echocardiographic data, cardio-ankle vascular index, and cardiopulmonary exercise test findings between the two groups and prospectively followed cardiac and all-cause mortality. Compared with the non-hyperuricemia group ( n = 170), the hyperuricemia group ( n = 254) had a higher prevalence of hypertension ( P = 0.013), diabetes mellitus ( P = 0.01), dyslipidemia ( P = 0.038), atrial fibrillation ( P = 0.001), and use of diuretics ( P < 0.001). Cardio-ankle vascular index (8.7 vs. 7.5, P < 0.001) and V̇e/V̇co2 slope (34.9 vs. 31.9, P = 0.02) were also higher. In addition, peak V̇o2 (14.9 vs. 17.9 ml·kg−1·min−1, P < 0.001) was lower. In the follow-up period (mean 897 days), cardiac and all-cause mortalities were significantly higher in those with hyperuricemia ( P = 0.006 and P = 0.004, respectively). In the multivariable Cox proportional hazard analyses after adjustment for several confounding factors including chronic kidney disease and use of diuretics, hyperuricemia was an independent predictor of all-cause mortality (hazard ratio 1.98, 95% confidence interval 1.036–3.793, P = 0.039). Hyperuricemia is associated with arterial stiffness, impaired exercise capacity, and high mortality in HFpEF.

P321A single factor related to left atrial pressure overload is useful for prognosis in elderly patients with heart failure with preserved ejection fraction: PURSUIT HFpEF study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Hoshida ◽  
T Watanabe ◽  
Y Shinoda ◽  
T Minamisaka ◽  
H Fukuoka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Left Atrial ◽  
Pressure Overload ◽  
Volume Index ◽  
Preserved Ejection Fraction ◽  
Single Factor ◽  
Cardiac Events ◽  
All Cause Mortality

Abstract Background E/e' and the ratio of diastolic elastance (Ed)/arterial elastance (Ea) = (E/e')/(0.9 × systolic blood pressure), indices of left atrial (LA) pressure overload, are elevated in elderly women with heart failure with preserved ejection fraction (HFpEF). The severity of diastolic dysfunction is assessed by a combination of several indices of LA volume and pressure overload. However, which overload is more important as a single factor for the prognosis of these patients remains undefined. Methods We enrolled patients with HFpEF showing sinus rhythm (n=145; left ventricular ejection fraction >50%; men/women, 56/89; mean age, 80.5 years). Blood examination and transthoracic echocardiography were performed before discharge. All-cause mortality and admission for cardiac events were evaluated after more than 1 year (mean, 370 days). Results The all-cause mortality rate was 11% (16/145). There were significant differences in age (p=0.005), serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level (p<0.001), LA volume index (p=0.018), E/e' (p=0.022), and Ed/Ea (p=0.016) between patients with and without all-cause mortality. When cutoff points for mortality by receiver operating characteristic curve analysis were examined, the area under the curve in LA volume index (0.564) was slightly smaller than that in age (0.734), NT-proBNP level (0.732), E/e' (0.695), and Ed/Ea (0.709). Kaplan-Meier survival analysis clearly showed that age >85 years (p<0.001), NT-proBNP level >888 pg/mL (p=0.003), E/e' >14.4 (p=0.020), and Ed/Ea >0.153 (p<0.001) were determinant factors for mortality. Cox hazard ratios were also significant in these indices (p=0.002, p=0.012, p=0.028, and p=0.001, respectively). In the case of all-cause mortality or admission for cardiac events, the results were nearly similar as those in the case of all-cause mortality. Ed/Ea exhibited a larger Cox hazard ratio for prognosis than E/e' in the multivariate analysis. Conclusions LA pressure overload compared to volume overload was a useful marker for prognosis in elderly patients with HFpEF. As a single index for LA pressure overload in noninvasive echocardiographic findings, Ed/Ea may be more suitable than E/e'.

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