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Gao Y, Chen S, Fu J, Wang C, Tang Y, Luo Y, Zhuo X, Chen X, Shen Y. Factors associated with risk analysis for asymptomatic left ventricular diastolic dysfunction in nondialysis patients with chronic kidney disease. Ren Fail 2024; 46:2353334. [PMID: 38785296 PMCID: PMC11133225 DOI: 10.1080/0886022x.2024.2353334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Heart failure (HF) constitutes a major determinant of outcome in chronic kidney disease (CKD) patients. The main pattern of HF in CKD patients is preserved ejection fraction (HFpEF), and left ventricular diastolic dysfunction (LVDD) is a frequent pathophysiological mechanism and specific preclinical manifestation of HFpEF. Therefore, exploring and intervention of the factors associated with risk for LVDD is of great importance in reducing the morbidity and mortality of cardiovascular disease (CVD) complications in CKD patients. We designed this retrospective cross-sectional study to collect clinical and echocardiographic data from 339 nondialysis CKD patients without obvious symptoms of HF to analyze the proportion of asymptomatic left ventricular diastolic dysfunction (ALVDD) and its related factors associated with risk by multivariate logistic regression analysis. Among the 339 nondialysis CKD patients, 92.04% had ALVDD. With the progression of CKD stage, the proportion of ALVDD gradually increased. The multivariate logistic regression analysis revealed that increased age (OR 1.237; 95% confidence interval (CI) 1.108-1.381, per year), diabetic nephropathy (DN) and hypertensive nephropathy (HTN) (OR 25.000; 95% CI 1.355-48.645, DN and HTN vs chronic interstitial nephritis), progression of CKD stage (OR 2.785; 95% CI 1.228-6.315, per stage), increased mean arterial pressure (OR 1.154; 95% CI 1.051-1.268, per mmHg), increased urinary protein (OR 2.825; 95% CI 1.484-5.405, per g/24 h), and low blood calcium (OR 0.072; 95% CI 0.006-0.859, per mmol/L) were factors associated with risk for ALVDD in nondialysis CKD patients after adjusting for other confounding factors. Therefore, dynamic monitoring of these factors associated with risk, timely diagnosis and treatment of ALVDD can delay the progression to symptomatic HF, which is of great importance for reducing CVD mortality, and improving the prognosis and quality of life in CKD patients.
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Affiliation(s)
- Yajuan Gao
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shengnan Chen
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jiani Fu
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Cui Wang
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yali Tang
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yongbai Luo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiaozhen Zhuo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xueying Chen
- Department of Nephrology, Shan Yang County People’s Hospital, Shangluo City, China
| | - Yan Shen
- Department of Nephrology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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2
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Kim YH, Her AY, Rha SW, Choi CU, Choi BG, Hyun SJ, Park S, Kang DO, Cho JR, Kim MW, Park JY, Park SH, Jeong MH. Three-year outcomes following non-ST-segment elevation myocardial infarction and new-generation drug-eluting stent implantation, stratified by patient age (under and over 75 years) and left ventricular ejection fraction: A prospective cohort study. Medicine (Baltimore) 2024; 103:e39606. [PMID: 39287301 PMCID: PMC11404945 DOI: 10.1097/md.0000000000039606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Due to limited published data, we investigated 3-year outcomes according to left ventricular ejection fraction (LVEF) in patients older and younger than 75 years with non-ST-segment elevation myocardial infarction (NSTEMI) who underwent successful newer-generation drug-eluting stent (DES) implantation. This research analyzed the data of 4558 patients (1032 older adults [≥75 years] and 3526 younger adults [<75 years]) from the Korea Acute MI Registry-NIH. We further divided the older group based on LVEF: heart failure (HF) with reduced EF (HFrEF, ≤40%, n = 196; group A), HF with mildly reduced EF (HFmrEF, 41-49%, n = 228; group B), and HF with preserved EF (HFpEF, ≥50%, n = 608; group C). Similarly, the younger group was divided into HFrEF (group D, n = 353), HFmrEF (group E, n = 577), and HFpEF (group F, n = 2596). The primary outcome was a composite of major adverse cardiac events (MACE) at 3 years, including all-cause death, recurrent MI, any repeat revascularization, or hospitalization for HF. MACE rates were highest in the HFrEF groups (A and D), followed by the HFmrEF groups (B and E), and lowest in the HFpEF groups (C and F) for both age groups. All-cause death, cardiac death (CD), all-cause death or MI, and hospitalization for HF rates were higher in group A than in groups B and C, and higher in group D than in groups E and F. Across all LVEF categories, MACE, all-cause death, CD, and non-CD, and all-cause death or MI rates were higher in the older group. This multicenter cohort study demonstrates that older patients have higher mortality rates compared to younger patients. Additionally, MACE rates were highest in the HFrEF group, followed by the HFmrEF group, and lowest in the HFpEF group across both age groups. Further research is needed to confirm these findings.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Cheol Ung Choi
- Department of Biomedical Laboratory Science, Honam University, Gwangju, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Su Jin Hyun
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Min-Woong Kim
- Department of Cardiology, Changwon Hanmaeum Hospital, Hanyang University College of Medicine, Changwon, Republic of Korea
| | - Ji Young Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Center, Gwangju Veterans Hospital, Gwangju, Republic of Korea
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Shahim A, Donal E, Hage C, Oger E, Savarese G, Persson H, Haugen-Löfman I, Ennezat PV, Sportouch-Dukhan C, Drouet E, Daubert JC, Linde C, Lund LH. Rates and predictors of cardiovascular and non-cardiovascular outcomes in heart failure with preserved ejection fraction. ESC Heart Fail 2024. [PMID: 39075721 DOI: 10.1002/ehf2.14928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/24/2024] [Accepted: 06/14/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS The detailed sub-categories of death and hospitalization, and the impact of comorbidities on cause-specific outcomes, remain poorly understood in heart failure (HF) with preserved ejection fraction (HFpEF). We sought to evaluate rates and predictors of cardiovascular (CV) and non-CV outcomes in HFpEF. METHODS The Karolinska-Rennes study was a bi-national prospective observational study designed to characterize HFpEF (ejection fraction ≥45%). Patients were followed for cause-specific death and hospitalization. Baseline characteristics were pre-selected based on clinical relevance and potential eligibility criteria for HFpEF trials. The associations between characteristics and cause-specific outcomes were assessed with univariable and multivariable Cox regressions. RESULTS Five hundred thirty-nine patients [56% females; median (inter-quartile range) age 79 (72-84) years; NT-proBNP/BNP 2448 (1290-4790)/429 (229-805) ng/L] were included. Over 1196 patient-years follow-up [median (min, max) 744 days (13-1959)], there were 159 (29%) deaths (13 per 100 patient-years: CV 5.1 per 100, dominated by HF 3.9 per 100; and non-CV 5.8 per 100, dominated by cancer, 2.3 per 100). There were 723 hospitalizations in 338 patients (63%; 60 per 100 patient-years: CV 33 per 100, dominated by HF 17 per 100; and non-CV 27 per 100, dominated by lung disease 5 per 100). Higher age and natriuretic peptides, lower serum natraemia and NYHA class III-IV were independent predictors of CV death; lower serum natraemia, anaemia and stroke of non-CV death; and anaemia and lower serum natraemia of non-CV death or hospitalizations. There were no apparent predictors of CV death or hospitalization. CONCLUSIONS In a clinical cohort hospitalized and diagnosed with HFpEF, death and hospitalization rates were roughly similar for CV and non-CV causes. CV deaths were predicted primarily by severity of HF; non-CV deaths primarily by anaemia and prior stroke. Lower serum sodium predicted both. Hospitalizations were difficult to predict.
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Affiliation(s)
- Angiza Shahim
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erwan Donal
- Département de Cardiologie & CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France
- LTSI, Université Rennes 1, INSERM, Rennes, France
| | - Camilla Hage
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Emmanuel Oger
- Pharmacoepidemiology and Health Services Research, REPERES, University of Rennes, Rennes, France
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Persson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Ida Haugen-Löfman
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Jean-Claude Daubert
- Département de Cardiologie & CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France
- LTSI, Université Rennes 1, INSERM, Rennes, France
| | - Cecilia Linde
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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Huang X, Li Y, Zheng H, Xu Y. Sudden Cardiac Death Risk Stratification in Heart Failure With Preserved Ejection Fraction. Cardiol Rev 2024:00045415-990000000-00279. [PMID: 38814094 DOI: 10.1097/crd.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) poses a significant clinical challenge, with sudden cardiac death (SCD) emerging as one of the leading causes of mortality. Despite advancements in cardiovascular medicine, predicting and preventing SCD in HFpEF remains complex due to multifactorial pathophysiological mechanisms and patient heterogeneity. Unlike heart failure with reduced ejection fraction, where impaired contractility and ventricular remodeling predominate, HFpEF pathophysiology involves heavy burden of comorbidities such as hypertension, obesity, and diabetes. Diverse mechanisms, including diastolic dysfunction, microvascular abnormalities, and inflammation, also contribute to distinct disease and SCD risk profiles. Various parameters such as clinical factors and electrocardiogram features have been proposed in SCD risk assessment. Advanced imaging modalities and biomarkers offer promise in risk prediction, yet comprehensive risk stratification models specific to HFpEF ar0e lacking. This review offers recent evidence on SCD risk factors and discusses current therapeutic strategies aimed at reducing SCD risk in HFpEF.
