scholarly journals Epicardial Adiposity in Relation to Metabolic Abnormality, Circulating Adipocyte FABP, and Preserved Ejection Fraction Heart Failure

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 397
Author(s):  
Jiun-Lu Lin ◽  
Kuo-Tzu Sung ◽  
Yau-Huei Lai ◽  
Chih-Hsuan Yen ◽  
Chun-Ho Yun ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Ejection Fraction ◽  
Renal Insufficiency ◽  
Strain Rates ◽  
Preserved Ejection Fraction ◽  
Fatty Acid Binding ◽  
Cardiometabolic Syndrome ◽  
The Metabolic Syndrome ◽  
New Onset

Epicardial adipose tissue (EAT) as a source of pro-inflammatory cytokines tightly linked to metabolic abnormalities. Data regarding the associations of EAT with adipocyte fatty acid-binding protein (A-FABP), a cytokine implicated in the cardiometabolic syndrome, might play an important part in mediating the association between EAT and cardiac structure/function in preserved ejection fraction heart failure (HFpEF). We conducted a prospective cohort study comprising 252 prospectively enrolled study participants classified as healthy (n = 40), high-risk (n = 161), or HFpEF (n = 51). EAT was assessed using echocardiography and compared between the three groups and related to A-FABP, cardiac structural/functional assessment utilizing myocardial deformations (strain/strain rates) and HF outcomes. EAT thickness was highest in participants with HFpEF (9.7 ± 1.7 mm) and those at high-risk (8.2 ± 1.5 mm) and lowest in healthy controls (6.4 ± 1.9 mm, p < 0.001). Higher EAT correlated with the presence of cardiometabolic syndrome, diabetes and renal insufficiency independent of BMI and waist circumference (pinteraction for all > 0.1), and was associated with reduced LV global longitudinal strain (GLS) and LV mass-independent systolic/diastolic strain rates (SRs/SRe) (all p < 0.05). Higher A-FABP levels were associated with greater EAT thickness (pinteraction > 0.1). Importantly, in the combined control cohort, A-FABP levels mediated the association between EAT and new onset HF. Excessive EAT is independently associated with the metabolic syndrome, renal insufficiency, and higher A-FABP levels. The association between EAT and new onset HF is mediated by A-FABP, suggesting a metabolic link between EAT and HF.

scholarly journals Opportunistic screening models for high-risk men and women to detect diastolic dysfunction and heart failure with preserved ejection fraction in the community

2018 ◽  
Vol 26 (6) ◽  
pp. 613-623 ◽  
Author(s):  
Aisha Gohar ◽  
Rogier F Kievit ◽  
Gideon B Valstar ◽  
Arno W Hoes ◽  
Evelien E Van Riet ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Men And Women ◽  
Ventricular Diastolic Dysfunction

Background The prevalence of undetected left ventricular diastolic dysfunction is high, especially in the elderly with comorbidities. Left ventricular diastolic dysfunction is a prognostic indicator of heart failure, in particularly of heart failure with preserved ejection fraction and of future cardiovascular and all-cause mortality. Therefore we aimed to develop sex-specific diagnostic models to enable the early identification of men and women at high-risk of left ventricular diastolic dysfunction with or without symptoms of heart failure who require more aggressive preventative strategies. Design Individual patient data from four primary care heart failure-screening studies were analysed (1371 participants, excluding patients classified as heart failure and left ventricular ejection fraction <50%). Methods Eleven candidate predictors were entered into logistic regression models to be associated with the presence of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in men and women separately. Internal-external cross-validation was performed to develop and validate the models. Results Increased age and β-blocker therapy remained as predictors in both the models for men and women. The model for men additionally consisted of increased body mass index, moderate to severe shortness of breath, increased pulse pressure and history of ischaemic heart disease. The models performed moderately and similarly well in men (c-statistics range 0.60–0.75) and women (c-statistics range 0.51–0.76) and the performance improved significantly following the addition of N-terminal pro b-type natriuretic peptide (c-statistics range 0.61–0.80 in women and 0.68–0.80 in men). Conclusions We provide an easy-to-use screening tool for use in the community, which can improve the early detection of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in high-risk men and women and optimise tailoring of preventive interventions.

scholarly journals Risk Prediction in Patients With Heart Failure With Preserved Ejection Fraction Using Gene Expression Data and Machine Learning

2021 ◽  
Vol 12 ◽  
Author(s):  
Liye Zhou ◽  
Zhifei Guo ◽  
Bijue Wang ◽  
Yongqing Wu ◽  
Zhi Li ◽  
...  
Keyword(s):  
Gene Expression ◽  
Machine Learning ◽  
Heart Failure ◽  
High Risk ◽  
Ejection Fraction ◽  
Gene Expression Data ◽  
Risk Groups ◽  
Support Vector ◽  
Expression Data ◽  
Preserved Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) has become a major health issue because of its high mortality, high heterogeneity, and poor prognosis. Using genomic data to classify patients into different risk groups is a promising method to facilitate the identification of high-risk groups for further precision treatment. Here, we applied six machine learning models, namely kernel partial least squares with the genetic algorithm (GA-KPLS), the least absolute shrinkage and selection operator (LASSO), random forest, ridge regression, support vector machine, and the conventional logistic regression model, to predict HFpEF risk and to identify subgroups at high risk of death based on gene expression data. The model performance was evaluated using various criteria. Our analysis was focused on 149 HFpEF patients from the Framingham Heart Study cohort who were classified into good-outcome and poor-outcome groups based on their 3-year survival outcome. The results showed that the GA-KPLS model exhibited the best performance in predicting patient risk. We further identified 116 differentially expressed genes (DEGs) between the two groups, thus providing novel therapeutic targets for HFpEF. Additionally, the DEGs were enriched in Gene Ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways related to HFpEF. The GA-KPLS-based HFpEF model is a powerful method for risk stratification of 3-year mortality in HFpEF patients.

