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Nielsen RR, Pryds K, Olesen KKW, Mortensen MB, Gyldenkerne C, Nielsen JC, Hindricks G, Dagres N, Maeng M. Coronary Artery Disease Is A Stronger Predictor of All-Cause Mortality Than Left Ventricular Ejection Fraction Among Patients With Newly Diagnosed Heart Failure: Insights From the WDHR. J Am Heart Assoc 2024; 13:e9771. [PMID: 38958148 DOI: 10.1161/jaha.123.033938] [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] [Received: 12/11/2023] [Accepted: 05/14/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND In patients with newly diagnosed heart failure (HF) and left ventricular ejection fraction (LVEF) <50%, little is known whether LVEF per se or presence of coronary artery disease (CAD) provides independent prognostic information on all-cause mortality. METHODS AND RESULTS Using the WDHR (Western Denmark Heart Registry), we identified 3620 patients with newly diagnosed HF and LVEF 10% to 49% referred for first-time coronary angiography as part of general workup of HF. Patients were stratified by LVEF (10%-35% versus 36%-49%) and presence of CAD. We estimated 10-year all-cause mortality risk and calculated hazard ratios adjusted for relevant comorbidities and risk factors (aHRs). CAD was present in 1592 (44%) patients. Lower LVEF was associated with a relative 15% increased 10-year mortality: 37% for LVEF 36% to 49% versus 42% for LVEF 10% to 35% (aHR, 1.15 [95% CI, 0.99-1.34]). This result did not change when stratified into those with CAD (52% versus 56%; aHR, 1.11 [95% CI, 0.91-1.35]) and those without CAD (27% versus 33%; aHR, 1.24 [95% CI, 0.97-1.57]). In comparison, presence and extent of CAD were associated with a relative 43% increased 10-year mortality (CAD versus no CAD, 55.0% versus 31.5%; aHR, 1.43 [95% CI, 1.25-1.64]). Compared with a matched general population, excess mortality risk was higher for patients with HF and CAD (54.7% versus 26.3%; aHR, 2.10 [95% CI, 1.85-2.39]) versus those with HF and no CAD (31.4% versus 17.2%; aHR, 1.76 [95% CI, 1.52-2.02]). CONCLUSIONS Among newly diagnosed patients with HF and LVEF <50%, presence and extent of CAD are associated with substantial higher all-cause mortality risk than lower LVEF.
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Affiliation(s)
- Roni Ranghoej Nielsen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University, Health Aarhus Denmark
| | - Kasper Pryds
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | | | - Martin Bødtker Mortensen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University, Health Aarhus Denmark
- Department of Cardiology Johns Hopkins Baltimore MD
| | | | - Jens Cosedis Nielsen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University, Health Aarhus Denmark
| | | | | | - Michael Maeng
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University, Health Aarhus Denmark
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Núñez E, Santas E, Merenciano H, Lorenzo-Hernández M, Mollar A, Miñana G, Palau P, Fuertes L, Valero E, de la Espriella R, Bodí V, Sanchis J, Bayés-Genís A, Núñez J. Differential sex-related effect of left ventricular ejection fraction trajectory on the risk of mortality and heart failure readmission following hospitalization for acute heart failure: A longitudinal study. Eur J Heart Fail 2024. [PMID: 38679819 DOI: 10.1002/ejhf.3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/18/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024] Open
Abstract
AIMS There is limited information on the sex-specific longitudinal changes of left ventricular ejection fraction (LVEF) after an acute heart failure (AHF) hospitalization. We aimed to investigate whether LVEF trajectories over time and their impact on mortality and AHF readmission rates differ between men and women. METHODS AND RESULTS We conducted a retrospective sex-specific analysis of longitudinal LVEF measurements (n = 9581) in 3383 patients with an index hospitalization for AHF in a single tertiary-level hospital. Statistical techniques suited for longitudinal data analysis were used. The mean age of the sample was 73.8 ± 11.2 years, and 47.9% were women. The mean LVEF was 49.4 ± 15.3%. At a median follow-up of 2.58 years (interquartile range 0.77-5.62), we registered 2197 deaths (64.9%) and 2597 AHF readmissions in 1302 (38.5%) patients. The longitudinal analysis showed that women had consistently higher LVEF values throughout the follow-up with both trajectories characterized by an early peak-approximately at 1 year-followed by decreasing values in men but a plateau in women. Multivariate between-sex comparisons across LVEF categories revealed that women had lower rates of AHF readmissions when LVEF ≤40%. On the contrary, women displayed an excess risk of AHF readmissions when LVEF >60%. A trend in the same direction was found for cardiovascular and all-cause mortality. CONCLUSION Sex was a significant factor in determining the follow-up trajectory of LVEF and predicting differences in outcomes after an AHF admission. The findings suggest that women have a higher risk of AHF readmissions at higher LVEF values, while men have a higher risk at lower LVEF values. For all-cause and cardiovascular mortality, the same direction of the association was inferred but they were not significant.
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Affiliation(s)
- Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Hector Merenciano
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Miguel Lorenzo-Hernández
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Laura Fuertes
- Cardiology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Ernesto Valero
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
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Triposkiadis F, Xanthopoulos A, Drakos SG, Boudoulas KD, Briasoulis A, Skoularigis J, Tsioufis K, Boudoulas H, Starling RC. Back to the basics: The need for an etiological classification of chronic heart failure. Curr Probl Cardiol 2024; 49:102460. [PMID: 38346611 DOI: 10.1016/j.cpcardiol.2024.102460] [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: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
The left ventricular (LV) ejection fraction (LVEF), despite its severe limitations, has had an epicentral role in heart failure (HF) classification, management, and risk stratification for decades. The major argument favoring the LVEF based HF classification has been that it defines groups of patients in which treatment is effective. However, this reasoning has recently collapsed, since medical treatment with neurohormonal inhibitors, has proved beneficial in most HF patients regardless of the LVEF. In addition, there has been compelling evidence, that the LVEF provides poor guidance for device treatment of chronic HF (implantation of cardioverter defibrillator, cardiac resynchronization therapy) since sudden cardiac death may occur and cardiac dyssynchronization may be disastrous in all HF patients. The same holds true for LV assist device implantation, in which the LVEF has been used as a surrogate for LV size. In this review article we update the evidence questioning the use of LVEF-based HF classification and argue that guidance of chronic HF treatment should transition to more contemporary concepts. Specifically, we propose an etiologic chronic HF classification predominantly based on epidemiological data, which will be foundational for further higher resolution phenotyping in the emerging era of precision medicine.
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Affiliation(s)
- Filippos Triposkiadis
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece.
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Stavros G Drakos
- University of Utah Health and School of Medicine and Salt Lake VA Medical Center, Salt Lake City, UT 84108, USA
| | | | - Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, Athens 15772, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, Hippokration Hospital, University of Athens, Athens 115 27, Greece
| | | | - Randall C Starling
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Ratwatte S, Stewart S, Strange G, Playford D, Celermajer DS. Association of Pulmonary Artery Pressures With Mortality in Adults With Reduced Left Ventricular Ejection Fraction. JACC. HEART FAILURE 2024:S2213-1779(24)00147-1. [PMID: 38520460 DOI: 10.1016/j.jchf.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The independent effect of pulmonary hypertension (PHT) severity on mortality in those with reduced left ventricular ejection fraction (LVEF) is not well known. OBJECTIVES The authors aimed to examine the prognostic impact of increasingly elevated pulmonary pressures in a large clinical cohort of adults with reduced LVEF. METHODS The authors analyzed data from the National Echocardiography Database of Australia, a large clinical registry linking routine echocardiographic investigations to mortality. In 23,675 adults with a recorded tricuspid regurgitation peak velocity (TRV) and reduced LVEF (<50%), the authors evaluated the relationship between conventional thresholds of increasing risk of PHT and mortality during median follow-up of 2.9 years (Q1-Q3: 1.0-5.4 years). RESULTS Mean age was 70 ± 15 years, and 7,498 (31.7%) individuals were female. Overall, 8,801 (37.2%) had normal (TRV <2.5 m/s), 7,061 (29.8%) had borderline (2.5-2.8 m/s), 5,676 (24.0%) intermediate (2.9-3.4 m/s), and 2,137 (9.0%) individuals had high-risk PHT (>3.4 m/s). With increasing risk of PHT, 1- and 5-year actuarial mortality increased from 13.3% and 43.8% to 41.5% and 81.4%, respectively (P < 0.0001) from normal to severely elevated TRV. The adjusted HR of mortality increased by 1.31-fold (95% CI: 1.23-1.38), 1.82-fold (95% CI: 1.72-1.93), and 2.38-fold (95% CI: 2.21-2.56) in those with borderline, intermediate, and high risk of PHT respectively, compared with normal TRV. Further analyses suggested a distinctive threshold with a TRV reached >2.41 m/s (adjusted HR: 1.18 [95% CI: 1.04-1.33]). CONCLUSIONS The authors demonstrate the prevalence and negative prognostic impact of increasingly elevated TRV levels in individuals with reduced LVEF, with a threshold for mortality lying within the range of "borderline risk" PHT.