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Affiliation(s)
- Xu Huang
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Fujimoto Y, Matsue Y. Seeking ways to address non-cardiovascular death in patients with heart failure. Eur J Heart Fail 2024; 26:1160-1162. [PMID: 38695319 DOI: 10.1002/ejhf.3280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Yudai Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Huttelmaier MT, Münsterer S, Morbach C, Sahiti F, Scholz N, Albert J, Gabel A, Angermann C, Ertl G, Frantz S, Störk S, Fischer TH. Activated rate-response is associated with increased mortality risk in cardiac device carriers with acute heart failure. PLoS One 2024; 19:e0302321. [PMID: 38635729 PMCID: PMC11025974 DOI: 10.1371/journal.pone.0302321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/01/2024] [Indexed: 04/20/2024] Open
Abstract
AIMS This study investigated whether an activated R-mode in patients carrying a cardiac implantable electronic device (CIED) is associated with worse prognosis during and after an episode of acutely decompensated heart failure (AHF). METHODS Six hundred and twenty-three patients participating in an ongoing prospective cohort study that phenotypes and follows patients admitted for AHF were studied. We compared CIED carriers with activated R-mode stimulation (CIED-R) to CIED carriers not in R-mode (CIED-0) and patients without CIEDs (no-CIED). The independent impact of R-mode activation on 12-month all-cause death was examined using uni- and multivariable Cox proportional hazards regression taking into account potential confounders, and hazard ratios (HR) with their 95% confidence intervals (CI) were reported. RESULTS Mean heart rate on admission was lower in CIED-R (n = 37, 16% women) vs. CIED-0 (n = 64, 23% women) or no-CIED (n = 511, 43% women): 70 bpm vs. 80 bpm or 82 bpm; both p<0.001. In-hospital mortality was similar across groups, but age- and sex-adjusted all-cause 12-month mortality risk was differentially affected by R-mode activation; CIED-R vs. CIED-0: HR 2.44, 95%CI 1.25-4.74; CIED-R vs. no-CIED: HR 2.61, 95%CI 1.59-4.29. These effects persisted after multivariable adjustment for potential confounders. Within CIED-R, mortality risk was similar in patients with pacemakers vs. ICDs and in subgroups with left ventricular ejection fraction (LVEF) <50% vs. ≥50%. CONCLUSION In patients admitted with AHF, R-mode stimulation was associated with a significantly increased 12-month mortality risk. Our findings shed new light on "admission heart rate" as a potentially treatable target in AHF. Our data are compatible with the concept that chronotropic incompetence contributes to an adverse outcome in these patients and may not be adequately treated through accelerometer-based R-mode stimulation.
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Affiliation(s)
| | - Sascha Münsterer
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Floran Sahiti
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Nina Scholz
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Judith Albert
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Alexander Gabel
- Helmholtz Institute for RNA-based Infection Research (HIRI), Helmholtz Centre for Infection Research (HZI), Würzburg, Germany
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - Christiane Angermann
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Georg Ertl
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Stefan Störk
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Dept. Clinical Research & Epidemiology, Comprehensive Heart Failure Centre Würzburg, Würzburg, Germany
| | - Thomas H. Fischer
- Dept. of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
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Chen Z, Shi A, Dong H, Laptseva N, Chen F, Yang J, Guo X, Duru F, Chen K, Chen L. Prognostic implications of premature ventricular contractions and non-sustained ventricular tachycardia in light-chain cardiac amyloidosis. Europace 2024; 26:euae063. [PMID: 38466042 DOI: 10.1093/europace/euae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/06/2024] [Indexed: 03/12/2024] Open
Abstract
AIMS Premature ventricular contractions (PVC) and non-sustained ventricular tachycardia (NSVT) are commonly observed in light chain cardiac amyloidosis (AL-CA), but their association with prognosis is still unclear. We aimed to evaluate the prognostic value of PVCs and NSVT in patients with moderate-to-advanced AL-CA. METHODS AND RESULTS We retrospectively included patients with AL-CA at modified 2004 Mayo stages II-IIIb between February 2014 and December 2020. Twenty-four-hour Holter recordings were assessed on admission. The outcomes included (i) new onset of adverse ventricular arrhythmia (VA) or sudden cardiac death (SCD) and (ii) cardiac death during follow-up. Of the 143 patients studied (60.41 ± 11.06 years, male 64.34%), 132 (92.31%) had presence of PVC, and 50 (34.97%) had NSVT on Holter. Twelve (8.4%) patients died in hospital and 131 patients were followed up (median 24.4 months), among whom 71 patients had cardiac death, and 15 underwent adverse VA/SCD. NSVT [hazard ratio (HR): 13.57, 95% confidence interval (CI): 3.06-60.18, P < 0.001], log-transformed PVC counts (HR: 1.46, 95%CI: 1.15-1.86, P = 0.002) and PVC burden (HR: 1.43 95%CI:1.14-1.80, P = 0.002) were predictive of new onset of adverse VA/SCD. The highest tertile of PVC counts (HR: 2.33, 95%CI: 1.27-4.28, P = 0.006) and PVC burden (HR: 2.58, 95%CI: 1.42-4.69, P = 0.002), rather than NSVT (HR: 1.16, 95%CI: 0.67-1.98, P = 0.603), was associated with cardiac death. Higher PVC counts/burden provided incremental value on modified 2004 Mayo stage in predicting cardiac death, with C index increasing from 0.681 to 0.712 and 0.717, respectively (P values <0.05). CONCLUSION PVC count, burden, and NSVT significantly correlated with adverse VA/SCD during follow-up in patients with AL-CA. Higher PVC counts/burdens added incremental value for predicting cardiac death.
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Affiliation(s)
- Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 10037, China
| | - Anteng Shi
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Hongbin Dong
- Department of Radiology, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 10037, China
| | - Natallia Laptseva
- Division of Heart Failure, Department of Cardiology, University Heart Center, Rämistrasse 100, Zurich CH-8091, Switzerland
| | - Feng Chen
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 10037, China
| | - Jiandu Yang
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 10037, China
| | - Xiaogang Guo
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 10037, China
| | - Firat Duru
- Center for Translational and Experimental Cardiology, University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
- Division of Cardiac Arrhythmias, Department of Cardiology, University Heart Center, Rämistrasse 100, Zurich CH-8091, Switzerland
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 10037, China
| | - Liang Chen
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China
- Center for Translational and Experimental Cardiology, University of Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
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8
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Kadowaki H, Akazawa H, Shindo A, Ueda T, Ishida J, Komuro I. Shared and Reciprocal Mechanisms Between Heart Failure and Cancer - An Emerging Concept of Heart-Cancer Axis. Circ J 2024; 88:182-188. [PMID: 38092383 DOI: 10.1253/circj.cj-23-0838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Epidemiological evidence of increased risks of cancer in heart failure (HF) patients and HF in cancer patients has suggested close relationships between the pathogenesis of both diseases. Indeed, HF and cancer share common risk factors, including aging and unhealthy lifestyles, and underlying mechanisms, including activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, chronic inflammation, and clonal hematopoiesis of indeterminate potential. Mechanistically, HF accelerates cancer development and progression via secreted factors, so-called cardiokines, and epigenetic remodeling of bone marrow cells into an immunosuppressive phenotype. Reciprocally, cancer promotes HF via cachexia-related wasting and metabolic remodeling in the heart, and possibly via cancer-derived extracellular vesicles influencing myocardial structure and function. The novel concept of the "heart-cancer axis" will help in our understanding of the shared and reciprocal relationships between HF and cancer, and provide innovative diagnostic and therapeutic approaches for both diseases.
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Affiliation(s)
- Hiroshi Kadowaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hiroshi Akazawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Akito Shindo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Tomomi Ueda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Junichi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo
- International University of Health and Welfare
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9
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Tsutsui H, Momomura SI, Saito Y, Ito H, Yamamoto K, Sakata Y, Ohishi T, Kumar P, Kitamura T. Long-Term Treatment With Sacubitril/Valsartan in Japanese Patients With Chronic Heart Failure and Reduced Ejection Fraction - Open-Label Extension of the PARALLEL-HF Study. Circ J 2023; 88:43-52. [PMID: 37635080 DOI: 10.1253/circj.cj-23-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND The PARALLEL-HF study assessed the efficacy and safety of sacubitril/valsartan vs. enalapril in Japanese patients with chronic heart failure with reduced ejection fraction (HFrEF). This open-label extension (OLE) assessed long-term safety with sacubitril/valsartan. METHODS AND RESULTS This study enrolled 150 patients who received sacubitril/valsartan 50 or 100 mg, b.i.d., in addition to optimal background heart failure (HF) therapy. A dose level of sacubitril/valsartan 200 mg, b.i.d., was targeted by Week 8. At OLE baseline, higher concentrations of B-type natriuretic peptide (BNP) and urine cGMP, and lower concentrations of N-terminal pro B-type natriuretic peptide (NT-proBNP), were observed in the sacubitril/valsartan core group (patients who received sacubitril/valsartan in both the core and extension study) than in the enalapril core group (patients who received enalapril in the core study and were then transitioned to sacubitril/valsartan). The mean exposure to study drug was 98.9%. There was no trend of worsening of HF at Month 12. No obvious changes in cardiac biomarkers were observed, whereas BNP and urine cGMP increased and NT-proBNP decreased in the enalapril core group, which was evident at Weeks 2-4 and sustained to Month 12. CONCLUSIONS Long-term sacubitril/valsartan at doses up to 200 mg, b.i.d., has a positive risk-benefit profile; it was safe and well tolerated in Japanese patients with chronic HFrEF.