Abstract 15220: Development of a Prediction Model for Atrial Fibrillation in Patients With Heart Failure and Preserved Ejection Fraction: Secondary Analysis of Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (topcat) Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Khaled Elkholey ◽  
Zain Ul Abideen Asad ◽  
Lampros Papadimitriou ◽  
Udho THADANI ◽  
Stavros Stavrakis
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
High Risk ◽  
Ejection Fraction ◽  
Risk Score ◽  
Cox Regression ◽  
Risk Groups ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Increased Risk

Background: Atrial fibrillation (AF) is a common comorbidity in heart failure with preserved ejection fraction (HFpEF) and portends an increased risk of cardiovascular events. We sought to identify predictors and develop a risk score of incident AF among patients with HFpEF. Methods: This was an exploratory, post-hoc analysis of the TOPCAT trial. Patients without known AF were included. Cox regression was used to identify independent predictors of incident AF. A risk score was derived from the weighed sum of the regression coefficients of each independent risk factor in the final model using Cox regression analysis. Results: A total of 2174 patients (mean age 67.0±9.4 years; female 55%) without known AF at baseline were included. During a median follow-up of 3 years, 102 (4.7%) patients developed new onset AF. Diabetes (HR=2.1, 95% CI 1.4-3.1; p=0.0002), peripheral arterial disease (HR=2.0, 95% CI 1.2-3.4; p=0.006), elevated (>144meq/dL) sodium (HR=2.1, 95% CI 1.4-3.1; p=0.0002) independently predicted incident AF, whereas current use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was protective (HR=0.61, 95% CI 0.38-0.99, p=0.048). Based on the simplified risk score which included these 4 variables, annualized AF incidence rates were 0.8%, 1.8%, and 3.6% in the low (score=0), intermediate (score=1 or 2), and high-risk (score >2) groups, respectively (log rank P<0.0001; Figure). Compared to the low risk group, the intermediate and high risk groups had a 2.5-fold and 5-fold increase in the risk of incident AF, respectively (HR=2.5, 95% CI 1.5-4.0, p=0.0003 and HR=4.9, 95% CI 2.9-9.4, p<0.0001, respectively). Model discrimination was good (c-statistic=0.67; 95% CI 0.61-0.72). Conclusions: A simplified risk score derived from clinical and laboratory characteristics predicts incident AF in patients with HFpEF and, upon further validation, may be used clinically for risk stratification or for AF screening in high risk groups. Figure

217Metabolomic profile of patients with new onset heart failure; more microvascular dysfunction in patients with preserved ejection fraction compared to reduced ejection fraction - the PREFERS Study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Hage ◽  
L Lofgren ◽  
F Michopoulos ◽  
R Nilsson ◽  
P Davidsson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Microvascular Dysfunction ◽  
Innate Immune ◽  
Plasma Metabolites ◽  
Preserved Ejection Fraction ◽  
Regional Study ◽  
Reduced Ejection Fraction ◽  
Dimethyl Arginine ◽  
New Onset

Abstract Background Heart failure with preserved (HFpEF) and reduced (HFrEF) ejection fraction are both associated with metabolic derangements which may have different pathophysiological implications Purpose To identify metabolites and pathways differentially altered with the potential to differentiate HFpEF from HFrEF. Methods In the PREFERS Stockholm study (Preserved and Reduced Ejection Fraction Epidemiological Regional Study) 121 endogenous plasma metabolites were assessed by targeted mass spectrometry. Partial Least Squares Discriminant Analysis (PLS-DA) was used to identify metabolites differentially altered in new onset HF divided into HFpEF (EF ≥50%, n=46) versus HFrEF (ÈF<40%, n=75) patients. Multivariable logistic regression was used to assess independent associations between HF group and selected metabolites, including sex, age and eGFR as co-variates. Results Compared to HFrEF, HFpEF patients were older; 77 vs 65 years (p<0.001), more often female 54% vs 46% (p=0.004) with hypertension 60% vs 40% (p<0.001) and diabetes 63% vs 37% (p=0.007), and lower NT-proBNP 720 vs 1295 ng/L (p=0.014) and eGFR 63 vs 72 mL/min/1.73 m2 (p<0.001). HFpEF patients had higher levels of hydroxyproline, cysteine, symmetric dimethyl arginine, alanine, kynurenine and acylcarinitines and lower levels of cAMP, lysoPC, L-carnitine, arginine, cGMP, serine and lactate (Figure). HFpEF was independently associated with reduced levels of cGMP (OR 0.98 [95% CI: 0.97–0.99; p=0.008]), serine (0.97 [0.95–1.00; 0.047]) and cAMP (0.97 [0.94–0.99; 0.009]). Figure 1 Conclusions In new onset HF patients, HFpEF was associated with decreased cGMP, cAMP and serine indicating increased oxidative stress, impaired innate immune function and myocardial hypertrophy. HFpEF patients displayed a distinct metabolic profile reflecting increased endothelial dysfunction, hypoxia, inflammation and myocardial fibrosis pointing towards more involvement of microvascular dysfunction compared to HFrEF. Acknowledgement/Funding Science for Life Laboratory–Astra Zeneca; Mölndal, Sweden collaborative grant No. 1377

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