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Affiliation(s)
- Seshika Ratwatte
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Simon Stewart
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom; Institute for Health Research, The University of Notre Dame Australia, Freemantle, Western Australia, Australia
| | - Geoff Strange
- Institute for Health Research, The University of Notre Dame Australia, Freemantle, Western Australia, Australia; Heart Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Playford
- Institute for Health Research, The University of Notre Dame Australia, Freemantle, Western Australia, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia; Heart Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
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Smereka Y, Ezekowitz JA. HFpEF and sex: understanding the role of sex differences. Can J Physiol Pharmacol 2024. [PMID: 38447124 DOI: 10.1139/cjpp-2023-0403] [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: 03/08/2024]
Abstract
Heart failure is a complex clinical syndrome with many etiological factors and complex pathophysiology affecting millions worldwide. Males and females can have distinct clinical presentation and prognosis, and there is an emerging understanding of the factors that highlight the similarities and differences to synthesize and present available data for sex-specific differences in heart failure with preserved ejection fraction (HFpEF). While the majority of data demonstrate more similarities than differences between females and males in terms of heart failure, there are key differences. Data showed that females have a higher risk of developing HFpEF, but a lower risk of mortality and hospitalization. This can be conditioned by different profiles of comorbidities, postmenopausal changes in sex hormone levels, higher levels of inflammation and chronic microvascular dysfunction in females. These factors, combined with different left ventricular dimensions and function, which are more pronounced with age, lead to a higher prevalence of LV diastolic dysfunction at rest and exercise. As a result, females have lower exercise capacity and quality of life when compared to males. Females also have different activities of systems responsible for drug transformation, leading to different efficacy of drugs as well as higher risk of adverse drug reactions. These data prove the necessity for creating sex-specific risk stratification scales and treatment plans.
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Affiliation(s)
- Yuliia Smereka
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin A Ezekowitz
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Canadian VIGOUR Centre, Edmonton, AB, Canada
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6
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Santas E, Llácer P, Palau P, de la Espriella R, Miñana G, Lorenzo M, Núñez-Marín G, Miró Ò, Chorro FJ, Bayés-Genís A, Sanchis J, Núñez J. Noncardiovascular morbidity and mortality across left ventricular ejection fraction categories following hospitalization for heart failure. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:206-214. [PMID: 37315921 DOI: 10.1016/j.rec.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/16/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES Noncardiovascular events represent a significant proportion of the morbidity and mortality burden in patients with heart failure (HF). However, the risk of these events appears to differ by left ventricular ejection fraction (LVEF) status. In this study, we sought to evaluate the risk of noncardiovascular death and recurrent noncardiovascular readmission by LVEF status following an admission for acute HF. METHODS We retrospectively assessed a cohort of 4595 patients discharged after acute HF in a multicenter registry. We evaluated LVEF as a continuum, stratified in 4 categories (LVEF ≤ 40%, 41%-49%, 50%-59%, and ≥ 60%). Study endpoints were the risks of noncardiovascular mortality and recurrent noncardiovascular admissions during follow-up. RESULTS At a median follow-up of 2.2 [interquartile range, 0.76-4.8] years, we registered 646 noncardiovascular deaths and 4014 noncardiovascular readmissions. After multivariable adjustment including cardiovascular events as a competing event, LVEF status was associated with the risk of noncardiovascular mortality and recurrent noncardiovascular admissions. When compared with patients with LVEF ≤ 40%, those with LVEF 51%-59%, and especially those with LVEF ≥ 60%, were at higher risk of noncardiovascular mortality (HR, 1.31; 95%CI, 1.02-1,68; P=.032; and HR, 1.47; 95%CI, 1.15-1.86; P=.002; respectively), and at higher risk of recurrent noncardiovascular admissions (IRR, 1.17; 95%CI, 1.02-1.35; P=.024; and IRR, 1.26; 95%CI, 1.11-1.45; P=.001; respectively). CONCLUSIONS Following an admission for HF, LVEF status was directly associated with the risk of noncardiovascular morbidity and mortality. Patients with HFpEF were at higher risk of noncardiovascular death and total noncardiovascular readmissions, especially those with LVEF ≥ 60%.
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Affiliation(s)
- Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Pau Llácer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Miguel Lorenzo
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Gonzalo Núñez-Marín
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Òscar Miró
- Servicio de Urgencias, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antoni Bayés-Genís
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Inoue N, Ohtani H, Morikawa S, Takayama Y, Ogane T, Hiramatsu T, Kumihashi H, Murohara T. Risk of supranormal left ventricular ejection fraction in patients with aortic stenosis. Clin Cardiol 2024; 47:e24255. [PMID: 38469926 PMCID: PMC10928761 DOI: 10.1002/clc.24255] [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] [Received: 01/03/2024] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Cardiovascular events are increasing in patients with supranormal left ventricular ejection fraction (snLVEF). However, the effect of snLVEF in patients with aortic stenosis (AS) remains unclear, especially in patients with moderate AS. HYPOTHESIS This study aimed to evaluate the prognosis of mortality and heart failure (HF) in patients with LVEF ≥ 50% and moderate or severe AS. METHODS This retrospective study targeted patients with moderate or severe AS and LVEF > 50%. LVEF of 50%-65% was classified as normal LVEF (nLVEF, nEF group) and >65% as snLVEF (snEF group). AS severity was stratified based on the aortic valve area into moderate (1.0-1.5 cm²) and severe (<1.0 cm²). Primary outcomes included all-cause mortality and HF hospitalization. RESULTS A total of 226 participants were included in this study. There were 67 and 65 participants with moderate AS in snEF (m-snEF) and nEF groups (m-nEF), respectively, and 41 and 53 participants with severe AS in the snEF (s-snEF) and nEF groups (s-nEF), respectively. During the observation period (median: 554 days), the primary composite outcome occurred in 108 individuals. Cox hazard analysis revealed no significant differences among the four groups in primary composite outcomes. With respect to HF hospitalization, the adjusted hazard ratios (95% confidence intervals) with m-snEF as the reference were as follows: m-nEF, 0.41 (0.19-0.89); s-nEF, 1.43 (0.76-2.67); and s-snEF, 1.83 (1.00-3.35). CONCLUSIONS The risk of HF hospitalization for m-snLVEF was higher than m-nLVEF and not significantly different from s-nLVEF.