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Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | | | | | - Hiroshi Ito
- Department of General Internal Medicine 3, Kawasaki Medical School
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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10
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Kapelios CJ, Shahim B, Lund LH, Savarese G. Epidemiology, Clinical Characteristics and Cause-specific Outcomes in Heart Failure with Preserved Ejection Fraction. Card Fail Rev 2023; 9:e14. [PMID: 38020671 PMCID: PMC10680134 DOI: 10.15420/cfr.2023.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/15/2023] [Indexed: 12/01/2023] Open
Abstract
Heart failure (HF) is a global pandemic affecting 64 million people worldwide. HF with preserved ejection fraction (HFpEF) has traditionally received less attention than its main counterpart, HF with reduced ejection fraction (HFrEF). The incidence and prevalence of HFpEF show geographic variation and are increasing over time, soon expected to surpass those of HFrEF. Morbidity and mortality rates of HFpEF are considerable, albeit lower than those of HFrEF. This review focuses on the burden of HFpEF, providing contemporary data on epidemiology, clinical characteristics and comorbidities, cause-specific outcomes, costs and pharmacotherapy.
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Affiliation(s)
- Chris J Kapelios
- Department of Cardiovascular Medicine, University of Utah Health Sciences CenterSalt Lake City, UT, US
| | - Bahira Shahim
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
| | - Gianluigi Savarese
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
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11
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Saito I, Yamagishi K, Kokubo Y, Yatsuya H, Iso H, Sawada N, Inoue M, Tsugane S. Impact of Cardiovascular Disease on the Death Certificate Diagnosis of Heart Failure, Ischemic Heart Disease, and Cerebrovascular Disease - The Japan Public Health Center-Based Prospective Study. Circ J 2023; 87:1196-1202. [PMID: 36948630 DOI: 10.1253/circj.cj-22-0805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND There is considerable interest in the trending discrepancy between ischemic heart disease (IHD) and heart failure (HF) in vital statistics. Clinically, acute myocardial infarction (AMI) and stroke are closely associated with HF, but their contribution to HF as the underlying cause of death (UCD) is unclear. METHODS AND RESULTS In 1990 and 1992-1993, we enrolled a total of 140,420 residents of Japanese nationality (aged 40-69 years) from 11 public health center areas. We prospectively examined the occurrence of cardiovascular disease (CVD), including AMI, sudden cardiac death within 1 h (SCD), and stroke, and analyzed the 14,375 participants without a history of CVD at baseline who died during the 20-year follow-up. A time-dependent Cox proportional hazards model was used to estimate hazard ratios and the population attributable fraction (PAF) of AMI, AMI+SCD, stroke, and CVD for deaths due to HF, IHD, and cerebrovascular disease as the UCD, adjusted for individuals' lifestyles and comorbid conditions. The PAF of AMI for HF deaths was 2.4% (95% confidence interval [CI] 1.7-2.9%), which increased to 12.0% (95% CI 11.6-12.2%) for AMI+SCD. The PAF of CVD-attributed HF deaths was estimated to be 17.6% (95% CI 15.9-18.9%). CONCLUSIONS HF as the UCD was partly explained by CVD. The data imply that most HF deaths reported in vital statistics may be associated with underlying causes other than CVD.
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Affiliation(s)
- Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicin
| | - Hiroyasu Iso
- Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
- The Institute for Global Health Policy Research, National Center for Global Health and Medicine
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control
| | - Manami Inoue
- Division of Cohort Research, National Cancer Center Institute for Cancer Control
- Division of Prevention, National Cancer Center Institute for Cancer Control
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
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12
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Lin MS, Wang PC, Lin MH, Kuo TY, Lin YS, Chen TH, Tsai MH, Yang YH, Lin CL, Chung CM, Chu PH. Acute heart failure with mildly reduced ejection fraction and myocardial infarction: a multi-institutional cohort study. BMC Cardiovasc Disord 2023; 23:272. [PMID: 37221514 DOI: 10.1186/s12872-023-03286-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Little research has been done on ischemic outcomes related to left ventricular ejection fraction (EF) in acute decompensated heart failure (ADHF). METHODS A retrospective cohort study was conducted between 2001 and 2021 using the Chang Gung Research Database. ADHF Patients discharged from hospitals between January 1, 2005, and December 31, 2019. Cardiovascular (CV) mortality and heart failure (HF) rehospitalization are the primary outcome components, along with all-cause mortality, acute myocardial infarction (AMI) and stroke. RESULTS A total of 12,852 ADHF patients were identified, of whom 2,222 (17.3%) had HFmrEF, the mean (SD) age was 68.5 (14.6) years, and 1,327 (59.7%) were males. In comparison with HFrEF and HFpEF patients, HFmrEF patients had a significant phenotype comorbid with diabetes, dyslipidemia, and ischemic heart disease. Patients with HFmrEF were more likely to experience renal failure, dialysis, and replacement. Both HFmrEF and HFrEF had similar rates of cardioversion and coronary interventions. There was an intermediate clinical outcome between HFpEF and HFrEF, but HFmrEF had the highest rate of AMI (HFpEF, 9.3%; HFmrEF, 13.6%; HFrEF, 9.9%). The AMI rates in HFmrEF were higher than those in HFpEF (AHR, 1.15; 95% Confidence Interval, 0.99 to 1.32) but not in HFrEF (AHR, 0.99; 95% Confidence Interval, 0.87 to 1.13). CONCLUSION Acute decompression in patients with HFmrEF increases the risk of myocardial infarction. The relationship between HFmrEF and ischemic cardiomyopathy, as well as optimal anti-ischemic treatment, requires further research on a large scale.
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Affiliation(s)
- Ming-Shyan Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Po-Chang Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Ting-Yu Kuo
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Keelung, Taiwan
| | - Ming-Horng Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Chang-Min Chung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, No.5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305, Taiwan.
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital Chang Gung University College of Medicine, Taipei, Taiwan.
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13
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Kanzawa Y, Ishimaru N, Shimokawa T, Kinami S, Imanaka Y. Role of hospitalists in Japan for heart failure in the elderly: single center retrospective cohort study. Hosp Pract (1995) 2023:1-6. [PMID: 36927225 DOI: 10.1080/21548331.2023.2192574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE In Japan, the benefits of hospitalist physician-led care after heart failure have not been sufficiently demonstrated. We evaluated quality of care by the general internal medicine hospitalist (GIM-H) system for patients after acute heart failure and compared it with care by cardiologists. METHODS This retrospective cohort study enrolled adult patients from within a two-year period who were admitted to our institution for heart failure. Primary outcome measures were medico-economic indicators: length of hospital stay and medical costs. Secondary outcomes included readmission within 30 days of discharge, death within 30 days of admission, rate of prescription of ACEI/ARB and beta-blockers for heart failure with reduced left ventricular ejection fraction, and the percentage of patients receiving bespoke written treatment plans after discharge. This was thought to represent quality of heart failure-specific care. Outcomes between the groups were compared by adjusting for background factors using a propensity score. RESULTS We enrolled 404 patients, and 81 were assigned to each group after matching (mean age: 86 years, female: 64.2%, mean left ventricular ejection fraction: 53.2%). The GIM-H-treated group had a significantly shorter hospital stay (13.7 days vs. 21.8 days, P < 0.001), a significantly lower total medical cost (618,805 JPY vs. 867,857 JPY, P < 0.05) but a higher medical cost per day (48,010 JPY vs 42,813 JPY, P < 0.05) than the cardiologist-treated group. Other indicators were not significantly different. CONCLUSIONS : GIM-H physicians in Japan are suggested to be useful and effective in care of patients with heart failure. The hospitalist system may positively impact the health economic outcomes of such patients.
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Affiliation(s)
- Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical Center, Hyogo, Japan
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Japan
| | - Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Hyogo, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Hyogo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Japan
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14
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Nakamaru R, Shiraishi Y, Sandhu AT, Heidenreich PA, Shoji S, Kohno T, Takei M, Nagatomo Y, Nakano S, Kohsaka S, Yoshikawa T. Cardiovascular vs. non-cardiovascular deaths after heart failure hospitalization in young, older, and very old patients. ESC Heart Fail 2022; 10:673-684. [PMID: 36436825 PMCID: PMC9871708 DOI: 10.1002/ehf2.14245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS The long-term outcome in patients with heart failure (HF) after hospitalization may vary substantially depending on their age and left ventricular ejection fraction (LVEF). We aimed to assess the relative rates of cardiovascular death (CVD) and non-CVD based on the age and how the rates differ under the updated LVEF classification system. METHODS AND RESULTS Consecutively registered hospitalized patients with HF (N = 3558; 39.7% women with a mean age of 73.9 ± 13.3 years) were followed for a median of 2 (interquartile range, 0.8-3.1) years. The CVDs and non-CVDs were evaluated based on age [young (<65 years), older (65-84 years), and very old (≥85 years)] and LVEF classification [HF with preserved EF (HFpEF; LVEF ≥50%) and non-HFpEF (LVEF <50%)]. The adverse clinical events were adjudicated independently by a central committee. Overall, 1505 (42.3%) had HFpEF [young: n = 182 (12.1%), older: n = 894 (59.4%), very old: n = 429 (28.5%)], and 2053 (57.7%) had non-HFpEF [young: n = 575 (28.0%), older: n = 1159 (56.5%), very old: n = 319 (15.5%)]. During the follow-up, the crude incidence of all-cause death was higher in non-HFpEF than in HFpEF across all age groups (non-HFpEF vs. HFpEF, young: 10.4% vs. 5.5%, log-rank P = 0.10; older: 26.6% vs. 20.9%, log-rank P = 0.002; very old: 36.7% vs. 31.7%, log-rank P = 0.043). CVDs accounted for more than half of all deaths in non-HFpEF (young 65.0%, older 64.2%, and very old 55.6%), whereas the proportion of CVDs remained less than half in HFpEF (young 50.0%, older 41.2%, very old 38.2%). HF readmission was associated with subsequent all-cause death in non-HFpEF [hazard ratio (HR): 1.72, 95% confidence interval (CI): 1.41-2.09, P < 0.001], but not in HFpEF (HR: 1.12, 95% CI: 0.87-1.43, P = 0.39). CONCLUSIONS The probability of a non-CVD increases in both LVEF categories with advancing age, but that it is greater in the HFpEF category. The findings indicate that mitigating CV-related outcomes alone may be insufficient for treating HF in older population, particularly in the HFpEF category.