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Affiliation(s)
- Naoya Inoue
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineShizuokaHamamatsuJapan
| | - Shuji Morikawa
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Yohei Takayama
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Takashi Ogane
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
| | - Takehiro Hiramatsu
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Hiroki Kumihashi
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
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Playford D, Strange GA, Atherton JJ, Harris S, Chan YK, Stewart S. Clinical to Population Prevalence of Hypertrophic Cardiomyopathy Phenotype: Insights From the National Echo Database Australia. Heart Lung Circ 2024; 33:212-221. [PMID: 38177016 DOI: 10.1016/j.hlc.2023.10.021] [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: 03/07/2023] [Revised: 10/22/2023] [Accepted: 10/29/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND There is a paucity of data describing the underlying prevalence of hypertrophic cardiomyopathy (HCM), a primary genetic disorder characterised by progressive left ventricular (LV) hypertrophy and sudden death, from both a clinical and a population perspective. METHODS We screened the echocardiographic reports of 155,668 men and 147,880 women within the multicentre National Echo Database Australia (NEDA) (2001-2019). End-diastolic wall thickness ≥15 mm anywhere in the left ventricle was identified as a characteristic of an HCM phenotype according to current guideline recommendations. Applying a septal-to-posterior wall thickness ratio >1.3 and LV outflow tract obstruction ≥30 mmHg (when documented), we further identified asymmetric septal hypertrophy and obstructive HCM (oHCM), respectively. The observed pattern of phenotypical HCM within the overall NEDA cohort (>650,000 cases) was then extrapolated to the ∼539,000 (5.7% of adult population) and ∼474,000 (4.8%) Australian men and women, respectively, who were investigated with echocardiography in 2021 on an age-specific basis. RESULTS Overall, 15,380 cases (mean age 71.1±14.6 years, 10,138 men [65.9%]) with the characteristic HCM phenotype within the NEDA cohort were identified. Of these 15,380 cases, 5,552 (36.1%) had asymmetric septal hypertrophy, and 2,276 of the 10,290 cases with LV outflow tract obstruction profiling data (22.1%) had obstructive HCM. A further 3,389 of 13,715 cases (24.7%) had evidence of LV systolic dysfunction (LV ejection fraction <55%). Within the entire NEDA cohort (including those without LV profiling), HCM was found in 10,138 of 342,161 men (2.96%; 95% confidence interval [CI] 2.91%-3.02%) and 5,242 of 308,539 women (1.70%; 95% CI 1.65%-1.75%). When extrapolated to the Australian population, we estimate that a minimum of 15,971 men and 8,057 women presented with echocardiographic features of phenotypical HCM in 2021. This translates into a minimum caseload/prevalence of ∼17 adult men (∼2.5 in those aged ≤50 years) and eight adult women (∼1 in those aged ≤50 years) per 10,000 population meeting phenotypical HCM criteria. CONCLUSIONS Using contemporary Australian echocardiographic and population data, we estimate that a minimum of 15,971 (17.5 cases/10,000) men and 8,057 women (8.2 cases/10,000) had echocardiographic evidence of phenotypical HCM in 2021. These disease burden data are particularly relevant as new treatment options are emerging.
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Affiliation(s)
- David Playford
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.
| | - Geoff A Strange
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Sarah Harris
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic, Australia
| | - Simon Stewart
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia; School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
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Bourazana A, Xanthopoulos A, Briasoulis A, Magouliotis D, Spiliopoulos K, Athanasiou T, Vassilopoulos G, Skoularigis J, Triposkiadis F. Artificial Intelligence in Heart Failure: Friend or Foe? Life (Basel) 2024; 14:145. [PMID: 38276274 PMCID: PMC10817517 DOI: 10.3390/life14010145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
In recent times, there have been notable changes in cardiovascular medicine, propelled by the swift advancements in artificial intelligence (AI). The present work provides an overview of the current applications and challenges of AI in the field of heart failure. It emphasizes the "garbage in, garbage out" issue, where AI systems can produce inaccurate results with skewed data. The discussion covers issues in heart failure diagnostic algorithms, particularly discrepancies between existing models. Concerns about the reliance on the left ventricular ejection fraction (LVEF) for classification and treatment are highlighted, showcasing differences in current scientific perceptions. This review also delves into challenges in implementing AI, including variable considerations and biases in training data. It underscores the limitations of current AI models in real-world scenarios and the difficulty in interpreting their predictions, contributing to limited physician trust in AI-based models. The overarching suggestion is that AI can be a valuable tool in clinicians' hands for treating heart failure patients, as far as existing medical inaccuracies have been addressed before integrating AI into these frameworks.
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Affiliation(s)
- Angeliki Bourazana
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, IA 52242, USA
| | - Dimitrios Magouliotis
- Department of Cardiothoracic Surgery, University of Thessaly, 41110 Larissa, Greece; (D.M.); (K.S.)
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, 41110 Larissa, Greece; (D.M.); (K.S.)
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London W2 1NY, UK
| | - George Vassilopoulos
- Department of Hematology, University Hospital of Larissa, University of Thessaly Medical School, 41110 Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
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Pensa AV, Khan SS, Shah RV, Wilcox JE. Heart failure with improved ejection fraction: Beyond diagnosis to trajectory analysis. Prog Cardiovasc Dis 2024; 82:102-112. [PMID: 38244827 DOI: 10.1016/j.pcad.2024.01.014] [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] [Received: 01/14/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
Left ventricular (LV) systolic dysfunction represents a highly treatable cause of heart failure (HF). A substantial proportion of patients with HF with reduced ejection fraction (EF;HFrEF) demonstrate improvement in LV systolic function (termed HF with improved EF [HFimpEF]), either spontaneously or when treated with guideline-directed medical therapy (GDMT). Although it is a relatively new HF classification, HFimpEF has emerged in recent years as an important and distinct clinical entity. Improvement in LVEF leads to decreased rates of mortality and adverse HF-related outcomes compared to patients with sustained LV systolic dysfunction (HFrEF). While numerous clinical and imaging factors have been associated with HFimpEF, identification of which patients do and do not improve requires further investigation. In addition, patients improve at different rates, and what determines the trajectory of HFimpEF patients after improvement is incompletely characterized. A proportion of patients maintain improvement in LV systolic function, while others experience a recrudescence of systolic dysfunction, especially with GDMT discontinuation. In this review we discuss the contemporary guideline-recommended classification definition of HFimpEF, the epidemiology of improvement in LV systolic function, and the clinical course of this unique patient population. We also offer evidence-based recommendations for the clinical management of HFimpEF and provide a roadmap for future directions in understanding and improving outcomes in the care of patients with HFimpEF.
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Affiliation(s)
- Anthony V Pensa
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ravi V Shah
- Department of Medicine, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Jane E Wilcox
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
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Lu Y, Wang Y, Zhou B. Predicting long-term prognosis after percutaneous coronary intervention in patients with acute coronary syndromes: a prospective nested case-control analysis for county-level health services. Front Cardiovasc Med 2023; 10:1297527. [PMID: 38111892 PMCID: PMC10725923 DOI: 10.3389/fcvm.2023.1297527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose We aimed to establish and authenticate a clinical prognostic nomogram for predicting long-term Major Adverse Cardiovascular Events (MACEs) among high-risk patients who have undergone Percutaneous Coronary Intervention (PCI) in county-level health service. Patients and methods This prospective study included Acute Coronary Syndrome (ACS) patients treated with PCI at six county-level hospitals between September 2018 and August 2019, selected from both the original training set and external validation set. Least Absolute Shrinkage and Selection Operator (LASSO) regression techniques and logistic regression were used to assess potential risk factors and construct a risk predictive nomogram. Additionally, the potential non-linear relationships between continuous variables were tested using Restricted Cubic Splines (RCS). The performance of the nomogram was evaluated based on the Receiver Operating Characteristic (ROC) curve analysis, Calibration Curve, Decision Curve Analysis (DCA), and Clinical Impact Curve (CIC). Results The original training set and external validation set comprised 520 and 1,061 patients, respectively. The final nomogram was developed using nine clinical variables: Age, Killip functional classification III-IV, Hypertension, Hyperhomocysteinemia, Heart failure, Number of stents, Multivessel disease, Low-density Lipoprotein Cholesterol, and Left Ventricular Ejection Fraction. The AUC of the nomogram was 0.79 and 0.75 in the training set and external validation set, respectively. The DCA and CIC validated the clinical value of the constructed prognostic nomogram. Conclusion We developed and validated a prognostic nomogram for predicting the probability of 3-year MACEs in ACS patients who underwent PCI at county-level hospitals. The nomogram could provide a precise risk assessment for secondary prevention in ACS patients receiving PCI.
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Affiliation(s)
| | | | - Bo Zhou
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Hospital of China Medical University, Shenyang, China
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Kocabaş U, Ergin I, Kıvrak T, Yılmaz Öztekin GM, Tanık VO, Özdemir İ, Avcı Demir F, Doğduş M, Şen T, Altınsoy M, Üstündağ S, Urgun ÖD, Sinan ÜY, Uygur B, Yeni M, Özçalık E. Prognostic significance of medical therapy in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2023; 10:3677-3689. [PMID: 37804042 PMCID: PMC10682872 DOI: 10.1002/ehf2.14559] [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: 06/22/2023] [Revised: 08/31/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023] Open
Abstract
AIMS The use of guideline-directed medical therapy (GDMT) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains suboptimal. The SMYRNA study aims to identify the clinical factors for the non-use of GDMT and to determine the prognostic significance of GDMT in patients with HFrEF in a real-life setting. METHODS AND RESULTS The SMYRNA study is a prospective, multicentre, and observational study that included outpatients with HFrEF. Patients were divided into three groups according to the status of GDMT at the time of enrolment: (i) patients receiving all classes of HF medications including renin-angiotensin system (RAS) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs); (ii) patients receiving any two classes of HF medications (RAS inhibitors and beta-blockers, or RAS inhibitors and MRAs, or beta-blockers and MRAs); and (iii) either patients receiving class of HF medications (only one therapy) or patients not receiving any class of HF medications. The primary outcome was a composite of hospitalization for HF or cardiovascular death. The study population consisted of 1062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (range: 20-96) years. RAS inhibitors, beta-blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1% of the patients, respectively. The proportions of patients receiving target doses of guideline-directed medications were 24.4% for RAS inhibitors, 11.0% for beta-blockers, and 11.1% for MRAs. Overall, 491 patients (46.2%) were treated with triple therapy, 353 patients (33.2%) were treated with any two classes of HF medications, and 218 patients (20.6%) were receiving only one class of HF medication or not receiving any HF medication. Patient-related factors comprising older age, New York Heart Association functional class, rural living, presence of hypertension, and history of myocardial infarction were independently associated with the use or non-use of GDMT. During the median 24-month period, the primary composite endpoint occurred in 362 patients (34.1%), and 177 of 1062 (16.7%) patients died. Patients treated with two or three classes of HF medications had a decreased risk of hospitalization for HF or cardiovascular death compared with those patients receiving ≤1 class of HF medication [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.49-0.85; P = 0.002, and HR: 0.61; 95% CI: 0.47-0.79; P < 0.001, respectively]. CONCLUSIONS The real-life SMYRNA study provided comprehensive data about the clinical factors associated with the non-use of GDMT and showed that suboptimal GDMT is associated with an increased risk of hospitalization for HF or cardiovascular death in patients with HFrEF.
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Affiliation(s)
- Umut Kocabaş
- Department of CardiologyBaşkent University Izmir HospitalIzmirTurkey
| | - Isil Ergin
- Department of Public Health, Faculty of MedicineEge UniversityIzmirTurkey
| | - Tarık Kıvrak
- Department of Cardiology, Faculty of MedicineElazığ Fırat UniversityElazığTurkey
| | | | - Veysel Ozan Tanık
- Department of CardiologyDışkapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences UniversityAnkaraTurkey
| | | | | | - Mustafa Doğduş
- Department of CardiologyKaraman State HospitalKaramanTurkey
| | - Taner Şen
- Department of Cardiology, Faculty of MedicineKütahya Health Sciences UniversityKütahyaTurkey
| | - Meltem Altınsoy
- Department of CardiologyAnkara Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Health Sciences UniversityAnkaraTurkey
| | - Songül Üstündağ
- Department of CardiologyMengücek Gazi Educatıon and Research Hospıtal, Erzincan Binali Yıldırım UniversityErzincanTurkey
| | | | - Ümit Yaşar Sinan
- Faculty of Medicine, Institute of CardiologyIstanbul UniversityIstanbulTurkey
| | - Begüm Uygur
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences UniversityIstanbulTurkey
| | - Mehtap Yeni
- Department of CardiologyIsparta State HospitalIspartaTurkey
| | - Emre Özçalık
- Department of CardiologyBaşkent University Izmir HospitalIzmirTurkey
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Ono R, Falcão LM. Supra-Normal Left Ventricular Function. Am J Cardiol 2023; 207:84-92. [PMID: 37734305 DOI: 10.1016/j.amjcard.2023.08.169] [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] [Received: 06/05/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023]
Abstract
Heart failure (HF) is often categorized by left ventricular (LV) ejection fraction (LVEF). A new category of HF characterized by supra-normal LVEF (>65%), named HF with supra-normal ejection fraction (HFsnEF), has been recently proposed. Some studies reported that patients with supra-normal LVEF might have an increased risk of long-term major adverse cardiovascular events and U-shaped mortality patterns. Currently, the prognosis of HFsnEF is not well established but seems to be associated with an increased risk of long-term major adverse cardiovascular events. It has been reported that HFsnEF is more prevalent in women and is associated with higher prevalence of nonischemic HF, higher blood urea nitrogen plasma levels, lower levels of natriuretic peptides, and to be less likely treated with β blockers. The pathophysiology of HFsnEF would be associated with microvascular dysfunction because of microvascular inflammation or reduced coronary flow reserve, and low stroke volume index with smaller cardiac chamber dimensions and concentric LV geometry. In this study, we systematically reviewed published data on patients with s supra-normal LV function and reported its definition, proposed pathophysiology, phenotypes, diagnostic strategy, and prognosis.
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Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Luiz Menezes Falcão
- Department of Clinical Semiology, Academic Medical Center of Lisbon (CAML); Cardiovascular Center University of Lisbon (CCUL@RISE), Faculty of Medicine University of Lisbon, Lisbon, Portugal
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14
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Playford D, Stewart S, Harris SA, Chan Y, Strange G. Pattern and Prognostic Impact of Regional Wall Motion Abnormalities in 255 697 Men and 236 641 Women Investigated with Echocardiography. J Am Heart Assoc 2023; 12:e031243. [PMID: 37947119 PMCID: PMC10727298 DOI: 10.1161/jaha.123.031243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
Background Regional wall motion abnormalities (WMAs) after myocardial infarction are associated with adverse remodeling and increased mortality in the short to medium term. Their long-term prognostic impact is less well understood. Methods and Results Via the National Echo Database of Australia (2000-2019), we identified normal wall motion versus WMA for each left ventricular wall among 492 338 individuals aged 61.9±17.9 years. The wall motion score index was also calculated. We then examined actual 1- and 5-year mortality, plus adjusted risk of long-term mortality according to WMA status. Overall, 39 346/255 697 men (15.4%) and 17 834/236 641 women (7.5%) had a WMA. The likelihood of a WMA was associated with increasing age and greater systolic/diastolic dysfunction. A defect in the inferior versus anterior wall was the most and least common WMA in men (8.0% and 2.5%) and women (3.3% and 1.1%), respectively. Any WMA increased 5-year mortality from 17.5% to 29.7% in men and from 14.9% to 30.8% in women. Known myocardial infarction (hazard ratio [HR], 0.86 [95% CI, 0.80-0.93]) or revascularization (HR, 0.87 [95% CI, 0.82-0.92]) was independently associated with a better prognosis, whereas men (1.22-fold increase) and those with greater systolic/diastolic dysfunction had a worse prognosis. Among those with any WMA, apical (HR, 1.08 [95% CI, 1.02-1.13]) or inferior (HR, 1.09 [95% CI, 1.04-1.15]) akinesis, dyskinesis or aneurysm, or a wall motion score index >3.0 conveyed the worst prognosis. Conclusions In a large real-world clinical cohort, twice as many men as women have a WMA, with inferior WMA the most common. Any WMA confers a poor prognosis, especially inferoapical akinesis/dyskinesis/aneurysm.