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Affiliation(s)
- Ryo Nakamaru
- Department of CardiologyKeio University School of MedicineTokyoJapan,Department of Healthcare Quality AssessmentThe University of TokyoTokyoJapan
| | | | - Alexander T. Sandhu
- Division of Cardiology, Department of MedicineStanford UniversityStanfordCAUSA
| | - Paul A. Heidenreich
- Division of Cardiology, Department of MedicineStanford UniversityStanfordCAUSA
| | - Satoshi Shoji
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Takashi Kohno
- Department of Cardiovascular MedicineKyorin University Faculty of MedicineTokyoJapan
| | - Makoto Takei
- Department of CardiologySaiseikai Central HospitalTokyoJapan
| | - Yuji Nagatomo
- Department of CardiologyNational Defense Medical CollegeTokorozawaJapan
| | - Shintaro Nakano
- Department of CardiologySaitama Medical University, International Medical CenterSaitamaJapan
| | - Shun Kohsaka
- Department of CardiologyKeio University School of MedicineTokyoJapan
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15
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Safabakhsh S, Al-Shaheen A, Swiggum E, Mielniczuk L, Tremblay-Gravel M, Laksman Z. Arrhythmic Sudden Cardiac Death in Heart Failure With Preserved Ejection Fraction: Mechanisms, Genetics, and Future Directions. CJC Open 2022; 4:959-969. [PMID: 36444369 PMCID: PMC9700220 DOI: 10.1016/j.cjco.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is an increasingly recognized disorder. Many clinical trials have failed to demonstrate benefit in patients with HFpEF but have recognized alarming rates of sudden cardiac death (SCD). Genetic testing has become standard in the workup of patients with otherwise unexplained cardiac arrest, but the genetic architecture of HFpEF, and the overlap of a genetic predisposition to HFpEF and arrhythmias, is poorly understood. An understanding of the genetics of HFpEF and related SCD has the potential to redefine and generate novel diagnostic, prognostic, and therapeutic tools. In this review, we examine recent pathophysiological and clinical advancements in our understanding of HFpEF, which reinforce the heterogeneity of the condition. We also discuss data describing SCD events in patients with HFpEF and review the current literature on genetic underpinnings of HFpEF. Mechanisms of arrhythmogenesis which may lead to SCD in this population are also explored. Lastly, we outline several areas of promise for experimentation and clinical trials that have the potential to further advance our understanding of and contribute to improved clinical care of this patient population.
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Affiliation(s)
- Sina Safabakhsh
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Elizabeth Swiggum
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Mielniczuk
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Zachary Laksman
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Hoshida S, Hikoso S, Shinoda Y, Tachibana K, Minamisaka T, Shunsuke T, Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Yamada T, Yasumura Y, Nakatani D, Sakata Y. Time-sensitive prognostic performance of an afterload-integrated diastolic index in heart failure with preserved ejection fraction: a prospective multicentre observational study. BMJ Open 2022; 12:e059614. [PMID: 35948381 PMCID: PMC9379494 DOI: 10.1136/bmjopen-2021-059614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The prognostic significance of an afterload-integrated diastolic index, the ratio of diastolic elastance (Ed) to arterial elastance (Ea) (Ed/Ea=[E/e']/[0.9×systolic blood pressure]), is valid for 1 year after discharge in older patients with heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the association with changes in Ed/Ea from enrolment to 1 year and prognosis thereafter in patients with HFpEF. SETTING A prospective, multicentre observational registry of collaborating hospitals in Osaka, Japan. PARTICIPANTS We enrolled 659 patients with HFpEF hospitalised for acute decompensated heart failure (men/women: 296/363). Blood tests and transthoracic echocardiography were performed before discharge and at 1 year after. PRIMARY OUTCOME MEASURES All-cause mortality and/or re-admission for heart failure were evaluated after discharge. RESULTS High Ed/Ea assessed before discharge was a significant prognostic factor during the first, but not the second, year after discharge in all-cause mortality or all-cause mortality and/or re-admission for heart failure. When re-analysis was performed using the value of Ed/Ea at 1 year after discharge, high Ed/Ea was significant for the prognosis during the second year for both end points (p=0.012 and p=0.033, respectively). The poorest mortality during 1‒2 years after enrolment was observed in those who showed a worsening Ed/Ea during the first year associated with larger left ventricular mass index and reduced left ventricular ejection fraction. In all-cause mortality and/or re-admission for heart failure, the event rate during 1‒2 years was highest in those with persistently high Ed/Ea even after 1 year. CONCLUSIONS Time-sensitive prognostic performance of Ed/Ea, an afterload-integrated diastolic index, was observed in older patients with HFpEF. TRIAL REGISTRATION NUMBER UMIN000021831.
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Affiliation(s)
- Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukinori Shinoda
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
| | - Koichi Tachibana
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
| | - Tomoko Minamisaka
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
| | - Tamaki Shunsuke
- Department of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | | | - Akito Nakagawa
- Division of Cardiovascular Medicine, Amagasaki Chuo Hospital, Amagasaki, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, Kawanishi, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yoshio Yasumura
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Amagasaki, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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17
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Tolento Cortes L, Hong L. Heart failure with preserved ejection fraction—Out with the old and out with the new? Front Cardiovasc Med 2022; 9:943572. [PMID: 35966527 PMCID: PMC9363838 DOI: 10.3389/fcvm.2022.943572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
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18
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Fan S, Hu Y. Role of m6A Methylation in the Occurrence and Development of Heart Failure. Front Cardiovasc Med 2022; 9:892113. [PMID: 35811741 PMCID: PMC9263194 DOI: 10.3389/fcvm.2022.892113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
N6-methyladenosine (m6A) RNA methylation is one of the most common epigenetic modifications in RNA nucleotides. It is known that m6A methylation is involved in regulation, including gene expression, homeostasis, mRNA stability and other biological processes, affecting metabolism and a variety of biochemical regulation processes, and affecting the occurrence and development of a variety of diseases. Cardiovascular disease has high morbidity, disability rate and mortality in the world, of which heart failure is the final stage. Deeper understanding of the potential molecular mechanism of heart failure and exploring more effective treatment strategies will bring good news to the sick population. At present, m6A methylation is the latest research direction, which reveals some potential links between epigenetics and pathogenesis of heart failure. And m6A methylation will bring new directions and ideas for the prevention, diagnosis and treatment of heart failure. The purpose of this paper is to review the physiological and pathological mechanisms of m6A methylation that may be involved in cardiac remodeling in heart failure, so as to explain the possible role of m6A methylation in the occurrence and development of heart failure. And we hope to help m6A methylation obtain more in-depth research in the occurrence and development of heart failure.
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19
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Al-Omary MS, Majeed T, Al-Khalil H, Sugito S, Clapham M, Ngo DTM, Attia JR, Boyle AJ, Sverdlov AL. Patient characteristics, short-term and long-term outcomes after incident heart failure admissions in a regional Australian setting. Open Heart 2022; 9:e001897. [PMID: 35641098 PMCID: PMC9157343 DOI: 10.1136/openhrt-2021-001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/11/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS This study aims to (1) define the characteristics of patients with a first admission for heart failure (HF), stratified by type (reduced (HFrEF) vs preserved (HFpEF) ejection fraction) in a regional Australian setting; (2) compare the outcomes in terms of mortality and rehospitalisation and (3) assess adherence to the treatment guidelines. METHODS We identified all index hospitalisations with HF to John Hunter Hospital and Tamworth Rural Referral Hospital in the Hunter New England Local Health District over a 12 months. We used the recent Australian HF guidelines to classify HFrEF and HFpEF and assess adherence to guideline-directed therapy. The primary outcome of the study was to compare short-term (1 year) and long-term all-cause mortality and the composite of all-cause hospitalisation or all-cause mortality of patients with HFrEF and HFpEF. RESULTS There were 664 patients who had an index HF admission to John Hunter and Tamworth hospitals in 2014. The median age was 80 years, 47% were female and 22 (3%) were Aboriginal. In terms of HF type, 29% had HFrEF, 37% had HFpEF, while the remainder (34%) did not have an echocardiogram within 1 year of admission and could not be classified. The median follow-up was 3.3 years. HFrEF patients were predominantly male (64%) and in 48% the aetiology was ischaemic heart disease. The 1-year all-cause mortality was 23% in HFpEF subgroup and 29% in HFrEF subgroup (p=0.15). Five-year mortality was 61% in HFpEF and HFrEF patients. Of the HFrEF patients, only 61% were on renin-angiotensin-aldosterone blockers, 74% were on β-blockers and 39% were on aldosterone antagonist. CONCLUSION HF patients are elderly and about evenly split between HFrEF and HFpEF. In this regional cohort, both HF types are associated with similar 1-year and 5-year mortality following incident HF hospitalisation. Echocardiography and guideline-directed therapies were underused.