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Affiliation(s)
- David Playford
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of MedicineThe University of Notre DameFremantleWestern AustraliaAustralia
| | - Simon Stewart
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUnited Kingdom
| | - Sarah Ann Harris
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
| | - Yih‐Kai Chan
- Mary MacKillop Institute for Health Research, The Australian Catholic UniversityMelbourneVictoriaAustralia
| | - Geoff Strange
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- Heart Research InstituteSydneyNew South WalesAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
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15
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Motazedian P, Marbach JA, Prosperi-Porta G, Parlow S, Di Santo P, Abdel-Razek O, Jung R, Bradford WB, Tsang M, Hyon M, Pacifici S, Mohanty S, Ramirez FD, Huggins GS, Simard T, Hon S, Hibbert B. Diagnostic accuracy of point-of-care ultrasound with artificial intelligence-assisted assessment of left ventricular ejection fraction. NPJ Digit Med 2023; 6:201. [PMID: 37898711 PMCID: PMC10613290 DOI: 10.1038/s41746-023-00945-1] [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: 03/15/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023] Open
Abstract
Focused cardiac ultrasound (FoCUS) is becoming standard practice in a wide spectrum of clinical settings. There is limited data evaluating the real-world use of FoCUS with artificial intelligence (AI). Our objective was to determine the accuracy of FoCUS AI-assisted left ventricular ejection fraction (LVEF) assessment and compare its accuracy between novice and experienced users. In this prospective, multicentre study, participants requiring a transthoracic echocardiogram (TTE) were recruited to have a FoCUS done by a novice or experienced user. The AI-assisted device calculated LVEF at the bedside, which was subsequently compared to TTE. 449 participants were enrolled with 424 studies included in the final analysis. The overall intraclass coefficient was 0.904, and 0.921 in the novice (n = 208) and 0.845 in the experienced (n = 216) cohorts. There was a significant bias of 0.73% towards TTE (p = 0.005) with a level of agreement of 11.2%. Categorical grading of LVEF severity had excellent agreement to TTE (weighted kappa = 0.83). The area under the curve (AUC) was 0.98 for identifying an abnormal LVEF (<50%) with a sensitivity of 92.8%, specificity of 92.3%, negative predictive value (NPV) of 0.97 and a positive predictive value (PPV) of 0.83. In identifying severe dysfunction (<30%) the AUC was 0.99 with a sensitivity of 78.1%, specificity of 98.0%, NPV of 0.98 and PPV of 0.76. Here we report that FoCUS AI-assisted LVEF assessments provide highly reproducible LVEF estimations in comparison to formal TTE. This finding was consistent among senior and novice echocardiographers suggesting applicability in a variety of clinical settings.
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Affiliation(s)
- Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, OR, USA
| | - Graeme Prosperi-Porta
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - William B Bradford
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Miranda Tsang
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Michael Hyon
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Stefano Pacifici
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Sharanya Mohanty
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Gordon S Huggins
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephanie Hon
- Division of Pulmonary and Critical Care Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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16
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Wu S, Wei J, Lauzon M, Suppogu N, Kelsey SF, Reis SE, Shaw LJ, Sopko G, Handberg E, Pepine CJ, Bairey Merz CN. Left ventricular ejection fraction and long-term outcomes in women presenting with signs and symptoms of ischaemia. Heart 2023; 109:1624-1630. [PMID: 37316162 PMCID: PMC10592103 DOI: 10.1136/heartjnl-2023-322494] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Although women are known to have a relatively higher left ventricular ejection fraction (LVEF) compared with men, a sex-neutral LVEF threshold continues to be used for clinical management. We sought to investigate the relationship among high (>65%), normal (55%-65%) and low (<55%) LVEF and long-term all-cause mortality and major adverse cardiovascular events (MACEs) in women presenting with suspected myocardial ischaemia. METHODS A total of 734 women from the Women's Ischemia Syndrome Evaluation (WISE) were analysed. LVEF was calculated by invasive left ventriculography. The relationship between baseline characteristics, LVEF and outcomes was evaluated. A multivariable Cox regression model was used to assess the association of LVEF with outcomes, after adjusting for known risk factors. RESULTS Low LVEF was associated with higher rates of mortality and MACE compared with normal and high LVEF (p<0.0001). Normal LVEF was associated with higher mortality (p=0.047) and rate of myocardial infarctions (MIs) compared with high LVEF (p=0.03). Low LVEF remained a significant predictor of mortality compared with high LVEF (p=0.013) in a multivariable regression model and normal compared with high LVEF trended towards higher mortality (p=0.16). CONCLUSION Among women with suspected ischaemia, women with LVEF above the defined normal threshold (>65%) had lower rates of all-cause mortality and non-fatal MI. Further investigation is needed to determine the optimal LVEF in women. TRIAL REGISTRATION NUMBER NCT00000554.
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Affiliation(s)
- Stephanie Wu
- Cedars-Sinai Medical Center, Los Angeles, California, USA
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Janet Wei
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marie Lauzon
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nissi Suppogu
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sheryl F Kelsey
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Steven E Reis
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Leslee J Shaw
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Weill Cornell Medicine, New York, New York, USA
| | - George Sopko
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Eileen Handberg
- Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Carl J Pepine
- Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center Smidt Heart Institute, Los Angeles, California, USA
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Lam CSP, Myhre PL. Left ventricular ejection fraction in women: when normal isn't normal. Heart 2023; 109:1584-1585. [PMID: 37438053 DOI: 10.1136/heartjnl-2023-322924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore, Singapore
| | - Peder Langeland Myhre
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
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18
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Hamatani Y, Iguchi M, Minami K, Ishigami K, Esato M, Tsuji H, Wada H, Hasegawa K, Ogawa H, Abe M, Lip GY, Akao M. Utility of left ventricular ejection fraction in atrial fibrillation patients without pre-existing heart failure. ESC Heart Fail 2023; 10:3091-3101. [PMID: 37604489 PMCID: PMC10567650 DOI: 10.1002/ehf2.14500] [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: 11/01/2022] [Revised: 06/26/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