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Affiliation(s)
- Mohammed S Al-Omary
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tazeen Majeed
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Hafssa Al-Khalil
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Stuart Sugito
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Mathew Clapham
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Doan T M Ngo
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John R Attia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Andrew J Boyle
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Aaron L Sverdlov
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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20
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Nishimoto Y, Kato T, Morimoto T, Taniguchi R, Yaku H, Inuzuka Y, Tamaki Y, Yamamoto E, Yoshikawa Y, Kitai T, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Su K, Kawato M, Seko Y, Inoko M, Toyofuku M, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Shizuta S, Ono K, Kuwahara K, Ozasa N, Sato Y, Kimura T. Public assistance in patients with acute heart failure: a report from the KCHF registry. ESC Heart Fail 2022; 9:1920-1930. [PMID: 35289117 PMCID: PMC9065832 DOI: 10.1002/ehf2.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/11/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Aims There is a scarcity of data on the post‐discharge prognosis in acute heart failure (AHF) patients with a low‐income but receiving public assistance. The study sought to evaluate the differences in the clinical characteristics and outcomes between AHF patients receiving public assistance and those not receiving public assistance. Methods and results The Kyoto Congestive Heart Failure registry was a physician‐initiated, prospective, observational, multicentre cohort study enrolling 4056 consecutive patients who were hospitalized due to AHF for the first time between October 2014 and March 2016. The present study population consisted of 3728 patients who were discharged alive from the index AHF hospitalization. We divided the patients into two groups, those receiving public assistance and those not receiving public assistance. After assessing the proportional hazard assumption of public assistance as a variable, we constructed multivariable Cox proportional hazard models to estimate the risk of the public assistance group relative to the no public assistance group. There were 218 patients (5.8%) receiving public assistance and 3510 (94%) not receiving public assistance. Patients in the public assistance group were younger, more frequently had chronic coronary artery disease, previous heart failure hospitalizations, current smoking, poor medical adherence, living alone, no occupation, and a lower left ventricular ejection fraction than those in the no public assistance group. During a median follow‐up of 470 days, the cumulative 1 year incidences of all‐cause death and heart failure hospitalizations after discharge did not differ between the public assistance group and no public assistance group (13.3% vs. 17.4%, P = 0.10, and 28.3% vs. 23.8%, P = 0.25, respectively). After adjusting for the confounders, the risk of the public assistance group relative to the no public assistance group remained insignificant for all‐cause death [hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.69–1.32; P = 0.84]. Even after taking into account the competing risk of all‐cause death, the adjusted risk within 180 days in the public assistance group relative to the no public assistance group remained insignificant for heart failure hospitalizations (HR, 0.93; 95% CI, 0.64–1.34; P = 0.69), while the adjusted risk beyond 180 days was significant (HR, 1.56; 95% CI, 1.07–2.29; P = 0.02). Conclusions The AHF patients receiving public assistance as compared with those not receiving public assistance had no significant excess risk for all‐cause death at 1 year after discharge or a heart failure hospitalization within 180 days after discharge, while they did have a significant excess risk for heart failure hospitalizations beyond 180 days after discharge. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) and https://upload.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238)
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Affiliation(s)
- Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga Medical Center for Adults, Shiga, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Nara, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Shiga, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, Shiga, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takafumi Kawai
- Department of Cardiology, Kishiwada City Hospital, Osaka, Japan
| | - Akihiro Komasa
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan.,Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Kanae Su
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Mitsunori Kawato
- Department of Cardiology, Nishi-Kobe Medical Center, Hyogo, Japan
| | - Yuta Seko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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21
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Perfil clínico y causas de muerte de los pacientes con insuficiencia cardíaca atendidos en una unidad especializada de Cardiología según su fracción de eyección. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Liang M, Bian B, Yang Q. Characteristics and long-term prognosis of patients with reduced, mid-range, and preserved ejection fraction: A systemic review and meta-analysis. Clin Cardiol 2022; 45:5-17. [PMID: 35043472 PMCID: PMC8799045 DOI: 10.1002/clc.23754] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Patients with heart failure (HF) have a poor prognosis and are categorized by ejection fraction. We performed a meta-analysis to compare baseline characteristics and long-term outcomes of patients with heart failure with reduced (HFrEF), mid-range (HFmrEF), and preserved ejection fraction (HFpEF). METHODS AND RESULTS A total of 27 prospective studies were included. Patients with HFpEF were older and had a higher proportion of females, hypertension, diabetes, and insufficient neuroendocrine antagonist treatments, while patients with HFrEF and HFmrEF had a higher prevalence of coronary heart disease and chronic kidney disease. After more than 1-year of follow-up, all-cause mortality was significantly lower in patients with HFmrEF 9388/25 042 (37.49%) than those with HFrEF 39 333/90 023 (43.69%) and HFpEF 24 828/52 492 (47.30%) (p < .001). Cardiovascular mortality was lowest in patients with HFpEF 1130/9904 (11.41%), highest in patients with HFrEF 3419/16 277 (21.07%) mainly coming from HF death and sudden cardiac death, and middle in patients with HFmrEF 699/5171 (13.52%) and the non-cardiovascular mortality was on the contrary. Subgroup analysis showed that in high-risk patients with atrial fibrillation, the all-cause mortality of HFpEF was significantly higher than both HFrEF and HFmrEF (p < .001). HF hospitalization was lowest in patients with HFmrEF 1822/5285 (34.47%), highest in patients with HFrEF 12 607/28 590 (44.10%) and middle in patients with HFpEF 8686/22 763 (38.16%) and the composite of all-cause mortality and HF hospitalization was also observed similar results. CONCLUSIONS In summary, patients with HFmrEF had the lowest incidence of all-cause mortality and HF hospitalization, while the highest all-cause mortality and HF hospitalization rates were HFpEF and HFrEF patients, respectively.
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Affiliation(s)
- Min Liang
- Department of CardiologyTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Bo Bian
- Department of CardiologyTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Qing Yang
- Department of CardiologyTianjin Medical University General HospitalTianjinPeople's Republic of China
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23
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Mandai S, Ando F, Mori T, Susa K, Iimori S, Naito S, Sohara E, Uchida S, Fushimi K, Rai T. Burden of kidney disease on the discrepancy between reasons for hospital admission and death: An observational cohort study. PLoS One 2021; 16:e0258846. [PMID: 34731197 PMCID: PMC8565775 DOI: 10.1371/journal.pone.0258846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022] Open
Abstract
Background Physicians have long noted a substantial discrepancy between the reasons for hospital admission and ultimate causes of death, particularly among older adults or patients with complex underlying diseases. However, objective data on this phenomenon are lacking. We aimed to examine the risk of in-hospital death caused by a reason other than the original reason for hospitalization and its association with underlying kidney disease in a nationwide inpatient database. Methods In this retrospective cohort study, we studied 639,556 Japanese adults who died in the hospital from 2012 to 2015, using data from Japan’s Diagnosis Procedure Combination database. We analyzed the discrepancy rate between reasons for hospital admission and death and associated factors using the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes and seven related categories. Results Among non-chronic kidney disease (CKD) (590,551), CKD (24,708), and end-stage kidney disease (ESKD) (24,297) patients, the median age was 77 years (interquartile range [IQR]: 67–84 years), 83 years (IQR: 75–88), and 75 years (IQR: 67–81), and 25.7%, 30.3%, and 41.6% died from a reason other than the original reason for hospitalization, respectively. Multivariate logistic regression analyses determined CKD/ESKD as the predominant risk factor for this discrepancy, rather than older age, male sex, obesity, and other comorbidities. Sankey diagrams that presented diagnostic changes from hospital admission to death revealed multiple wider segments connecting to different disease classifications, particularly to congestive and septic death in CKD and ESKD patients, respectively. Death owing to another disease classification led to an increase in the median length of hospital stay by 5–7 days and to a 1.3-–1.4-fold increase in medical costs across the populations. Conclusions A substantial proportion of patients with CKD and ESKD died during hospitalization for a reason other than their original reason for admission, leading to increased length of hospital stay and cost.
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Affiliation(s)
- Shintaro Mandai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
- * E-mail: (SM); (TM)
| | - Fumiaki Ando
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Koichiro Susa
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Soichiro Iimori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Tatemitsu Rai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
- * E-mail: (SM); (TM)
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24
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Minami Y, Kikuchi N, Shiga T, Suzuki A, Shoda M, Hagiwara N. Incidence and predictors of early and late sudden cardiac death in hospitalized Japanese patients with new-onset systolic heart failure. J Arrhythm 2021; 37:1148-1155. [PMID: 34621413 PMCID: PMC8485812 DOI: 10.1002/joa3.12618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/22/2021] [Accepted: 08/07/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with heart failure (HF) and low left ventricular ejection fraction (LVEF) are at high risk of sudden cardiac death (SCD). Optimal HF treatment can improve LVEF and reduce the risk of SCD. The aim of this study was to evaluate the incidence and predictors of SCD in Japanese patients with new-onset systolic HF and to investigate factors that affect LVEF improvement. METHODS We retrospectively studied 174 consecutive hospitalized patients with new-onset HF and LVEF ≤35% (median age, 66 years; men, 71%). The primary outcome was a composite of SCD, sustained ventricular arrhythmias, and appropriate implantable cardioverter-defibrillator therapy. RESULTS The cumulative rates of meeting of the primary outcome at 3, 12, and 36 months after discharge were 3.9%, 8.1%, and 10.5%, respectively. Atrial fibrillation was a significant predictor of the primary outcome within 12 months after discharge (odds ratio, 5.87; 95% confidence interval [CI], 1.60-21.57). Among 104 patients who completed follow-up echocardiography within 12 months after discharge, changes in LVEF were inversely associated with SCD (odds ratio/1% increase, 0.78; 95% CI, 0.65-0.93). A QRS duration <130 ms and a B-type natriuretic peptide level <170 pg/mL were predictors of LVEF improvement to >35% (odds ratio, 3.69; 95% CI, 1.15-11.77; odds ratio, 3.19; 95% CI, 1.33-7.69, respectively). CONCLUSIONS Our results showed a high incidence of meeting of the primary outcome within 12 months after discharge in hospitalized patients with new-onset systolic HF. An improved LVEF may reduce the risk of late SCD.