AIMS Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little focus has been placed on the prevention of HF in patients with AF. Left ventricular ejection fraction (LVEF) is an established echocardiographic parameter in HF patients. We sought to investigate the association of LVEF with HF events in AF patients without pre-existing HF. METHODS AND RESULTS The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Japan. In this analysis, we excluded patients with pre-existing HF (defined as having one of the following: prior HF hospitalization, New York Heart Association class ≥ 2 in association with heart disease, or LVEF < 40%). Among 3233 AF patients without pre-existing HF, we investigated 2459 patients with the data of LVEF at enrolment. We divided the patients into three groups stratified by LVEF [mildly reduced LVEF (40-49%), below normal LVEF (50-59%), and normal LVEF (≥60%)] and compared the backgrounds and incidence of HF hospitalization between the groups. Of 2459 patients [mean age: 72.4 ± 10.5 years, female: 917 (37%), paroxysmal AF: 1405 (57%), and mean CHA2 DS2 -VASc score: 3.0 ± 1.6], the mean LVEF was 66 ± 8% [mildly reduced LVEF: 114 patients (5%), below normal LVEF: 300 patients (12%), and normal LVEF: 2045 patients (83%)]. Patients with lower LVEF demonstrated lower prevalence of female and paroxysmal AF (both P < 0.01), but age and CHA2 DS2 -VASc score were comparable between the three groups (both P > 0.05). During the median follow-up period of 6.0 years, 255 patients (10%) were hospitalized for HF (annual incidence: 1.9% per person-year). Multivariable Cox regression analysis demonstrated that lower LVEF strata were independently associated with the risk of HF [mildly reduced LVEF (40-49%): hazard ratio = 2.98, 95% confidence interval = 1.99-4.45 and below normal LVEF (50-59%): hazard ratio = 2.01, 95% confidence interval = 1.44-2.82, compared with normal LVEF (≥60%)] after adjustment by age, sex, type of AF, and CHA2 DS2 -VASc score. LVEF < 60% was significantly associated with the higher risk of HF hospitalization across all major subgroups without significant interaction (P for interaction; all P > 0.05). LVEF had an independent and incremental prognostic value for HF hospitalization in addition to natriuretic peptide levels in AF patients without pre-existing HF. CONCLUSIONS Lower LVEF was significantly associated with the higher incidence of HF hospitalization in AF patients without pre-existing HF, leading to the future risk stratification for and prevention of incident HF in AF patients.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Moritake Iguchi
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Kimihito Minami
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Kenjiro Ishigami
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Masahiro Esato
- Department of ArrhythmiaOgaki Tokushukai HospitalGifuJapan
| | | | - Hiromichi Wada
- Division of Translational ResearchNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Koji Hasegawa
- Division of Translational ResearchNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Hisashi Ogawa
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Mitsuru Abe
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Gregory Y.H. Lip
- Liverpool Center for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart and Chest HospitalLiverpoolUK
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Masaharu Akao
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
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19
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Kondo T, Dewan P, Anand IS, Desai AS, Packer M, Zile MR, Pfeffer MA, Solomon SD, Abraham WT, Shah SJ, Lam CSP, Jhund PS, McMurray JJV. Clinical Characteristics and Outcomes in Patients With Heart Failure: Are There Thresholds and Inflection Points in Left Ventricular Ejection Fraction and Thresholds Justifying a Clinical Classification? Circulation 2023; 148:732-749. [PMID: 37366061 DOI: 10.1161/circulationaha.122.063642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Recent guidelines proposed a classification for heart failure (HF) on the basis of left ventricular ejection fraction (LVEF), although it remains unclear whether the divisions chosen were biologically rational. Using patients spanning the full range of LVEF, we examined whether there was evidence of LVEF thresholds in patient characteristics or inflection points in clinical outcomes. METHODS Using patient-level information, we created a merged dataset of 33 699 participants who had been enrolled in 6 randomized controlled HF trials including patients with reduced and preserved ejection fraction. The relationship between the incidence of all-cause death (and specific causes of death) and HF hospitalization, and LVEF, was evaluated using Poisson regression models. RESULTS As LVEF increased, age, the proportion of women, body mass index, systolic blood pressure, and prevalence of atrial fibrillation and diabetes increased, whereas ischemic pathogenesis, estimated glomerular filtration rate, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) decreased. As LVEF increased >50%, age and the proportion of women continued to increase, and ischemic pathogenesis and NT-proBNP decreased, but other characteristics did not change meaningfully. The incidence of most clinical outcomes (except noncardiovascular death) decreased as LVEF increased, with a LVEF inflection point of around 50% for all-cause death and cardiovascular death, around 40% for pump failure death, and around 35% for HF hospitalization. Higher than those thresholds, there was little further decline in the incidence rate. There was no evidence of a J-shaped relationship between LVEF and death; no evidence of worse outcomes in patients with high-normal ("supranormal") LVEF. Similarly, in a subset of patients with echocardiographic data, there were no structural differences in patients with a high-normal LVEF suggestive of amyloidosis, and NT-proBNP levels were consistent with this conclusion. CONCLUSIONS In patients with HF, there was a LVEF threshold of around 40% to 50% where the pattern of patient characteristics changed, and event rates began to increase compared with higher LVEF values. Our findings provide evidence to support current upper LVEF thresholds defining HF with mildly reduced ejection fraction on the basis of prognosis. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT00634309, NCT00634400, NCT00634712, NCT00095238, NCT01035255, NCT00094302, NCT00853658, and NCT01920711.
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Affiliation(s)
- Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (T.K., P.D., P.S.J., J.J.V.M.)
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan (T.K.)
| | - Pooja Dewan
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (T.K., P.D., P.S.J., J.J.V.M.)
| | - Inder S Anand
- VA Medical Center and University of Minnesota, Minneapolis (I.S.A.)
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.S.D., M.A.P., S.D.S.)
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.)
| | - Michael R Zile
- Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.)
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.S.D., M.A.P., S.D.S.)
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.S.D., M.A.P., S.D.S.)
| | - William T Abraham
- The Ohio State University, Division of Cardiovascular Medicine (W.T.A.)
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore (C.S.P.L.)
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (T.K., P.D., P.S.J., J.J.V.M.)
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (T.K., P.D., P.S.J., J.J.V.M.)
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20
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Anker SD, Usman MS, Anker MS, Butler J, Böhm M, Abraham WT, Adamo M, Chopra VK, Cicoira M, Cosentino F, Filippatos G, Jankowska EA, Lund LH, Moura B, Mullens W, Pieske B, Ponikowski P, Gonzalez-Juanatey JR, Rakisheva A, Savarese G, Seferovic P, Teerlink JR, Tschöpe C, Volterrani M, von Haehling S, Zhang J, Zhang Y, Bauersachs J, Landmesser U, Zieroth S, Tsioufis K, Bayes-Genis A, Chioncel O, Andreotti F, Agabiti-Rosei E, Merino JL, Metra M, Coats AJS, Rosano GMC. Patient phenotype profiling in heart failure with preserved ejection fraction to guide therapeutic decision making. A scientific statement of the Heart Failure Association, the European Heart Rhythm Association of the European Society of Cardiology, and the European Society of Hypertension. Eur J Heart Fail 2023; 25:936-955. [PMID: 37461163 DOI: 10.1002/ejhf.2894] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/26/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) represents a highly heterogeneous clinical syndrome affected in its development and progression by many comorbidities. The left ventricular diastolic dysfunction may be a manifestation of various combinations of cardiovascular, metabolic, pulmonary, renal, and geriatric conditions. Thus, in addition to treatment with sodium-glucose cotransporter 2 inhibitors in all patients, the most effective method of improving clinical outcomes may be therapy tailored to each patient's clinical profile. To better outline a phenotype-based approach for the treatment of HFpEF, in this joint position paper, the Heart Failure Association of the European Society of Cardiology, the European Heart Rhythm Association and the European Hypertension Society, have developed an algorithm to identify the most common HFpEF phenotypes and identify the evidence-based treatment strategy for each, while taking into account the complexities of multiple comorbidities and polypharmacy.