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Affiliation(s)
- Yoshiaki Minami
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Noriko Kikuchi
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Tsuyoshi Shiga
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
- Department of Clinical Pharmacology and Therapeutics The Jikei University School of Medicine Tokyo Japan
| | - Atsushi Suzuki
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Morio Shoda
- Clinical Research Division for Heart Rhythm Management Tokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
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25
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Kusunose K, Okushi Y, Okayama Y, Zheng R, Nakai M, Sumita Y, Ise T, Yamaguchi K, Yagi S, Fukuda D, Yamada H, Soeki T, Wakatsuki T, Sata M. Use of Echocardiography and Heart Failure In-Hospital Mortality from Registry Data in Japan. J Cardiovasc Dev Dis 2021; 8:jcdd8100124. [PMID: 34677193 PMCID: PMC8536984 DOI: 10.3390/jcdd8100124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Echocardiography requires a high degree of skill on the part of the examiner, and the skill may be more improved in larger volume centers. This study investigated trends and outcomes associated with the use and volume of echocardiographic exams from a real-world registry database of heart failure (HF) hospitalizations. Methods: This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). A first analysis was performed to assess the trend of echocardiographic examinations between 2012 and 2016. A secondary analysis was performed to assess whether echocardiographic use was associated with in-hospital mortality in 2015. Results: During this period, the use of echocardiography grew at an average annual rate of 6%. Patients with echocardiography had declining rates of hospital mortality, and these trends were associated with high hospitalization costs. In the 2015 sample, a total of 52,832 echocardiograms were examined, corresponding to 65.6% of all HF hospital admissions for that year. We found that the use and volume of echocardiography exams were associated with significantly lower odds of all-cause hospital mortality in heart failure (adjusted odds ratio (OR): 0.48 for use of echocardiography and 0.78 for the third tertile; both p < 0.001). Conclusions: The use of echocardiography was associated with decreased odds of hospital mortality in HF. The volumes of echocardiographic examinations were also associated with hospital mortality.
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Affiliation(s)
- Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
- Correspondence: ; Tel.: +81-88-633-7851; Fax: +81-88-633-7894
| | - Yuichiro Okushi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Yoshihiro Okayama
- Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima 770-8503, Japan;
| | - Robert Zheng
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.N.); (Y.S.)
| | - Yoko Sumita
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan; (M.N.); (Y.S.)
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8503, Japan;
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; (Y.O.); (R.Z.); (T.I.); (K.Y.); (S.Y.); (D.F.); (T.S.); (T.W.); (M.S.)
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26
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Kawase Y, Kato T, Morimoto T, Hata R, Murai R, Tada T, Katoh H, Kadota K, Yamamoto E, Yaku H, Inuzuka Y, Tamaki Y, Ozasa N, Yoshikawa Y, Iguchi M, Nagao K, Sato Y, Kuwahara K, Kimura T. Admission systolic blood pressure as a prognostic predictor of acute decompensated heart failure: A report from the KCHF registry. PLoS One 2021; 16:e0253999. [PMID: 34214124 PMCID: PMC8253441 DOI: 10.1371/journal.pone.0253999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/18/2021] [Indexed: 01/19/2023] Open
Abstract
Background Admission systolic blood pressure has emerged as a predictor of postdischarge outcomes of patients with acute decompensated heart failure; however, its validity in varied clinical conditions of this patient subset is unclear. The aim of this study was to further explore the prognostic value of admission systolic blood pressure in patients with acute decompensated heart failure. Methods The Kyoto Congestive Heart Failure (KCHF) registry is a prospective, observational, multicenter cohort study enrolling consecutive patients with acute decompensated heart failure from 19 participating hospitals in Japan. Clinical characteristics at baseline and prognosis were examined by the following value range of admission systolic blood pressure: <100, 100–139, and ≥140 mmHg. The primary outcome measure was defined as all-cause death after discharge. Subgroup analyses were done for prior hospitalization for heart failure, hypertension, left ventricular ejection fraction, and medications at discharge. We excluded patients with acute coronary syndrome or insufficient data. Results We analyzed 3564 patients discharged alive out of 3804 patients hospitalized for acute decompensated heart failure. In the entire cohort, lower admission systolic blood pressure was associated with poor outcomes (1-year cumulative incidence of all-cause death: <100 mmHg, 26.8%; 100–139 mmHg, 20.2%; and ≥140 mmHg, 15.1%, p<0.001). The magnitude of the effect of lower admission systolic blood pressure for postdischarge all-cause death was greater in patients with prior hospitalization for heart failure, heart failure with reduced left ventricular ejection fraction, and β-blocker use at discharge than in those without. Conclusions Admission systolic blood pressure is useful for postdischarge risk stratification in patients with acute decompensated heart failure. Its magnitude of the effect as a prognostic predictor may differ across clinical conditions of patients.
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Affiliation(s)
- Yuichi Kawase
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Takeshi Morimoto
- Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Reo Hata
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Takeshi Tada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Harumi Katoh
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasutaka Inuzuka
- Cardiovascular Medicine, Shiga General Hospital, Moriyama, Japan
| | - Yodo Tamaki
- Department of Cardiology, Tenri Hospital, Nara, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical, Kyoto, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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27
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Giamouzis G, Dimos A, Xanthopoulos A, Skoularigis J, Triposkiadis F. Left ventricular hypertrophy and sudden cardiac death. Heart Fail Rev 2021; 27:711-724. [PMID: 34184173 DOI: 10.1007/s10741-021-10134-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) is among the leading causes of death worldwide, and it remains a public health problem, as it involves young subjects. Current guideline-directed risk stratification for primary prevention is largely based on left ventricular (LV) ejection fraction (LVEF), and preventive strategies such as implantation of a cardiac defibrillator (ICD) are justified only for documented low LVEF (i.e., ≤ 35%). Unfortunately, only a small percentage of primary prevention ICDs, implanted on the basis of a low LVEF, will deliver life-saving therapies on an annual basis. On the other hand, the vast majority of patients that experience SCD have LVEF > 35%, which is clamoring for better understanding of the underlying mechanisms. It is mandatory that additional variables be considered, both independently and in combination with the EF, to improve SCD risk prediction. LV hypertrophy (LVH) is a strong independent risk factor for SCD regardless of the etiology and the severity of symptoms. Concentric and eccentric LV hypertrophy, and even earlier concentric remodeling without hypertrophy, are all associated with increased risk of SCD. In this paper, we summarize the physiology and physiopathology of LVH, review the epidemiological evidence supporting the association between LVH and SCD, briefly discuss the mechanisms linking LVH with SCD, and emphasize the need to evaluate LV geometry as a potential risk stratification tool regardless of the LVEF.
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Affiliation(s)
- Grigorios Giamouzis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Apostolos Dimos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece. .,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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Palazzuoli A, Beltrami M. Are HFpEF and HFmrEF So Different? The Need to Understand Distinct Phenotypes. Front Cardiovasc Med 2021; 8:676658. [PMID: 34095263 PMCID: PMC8175976 DOI: 10.3389/fcvm.2021.676658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
Traditionally, patients with heart failure (HF) are divided according to ejection fraction (EF) threshold more or <50%. In 2016, the ESC guidelines introduced a new subgroup of HF patients including those subjects with EF ranging between 40 and 49% called heart failure with midrange EF (HFmrEF). This group is poorly represented in clinical trials, and it includes both patients with previous HFrEF having a good response to therapy and subjects with initial preserved EF appearance in which systolic function has been impaired. The categorization according to EF has recently been questioned because this variable is not really a representative of the myocardial contractile function and it could vary in relation to different hemodynamic conditions. Therefore, EF could significantly change over a short-term period and its measurement depends on the scan time course. Finally, although EF is widely recognized and measured worldwide, it has significant interobserver variability even in the most accredited echo laboratories. These assumptions imply that the same patient evaluated in different periods or by different physicians could be classified as HFmrEF or HFpEF. Thus, the two HF subtypes probably subtend different responses to the underlying pathophysiological mechanisms. Similarly, the adaptation to hemodynamic stimuli and to metabolic alterations could be different for different HF stages and periods. In this review, we analyze similarities and dissimilarities and we hypothesize that clinical and morphological characteristics of the two syndromes are not so discordant.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital University of Siena, Siena, Italy
| | - Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Florence, Italy
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Tsukamoto K, Suzuki A, Shiga T, Arai K, Hagiwara N. Changes in the Left Ventricular Ejection Fraction and Outcomes in Hospitalized Heart Failure Patients with Mid-range Ejection Fraction: A Prospective Observational Study. Intern Med 2021; 60:1509-1518. [PMID: 33328410 PMCID: PMC8188035 DOI: 10.2169/internalmedicine.6388-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective Current clinical guidelines have proposed heart failure (HF) with mid-range ejection fraction (HFmrEF), defined as a left ventricular ejection fraction (LVEF) of 40-49%, but the proportion and prognosis of patients transitioning toward HF with a reduced LVEF (LVEF <40%, HFrEF) or HF with a preserved LVEF (LVEF ≥50%, HFpEF) are not fully clear. The present study prospectively evaluated the changes in the LVEF one year after discharge and the outcomes of hospitalized patients with HFmrEF. Methods We prospectively studied 259 hospitalized patients with HFmrEF who were discharged alive at our institutions between 2015 and 2019. Among them, 202 patients with HFmrEF who underwent echocardiography at the one-year follow-up were included in this study. Patient characteristics, echocardiographic data and all-cause death were collected. Results Eighty-seven (43%) patients transitioned to HFpEF (improved group), and 35 (17%) transitioned to HFrEF (worsened group). During a median follow-up of 33 months, 27 (13%) patients died. After adjustment, patients in the worsened group had an increased risk of all-cause mortality compared with those in the improved group [hazard ratio 7.02, 95% confidence interval (CI) 1.13-43.48]. The baseline LVEF (per 1% decrease) and tricuspid annular plane systolic excursion (per 1 mm decrease) were independent predictors of the worsened LVEF category (odds ratio 2.13, 95% CI 1.25-3.63 and odds ratio 1.31, 95% CI 1.01-1.70, respectively). Conclusion Our study showed that a worsened LVEF one year after discharge was associated with a poor prognosis in hospitalized patients with HFmrEF.