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Affiliation(s)
- Stefan D Anker
- Department of Cardiology, Deutsches Herzzentrum der Charité (Campus CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Markus S Anker
- Deutsches Herzzentrum der Charité, Klinik fär Kardiologie, Angiologie und Intensivmedizin (Campus CBF), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Marianna Adamo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Francesco Cosentino
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Brenda Moura
- Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal; Serviço de Cardiologia, Hospital das Forças Armadas-Pólo do Porto, Porto, Portugal
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk and Faculty of Medicine and Life Sciences, University Hasselt, Belgium
| | - Burkert Pieske
- Berlin-Brandenburgische Gesellschaft für Herz-Kreislauferkrankungen (BBGK), Berlin, Germany
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Cardiology Department, Wroclaw Medical University, Wroclaw, Poland
| | - Jose R Gonzalez-Juanatey
- Cardiology Department, Hospital Clínico Universitario, Santiago de Compostela, IDIS, CIBERCV, Santiago de Compostela, Spain
| | - Amina Rakisheva
- Department of Cardiology, Scientific Institution of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar Seferovic
- Department Faculty of Medicine, University of Belgrade, Belgrade & Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, CA, USA
| | - Carsten Tschöpe
- Department of Cardiology, Deutsches Herzzentrum der Charité (Campus CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine (CVK), Charité Universitätsmedizin, Berlin, Germany
| | - Maurizio Volterrani
- Cardio-Pulmonary Department, San Raffaele Open University of Rome; Exercise Science and Medicine, IRCCS San Raffaele - Rome, Italy
| | | | - Jian Zhang
- Fuwai Hospital Chinese Academic of Medical Science, Beijing, China
| | - Yuhui Zhang
- Fuwai Hospital Chinese Academic of Medical Science, Beijing, China
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik fär Kardiologie, Angiologie und Intensivmedizin (Campus CBF), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba Winnipeg, Winnipeg, Manitoba, Canada
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Barcelona, Spain
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Felicita Andreotti
- Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
- Catholic University Medical School, Rome, Italy
| | - Enrico Agabiti-Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jose L Merino
- Department of Cardiology, La Paz University Hospital, IdiPaz, Universidad Autonoma, Madrid, Spain
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Giuseppe M C Rosano
- Cardio-Pulmonary Department, San Raffaele Open University of Rome; Exercise Science and Medicine, IRCCS San Raffaele - Rome, Italy
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21
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Ageev FT, Ovchinnikov AG, Ageeva SF, Mareev VY. [What is "normal left ventricular ejection fraction" and its relationship with the pathogenesis and effectiveness of the treatment of heart failure]. KARDIOLOGIIA 2023; 63:69-74. [PMID: 37470736 DOI: 10.18087/cardio.2023.6.n2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/10/2023] [Indexed: 07/21/2023]
Abstract
The article focuses on modern views on the role and place of left ventricular ejection fraction (LV EF) in determining the status of cardiovascular patients (primarily patients with heart failure) in the algorithm for their diagnosis, treatment, and prediction of the outcome. Conclusions and recommendations on the use of LV EF in patients with chronic heart failure (CHF) are the following: 1) LV EF remains a familiar and convenient instrumental indicator not so much of myocardial contractility as of hemodynamics in general. Assessment of LV EF is useful for selection and ranking of CHF patients whereas the LV EF dynamics is useful for assessing the quality of their management. 2) In the entire population of cardiovascular patients, the "normal" LV EF (mortality nadir) is in the range of 60-65%. 3) LV EF demonstrates a U-shaped relationship with prognosis: in cardiovascular patients with LV EF below the mortality nadir, the relationship is inversely proportional, and above the mortality nadir, it is directly proportional. The question of the boundary between "normal" and "reduced" LV EF in terms of CHF syndrome remains open, but obviously, this boundary is most likely within the range of 50 to 60%. 4) LV EF determines the effectiveness of CHF treatment, but this rule is not applicable to all LV EF ranges and not to all classes of drugs.
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Affiliation(s)
- F T Ageev
- Myasnikov Institute of Clinical Cardiology of the Chazov National Medical Research Center, Moscow
| | - A G Ovchinnikov
- Myasnikov Institute of Clinical Cardiology of the Chazov National Medical Research Center, Moscow; Evdokimov Moscow State University of Medicine and Dentistry, Moscow
| | - S F Ageeva
- Lomonosov Moscow State University, Moscow
| | - V Yu Mareev
- Medical Research and Science Center of the Lomonosov Moscow State University, Moscow
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22
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Playford D, Schwarz N, Chowdhury E, Williamson A, Duong M, Kearney L, Stewart S, Strange G. Comorbidities and Symptom Status in Moderate and Severe Aortic Stenosis: A Multicenter Clinical Cohort Study. JACC. ADVANCES 2023; 2:100356. [PMID: 38938261 PMCID: PMC11198361 DOI: 10.1016/j.jacadv.2023.100356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 06/29/2024]
Abstract
Background Symptoms associated with severe aortic stenosis (AS) are used to guide management. Objectives The purpose of this study was to examine the pattern of symptoms, comorbidities, and cardiac damage in moderate and severe AS. Methods A total of 846,198 echocardiographic investigations from 330,940 individuals aged >18 years were selected for the most recent echocardiogram, moderate or severe AS (mean gradient 20.0-39.9 mm Hg, aortic valve peak gradient 3.0-3.9 m/s and aortic valve area >1.0 cm2; or ≥ 40.0 mm Hg, ≥4.0 m/s or ≤1.0 cm2, respectively), and a cardiologist consultation. Natural Language Processing was applied to letters to extract comorbidities, dyspnea, chest pain, and syncope. Patients with prior aortic valve replacement were excluded. Results 2,213 patients (0.7% overall, 32.8% females) had moderate and 3,416 (1.0%, 47.3% females) had severe AS. Comorbidities were common, including hypertension, (56.6% moderate AS, 53.1% severe AS, P = 0.01), coronary disease (46.0% and 46.8%, respectively, P = 0.58) and atrial fibrillation (29.6% and 34.8%, respectively, P < 0.001). Symptoms were also common in both moderate (n = 915, 41.3%) and severe (n = 1,630, 47.7%) AS (P < 0.001). Comorbidities were more likely in symptomatic vs asymptomatic patients (P < 0.001). Dyspnea was more likely in severe AS, whereas angina and syncope were similar in moderate vs severe AS. In multivariable analysis, only dyspnea was associated with severe (vs moderate) AS (OR: 1.73, 95% CI: 1.41-2.13, P < 0.001). In both adjusted and unadjusted models, the degree of cardiac damage did not relate to presence of any symptoms but was associated with AS severity. Conclusions Dyspnea is common in both moderate and severe AS, is associated with comorbidities and is not related to the degree of cardiac damage. Symptom-guided management decisions in AS may need revision.
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Affiliation(s)
- David Playford
- Advara Heart Care, Leabrook, Adelaide, Australia
- School of Medicine, The University of Notre Dame, Fremantle, Australia
| | | | | | | | - MyNgan Duong
- Advara Heart Care, Leabrook, Adelaide, Australia
| | - Leighton Kearney
- Advara Heart Care, Leabrook, Adelaide, Australia
- Cardiology, Warringal Private Hospital, Heidelberg, Victoria, Australia
| | - Simon Stewart
- Institute for Health Research, The University of Notre Dame, Fremantle, Australia
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Geoff Strange
- School of Medicine, The University of Notre Dame, Fremantle, Australia
- Heart Research Institute, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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23
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Tomasoni D, Adamo M, Metra M. May 2023 at a glance: focus on pathophysiology, comorbidities and devices. Eur J Heart Fail 2023; 25:599-601. [PMID: 37326134 DOI: 10.1002/ejhf.2921] [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: 04/11/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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24
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Imaizumi T, Fujii N, Hamano T, Yang W, Taguri M, Kansal M, Mehta R, Shafi T, Taliercio J, Go A, Rao P, Hamm LL, Deo R, Maruyama S, Fukagawa M, Feldman HI. Excess risk of cardiovascular events in patients in the United States vs. Japan with chronic kidney disease is mediated mainly by left ventricular structure and function. Kidney Int 2023; 103:949-961. [PMID: 36738890 PMCID: PMC10869952 DOI: 10.1016/j.kint.2023.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023]
Abstract
While patients receiving dialysis therapy in the United States are more likely to develop cardiovascular disease (CVD) than those in Japan, direct comparisons of patients with predialysis chronic kidney disease (CKD) are rare. To study this, we compared various outcomes in patients with predialysis CKD using data from the Chronic Renal Insufficiency Cohort (CRIC) and CKD Japan Cohort (CKD-JAC) studies and determined mediators of any differences. Candidate mediators included left ventricular (LV) indices assessed by echocardiography. Among 3125 CRIC and 1097 CKD-JAC participants, the mean LV mass index (LVMI) and ejection fraction (EF) were 55.7 and 46.6 g/m2 and 54% and 65%, respectively (both significant). The difference in body mass index (32 and 24 kg/m2, respectively) largely accounted for the differences in LVMI and C-reactive protein levels across cohorts. Low EF and high LVMI were significantly associated with subsequent CVD in both cohorts. During a median follow-up of five years, CRIC participants were at higher risk for CVD (adjusted hazard ratio [95% confidence interval]: 3.66 [2.74-4.89]) and death (4.69 [3.05-7.19]). A three-fold higher C-reactive protein concentration and higher phosphate levels in the United States cohort were moderately strong mediators of the differences in CVD. However, echocardiographic parameters were stronger mediators than these laboratory measures. LVMI, EF and their combination mediated the observed difference in CVD (27%, 50%, and 57%, respectively) and congestive heart failure (33%, 62%, and 70%, respectively). Thus, higher LV mass and lower EF, even in the normal range, were found to be predictive of CVD in CKD.