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Affiliation(s)
- Kei Tsukamoto
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Japan
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, Japan
| | - Kotaro Arai
- Department of Cardiology, Tokyo Women's Medical University, Japan
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30
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Long-term prognostic value of myocardin expression levels in non-ischemic dilated cardiomyopathy. Heart Vessels 2021; 36:1841-1847. [PMID: 33983455 DOI: 10.1007/s00380-021-01869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
The mortality of patients with non-ischemic dilated cardiomyopathy (NIDCM) remains substantial. We evaluated gene expression levels of myocardin, an early cardiac gene, in the peripheral blood cells of NIDCM patients as a prognostic biomarker in their long-term outcome and mortality from congestive HF (CHF). We retrospectively analyzed 101 consecutives optimally treated NIDCM patients of Cretan origin who were enrolled from the HF clinic of our hospital from November 2005 to December 2008. Our patient data were either taken from their medical files or recorded during visits to the HF unit or hospitalizations. Follow-up was carried out by telephone interview and by accessing information from general practitioners and cardiologists in private practice. The median follow-up period was 8 years (mean follow-up 7 ± 3.4 years). The overall mortality during follow-up was 61.4%, while mortality due to congestive heart failure (CHF) was 49.5%. Higher CHF and all-cause mortality were observed in patients with myocardin levels < 14.26 (p < 0.001 for both CHF and all-cause mortality). A multivariate Cox regression analysis showed that myocardin level of expression had independent significant prognostic value for the risk of death from CHF (HR 14.5, 95% confidence interval (CI) 5.3-39) in those patients. Peripheral blood cells gene expression of myocardin, an early myocardial marker, may serve as prognostic biomarkers of the long-term outcome of patients with NIDCM. Our findings open new prospects in the risk stratification of these patients.
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31
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Yaku H, Seko Y, Kato T, Morimoto T, Kimura T. Prognostic Implications of Residual Pleural Effusions at Discharge in Patients with Acute Decompensated Heart Failure. Eur J Intern Med 2021; 85:133-135. [PMID: 33277139 DOI: 10.1016/j.ejim.2020.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Hidenori Yaku
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeshi Morimoto
- Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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32
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Shiba M, Kato T, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, Ozasa N, Seko Y, Yamamoto E, Yoshikawa Y, Kitai T, Yamashita Y, Iguchi M, Nagao K, Kawase Y, Morinaga T, Toyofuku M, Furukawa Y, Ando K, Kadota K, Sato Y, Kuwahara K, Kimura T. Prognostic value of reduction in left atrial size during a follow-up of heart failure: an observational study. BMJ Open 2021; 11:e044409. [PMID: 33608404 PMCID: PMC7898840 DOI: 10.1136/bmjopen-2020-044409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The association between sequential changes in left atrial diameter (LAD) and prognosis in heart failure (HF) remains to be elucidated. The present study aimed to investigate the link between reduction in LAD and clinical outcomes in patients with HF. DESIGN A multicentre prospective cohort study. SETTING This study was nested from the Kyoto Congestive Heart Failure registry including consecutive patients admitted for acute decompensated heart failure (ADHF) in 19 hospitals throughout Japan. PARTICIPANTS The current study population included 673 patients with HF who underwent both baseline and 6-month follow-up echocardiography with available paired LAD data. We divided them into two groups: the reduction in the LAD group (change <0 mm) (n=398) and the no-reduction in the LAD group (change ≥0 mm) (n=275). PRIMARY AND SECONDARY OUTCOMES The primary outcome measure was a composite of all-cause death or hospitalisation for HF during 180 days after 6-month follow-up echocardiography. The secondary outcome measures were defined as the individual components of the primary composite outcome measure and a composite of cardiovascular death or hospitalisation for HF. RESULTS The cumulative 180-day incidence of the primary outcome measure was significantly lower in the reduction in the LAD group than in the no-reduction in the LAD group (13.3% vs 22.2%, p=0.002). Even after adjusting 15 confounders, the lower risk of reduction in LAD relative to no-reduction in LAD for the primary outcome measure remained significant (HR 0.59, 95% CI 0.36 to 0.97 p=0.04). CONCLUSION Patients with reduction in LAD during follow-up after ADHF hospitalisation had a lower risk for a composite endpoint of all-cause death or HF hospitalisation, suggesting that the change of LAD might be a simple and useful echocardiographic marker during follow-up.
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Affiliation(s)
- Masayuki Shiba
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hidenori Yaku
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yasutaka Inuzuka
- Cardiovascular Medicine, Shiga General Hospital, Moriyama, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Tenri, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nishimoto Y, Kato T, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, Yamamoto E, Yoshikawa Y, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Su K, Kawato M, Seko Y, Inoko M, Toyofuku M, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Shizuta S, Ono K, Kuwahara K, Ozasa N, Sato Y, Kimura T. C-reactive protein at discharge and 1-year mortality in hospitalised patients with acute decompensated heart failure: an observational study. BMJ Open 2020; 10:e041068. [PMID: 33376169 PMCID: PMC7778780 DOI: 10.1136/bmjopen-2020-041068] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To examine the association of a high C-reactive protein (CRP) level at discharge from an acute decompensated heart failure (ADHF) hospitalisation with the 1-year clinical outcomes. DESIGN A post-hoc subanalysis of a prospective cohort study of patients hospitalised for ADHF (using the Kyoto Congestive Heart Failure (KCHF) registry) between October 2014 and March 2016 with a 1-year follow-up. SETTING A physician-initiated multicentre registry enrolled consecutive hospitalised patients with ADHF for the first time at 19 secondary and tertiary hospitals in Japan. PARTICIPANTS Among the 4056 patients enrolled in the KCHF registry, the present study population consisted of 2618 patients with an available CRP value both on admission and at discharge and post-discharge clinical follow-up data. We divided the patients into two groups, those with a high CRP level (>10 mg/L) and those with a low CRP level (≤10 mg/L) at discharge from the index hospitalisation. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was all-cause death after discharge from the index hospitalisation. The secondary outcome measures were heart failure hospitalisations, cardiovascular death and non-cardiovascular death. RESULTS The high CRP group and low CRP group included 622 patients (24%) and 1996 patients (76%), respectively. During a median follow-up period of 468 days, the cumulative 1-year incidence of the primary outcome was significantly higher in the high CRP group than low CRP group (24.1% vs 13.9%, log-rank p<0.001). Even after a multivariable analysis, the excess mortality risk in the high CRP group relative to the low CRP group remained significant (HR, 1.43; 95% CI, 1.19 to 1.71; p<0.001). The excess mortality risk was consistent regardless of the clinically relevant subgroup factors. CONCLUSIONS A high CRP level (>10 mg/L) at discharge from an ADHF hospitalisation was associated with an excess mortality risk at 1 year. TRIAL REGISTRATION DETAILS: https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238).
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Affiliation(s)
- Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Tenri, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Kyoto, Japan
| | | | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, Hikone, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takafumi Kawai
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Akihiro Komasa
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kanae Su
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Mitsunori Kawato
- Department of Cardiology, Nishi-Kobe Medical Center, Kobe, Japan
| | - Yuta Seko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, Yamamoto E, Yoshikawa Y, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Kawato M, Seko Y, Shiba M, Toyofuku M, Furukawa Y, Ando K, Kadota K, Sato Y, Kuwahara K, Kimura T. Association of an increase in serum albumin levels with positive 1-year outcomes in acute decompensated heart failure: A cohort study. PLoS One 2020; 15:e0243818. [PMID: 33370299 PMCID: PMC7769473 DOI: 10.1371/journal.pone.0243818] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite the prognostic importance of hypoalbuminemia, the prognostic implication of a change in albumin levels has not been fully investigated during hospitalization in patients with acute decompensated heart failure (ADHF). METHODS Using the data from the Kyoto Congestive Heart Failure registry on 3160 patients who were discharged alive for acute heart failure hospitalization and in whom the change in albumin levels was calculated at discharge, we evaluated the association with an increase in serum albumin levels from admission to discharge and clinical outcomes by a multivariable Cox hazard model. The primary outcome measure was a composite of all-cause death or hospitalization for heart failure. FINDINGS Patients with increased albumin levels (N = 1083, 34.3%) were younger and less often had smaller body mass index and renal dysfunction than those with no increase in albumin levels (N = 2077, 65.7%). Median follow-up was 475 days with a 96% 1-year follow-up rate. Relative to the group with no increase in albumin levels, the lower risk of the increased albumin group remained significant for the primary outcome measure (hazard ratio: 0.78, 95% confidence interval: 0.69-0.90: P = 0.0004) after adjusting for confounders including baseline albumin levels. When stratified by the quartiles of baseline albumin levels, the favorable effect of increased albumin was more pronounced in the lower quartiles of albumin levels, but without a significant interaction effect (interaction P = 0.49). CONCLUSIONS Independent of baseline albumin levels, an increase in albumin during index hospitalization was associated with a lower 1-year risk for a composite of all-cause death and hospitalization in patients with acute heart failure.
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Affiliation(s)
- Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Yasutaka Inuzuka
- Department of Cardiovascular Medicine, Shiga General Hospital, Shiga, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Nara, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Shiga, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, Shiga, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takafumi Kawai
- Department of Cardiology, Kishiwada City Hospital, Osaka, Japan
| | - Akihiro Komasa
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Mitsunori Kawato
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
| | | | - Masayuki Shiba
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Hoshida S, Hikoso S, Shinoda Y, Tachibana K, Minamisaka T, Tamaki S, Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Yamada T, Yasumura Y, Nakatani D, Sakata Y. Diastolic index as a short-term prognostic factor in heart failure with preserved ejection fraction. Open Heart 2020; 7:openhrt-2020-001469. [PMID: 33334859 PMCID: PMC7747540 DOI: 10.1136/openhrt-2020-001469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE During follow-up time, the value of prognostic factors may change, especially in the elderly patients, and the altered extent may affect the prognosis. We aimed to clarify the significance of the ratio of diastolic elastance (Ed) to arterial elastance (Ea), (Ed/Ea=(E/e')/(0.9×systolic blood pressure)), an afterload-integrated diastolic index, in relation to follow-up periods and other laboratory factors, on the prognosis of elderly patients with heart failure with preserved ejection fraction (HFpEF). METHODS We studied 552 HFpEF patients hospitalised for acute decompensated heart failure (men/women: 255/297). Blood testing and transthoracic echocardiography were performed before discharge. The primary endpoint was all-cause mortality. RESULTS During a median follow-up of 508 days, 88 patients (men/women: 39/49) had all-cause mortality. During the first year after discharge, Ed/Ea (p=0.045) was an independent prognostic factor in association with albumin (p<0.001) and N-terminal pro-brain natriuretic peptide (NT-proBNP, p=0.005) levels after adjusting for age and sex in the multivariate Cox hazard analysis. However, at 1 to 3 years after discharge, no other significant prognostic factors, except for albumin level (p=0.046), were detected. In the subgroup analysis, albumin, but not NT-proBNP level, showed a significant interaction with Ed/Ea for prognosis (p=0.047). CONCLUSION The prognostic significance of a haemodynamic parameter such as Ed/Ea may be valid only during a short-term period, but that of albumin was persisting during the entire follow-up period in the elderly patients. The clinical significance of prognostic factors in HFpEF patients may differ according to the follow-up period.
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Affiliation(s)
- Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukinori Shinoda
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Koichi Tachibana
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Tomoko Minamisaka
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
| | - Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | | | - Akito Nakagawa
- Division of Cardiovascular Medicine, Amagasaki Chuo Hospital, Amagasaki, Hyogo, Japan.,Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, Kawanishi, Hyogo, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yoshio Yasumura
- Division of Cardiovascular Medicine, Amagasaki Chuo Hospital, Amagasaki, Hyogo, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Shen L, Jhund PS, Anand IS, Carson PE, Desai AS, Granger CB, Køber L, Komajda M, McKelvie RS, Pfeffer MA, Solomon SD, Swedberg K, Zile MR, McMurray JJV. Developing and validating models to predict sudden death and pump failure death in patients with heart failure and preserved ejection fraction. Clin Res Cardiol 2020; 110:1234-1248. [PMID: 33301080 PMCID: PMC8318942 DOI: 10.1007/s00392-020-01786-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/24/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sudden death (SD) and pump failure death (PFD) are leading modes of death in heart failure and preserved ejection fraction (HFpEF). Risk stratification for mode-specific death may aid in patient enrichment for new device trials in HFpEF. METHODS Models were derived in 4116 patients in the Irbesartan in Heart Failure with Preserved Ejection Fraction trial (I-Preserve), using competing risks regression analysis. A series of models were built in a stepwise manner, and were validated in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved and Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trials. RESULTS The clinical model for SD included older age, men, lower LVEF, higher heart rate, history of diabetes or myocardial infarction, and HF hospitalization within previous 6 months, all of which were associated with a higher SD risk. The clinical model predicting PFD included older age, men, lower LVEF or diastolic blood pressure, higher heart rate, and history of diabetes or atrial fibrillation, all for a higher PFD risk, and dyslipidaemia for a lower risk of PFD. In each model, the observed and predicted incidences were similar in each risk subgroup, suggesting good calibration. Model discrimination was good for SD and excellent for PFD with Harrell's C of 0.71 (95% CI 0.68-0.75) and 0.78 (95% CI 0.75-0.82), respectively. Both models were robust in external validation. Adding ECG and biochemical parameters, model performance improved little in the derivation cohort but decreased in validation. Including NT-proBNP substantially increased discrimination of the SD model, and simplified the PFD model with marginal increase in discrimination. CONCLUSIONS The clinical models can predict risks for SD and PFD separately with good discrimination and calibration in HFpEF and are robust in external validation. Adding NT-proBNP further improved model performance. These models may help to identify high-risk individuals for device intervention in future trials. CLINICAL TRIAL REGISTRATION I-Preserve: ClinicalTrials.gov NCT00095238; TOPCAT: ClinicalTrials.gov NCT00094302; CHARM-Preserved: ClinicalTrials.gov NCT00634712.
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Affiliation(s)
- Li Shen
- Department of Medicine, Hangzhou Normal University, Hangzhou, 310003, China.,British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Inder S Anand
- Department of Medicine, University of Minnesota Medical School and VA Medical Center, Minneapolis, USA
| | - Peter E Carson
- Department of Cardiology, Washington VA Medical Center, Washington, DC, USA
| | - Akshay S Desai
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Lars Køber
- Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Michel Komajda
- Department of Cardiology, Hospital Saint Joseph, Paris, France
| | | | - Marc A Pfeffer
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Scott D Solomon
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Michael R Zile
- Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
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Kario K, Hoshide S, Mizuno H, Kabutoya T, Nishizawa M, Yoshida T, Abe H, Katsuya T, Fujita Y, Okazaki O, Yano Y, Tomitani N, Kanegae H. Nighttime Blood Pressure Phenotype and Cardiovascular Prognosis: Practitioner-Based Nationwide JAMP Study. Circulation 2020; 142:1810-1820. [PMID: 33131317 PMCID: PMC7643792 DOI: 10.1161/circulationaha.120.049730] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Supplemental Digital Content is available in the text. Ambulatory and home blood pressure (BP) monitoring parameters are better predictors of cardiovascular events than are office BP monitoring parameters, but there is a lack of robust data and little information on heart failure (HF) risk. The JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) used the same ambulatory BP monitoring device, measurement schedule, and diary-based approach to data processing across all study centers and determined the association between both nocturnal hypertension and nighttime BP dipping patterns and the occurrence of cardiovascular events, including HF, in patients with hypertension.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Hiroyuki Mizuno
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Masafumi Nishizawa
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Tetsuro Yoshida
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Hideyasu Abe
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Tomohiro Katsuya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Yumiko Fujita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Osamu Okazaki
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Yuichiro Yano
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
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- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
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Arsenos P, Gatzoulis KA, Doundoulakis I, Dilaveris P, Antoniou C, Stergios S, Sideris S, Ilias S, Tousoulis D. Arrhythmic risk stratification in heart failure mid-range ejection fraction patients with a non-invasive guiding to programmed ventricular stimulation two-step approach. J Arrhythm 2020; 36:890-898. [PMID: 33024466 PMCID: PMC7532265 DOI: 10.1002/joa3.12416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although some post myocardial infarction (post-MI) and dilated cardiomyopathy (DCM) patients with mid-range ejection fraction heart failure (HFmrEF/40%-49%) face an increased risk for arrhythmic sudden cardiac death (SCD), current guidelines do not recommend an implantable cardiac defibrilator (ICD). We risk stratified hospitalized HFmrEF patients for SCD with a combined non-invasive risk factors (NIRFs) guiding to programmed ventricular stimulation (PVS) two-step approach. METHODS Forty-eight patients (male = 83%, age = 64 ± 14 years, LVEF = 45 ± 5%, CAD = 69%, DCM = 31%) underwent a NIRFs screening first-step with electrocardiogram (ECG), SAECG, Echocardiography and 24-hour ambulatory ECG (AECG). Thirty-two patients with presence of one of three NIRFs (SAECG ≥ 2 positive criteria for late potentials, ventricular premature beats ≥ 240/24 hours, and non-sustained ventricular tachycardia [VT] episode ≥ 1/24 hours) were further investigated with PVS. Patients were classified as either low risk (Group 1, n = 16, NIRFs-), moderate risk (Group 2, n = 18, NIRFs+/PVS-), and high risk (Group 3, n = 14, NIRFs+/PVS+). All in Group 3 received an ICD. RESULTS After 41 ± 18 months, 9 of 48 patients, experienced the major arrhythmic event (MAE) endpoint (clinical VT/fibrillation = 3, appropriate ICD activation = 6). The endpoint occurred more frequently in Group 3 (7/14, 50%) than in Groups 1 and 2 (2/34, 5.8%). Logistic regression model adjusted for PVS, age, and LVEF revealed that PVS was an independent MAE predictor (OR: 21.152, 95% CI: 2.618-170.887, P = .004). Kaplan-Meier curves diverged significantly (log rank, P < .001) while PVS negative predictive value was 94%. CONCLUSIONS In hospitalized HFmrEF post-MI and DCM patients, a NIRFs guiding to PVS two-step approach efficiently detected the subgroup at increased risk for MAE.
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Affiliation(s)
- Petros Arsenos
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
- Arsenos Heart and Biosignals LabAvlonasGreece
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Ioannis Doundoulakis
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Polychronis Dilaveris
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Christos‐Konstantinos Antoniou
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Soulaidopoulos Stergios
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Skevos Sideris
- State Department of CardiologyHippokration General HospitalAthensGreece
| | | | - Dimitrios Tousoulis
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
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