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Affiliation(s)
- Takahiro Imaizumi
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan; Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Naohiko Fujii
- Medical and Research Center for Nephrology and Transplantation, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyōgo, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Wei Yang
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Masataka Taguri
- Department of Health Data Science, Tokyo Medical University, Tokyo, Japan
| | - Mayank Kansal
- Department of Medicine, School of Medicine, University of Illinois, Chicago, Illinois, USA
| | - Rupal Mehta
- Division of Nephrology and Hypertension, Department of Medicine and Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Chicago, Illinois, USA; Department of Preventive Medicine Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tariq Shafi
- School of Medicine, John Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Taliercio
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alan Go
- Departments of Epidemiology, Biostatistics and Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Panduranga Rao
- Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - L Lee Hamm
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Rajat Deo
- Departments of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masafumi Fukagawa
- Department of Internal Medicine, Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Harold I Feldman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cristóbal H, Enjuanes C, Batlle M, Tajes M, Campos B, Francesch J, Moliner P, Farrero M, Andrea R, Ortiz-Pérez JT, Morales A, Sabaté M, Comin-Colet J, García de Frutos P. Prognostic Value of Soluble AXL in Serum from Heart Failure Patients with Preserved and Reduced Left Ventricular Ejection Fraction. J Pers Med 2023; 13:446. [PMID: 36983628 PMCID: PMC10056687 DOI: 10.3390/jpm13030446] [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: 12/23/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
Heart failure (HF) is classified according to the degree of reduction in left ventricular ejection fraction (EF) in HF with reduced, mildly reduced, and preserved EF. Biomarkers could behave differently depending on EF type. Here, we analyze the soluble form of the AXL receptor tyrosine kinase (sAXL) in HF patients with reduced and preserved EF. Two groups of HF patients with reduced (HFrEF; n = 134) and preserved ejection fraction (HFpEF; n = 134) were included in this prospective observational study, with measurements of candidate biomarkers and functional, clinical, and echocardiographic variables. A Cox regression model was used to determine predictors for clinical events: cardiovascular mortality and all-cause mortality. sAXL circulating values predicted outcome in HF: for a 1.0 ng/mL increase in serum sAXL, the mortality hazard ratio (HR) was 1.019 for HFrEF (95% CI 1.000 to 1.038) and 1.032 for HFpEF (95% CI 1.013 to 1.052). In a multivariable Cox regression analysis, sAXL and NT-proBNP were independent markers for all-cause and cardiovascular mortality in HFpEF. In contrast, only NT-proBNP remained significant in the HFrEF group. When analyzing the event-free survival at a mean follow-up of 3.6 years, HFrEF and HFpEF patients in the higher quartile of sAXL had a reduced survival time. Interestingly, sAXL is a reliable predictor for all-cause and cardiovascular mortality only in the HFpEF cohort. The results suggest an important role for AXL in HFpEF, supporting sAXL evaluation in larger clinical studies and pointing to AXL as a potential target for HF therapy.
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Affiliation(s)
- Helena Cristóbal
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB-CSIC), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), E08036 Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, E08907 L’Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
| | - Montserrat Batlle
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - Marta Tajes
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, E08907 L’Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
| | - Begoña Campos
- Department of Basic Clinical Practice, Universitat de Barcelona, E08036 Barcelona, Spain
| | - Josep Francesch
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, E08907 L’Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
| | - Marta Farrero
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - José Tomás Ortiz-Pérez
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - Albert Morales
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB-CSIC), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), E08036 Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Clinical Cardiovascular Institute, Hospital Clinic and IDIBAPS, University of Barcelona, E08036 Barcelona, Spain
| | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, E08907 L’Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), E08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, E08036 Barcelona, Spain
| | - Pablo García de Frutos
- Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB-CSIC), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), E08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), E28029 Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM) and IIBB-CSIC Associated RDI Unit, E08036 Barcelona, Spain
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Ohte N, Kikuchi S, Iwahashi N, Kinugasa Y, Dohi K, Takase H, Masai K, Inoue K, Okumura T, Hachiya K, Kitada S, Seo Y. Unfavourable outcomes in patients with heart failure with higher preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2023; 24:293-300. [PMID: 36464890 DOI: 10.1093/ehjci/jeac240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS Newly introduced drugs for heart failure (HF) have been reported to improve the prognosis of HF with preserved ejection fraction (HFpEF) in the lower range of left ventricular ejection fraction (LVEF). We hypothesized that a higher LVEF is related to an unfavourable prognosis in patients with HFpEF. METHODS AND RESULTS We tested this hypothesis by analysing the data from a prospective multicentre cohort study in 255 patients admitted to the hospital due to decompensated HF (LVEF > 40% at discharge). The primary endpoint of this study was a composite outcome of all-cause death and readmission due to HF, and the secondary endpoint was readmission due to HF. LVEF and the mitral E/e' ratio were measured using echocardiography. In multicovariate parametric survival time analysis, LVEF [hazard ratio (HR) = 1.046 per 1% increase, P = 0.001], concurrent atrial fibrillation (AF) (HR = 3.203, P < 0.001), and E/e' (HR = 1.083 per 1.0 increase, P < 0.001) were significantly correlated with the primary endpoint. In addition to these covariates, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use was significantly correlated with the secondary endpoint (HR = 0.451, P = 0.008). Diagnostic performance plot analysis demonstrated that the discrimination threshold value for LVEF that could identify patients prone to reaching the primary endpoint was ≥57.2%. The prevalence of AF or E/e' ratio did not differ significantly between patients with LVEF ≥ 58% and with 40% < LVEF < 58%. CONCLUSION A higher LVEF is independently related to poor prognosis in patients with HFpEF, in addition to concurrent AF and an elevated E/e' ratio. ACEI/ARB use, in contrast, was associated with improved prognosis, especially with regard to readmission due to HF. CLINICAL TRIAL REGISTRATION https://www.umin.ac.jp/ctr/index.htm. UNIQUE IDENTIFIER UMIN000017725.
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Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
| | - Noriaki Iwahashi
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Kumiko Masai
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Takahiro Okumura
- Department of Cardiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kenta Hachiya
- Department of Cardiology, Nagoya City University East Medical Center, Nagoya, Japan
| | - Shuichi Kitada
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
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Wan Ahmad WA, Mohd Ghazi A, Abdul Ghapar AK, Muthusamy TS, Liew HB, Zainal Abidin I, Ong ML, Ross NT, Cham YL, Ho WS, Fegade M, Chew DSP. From Primary to Tertiary Care: Expert Position Statements to Guide Heart Failure with Preserved Ejection Fraction Diagnosis. Malays J Med Sci 2023; 30:49-66. [PMID: 36875198 PMCID: PMC9984115 DOI: 10.21315/mjms2023.30.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/31/2022] [Indexed: 03/05/2023] Open
Abstract
Globally, heart failure with preserved ejection fraction (HFpEF) is quickly becoming the dominant form of heart failure (HF) in ageing populations. However, there are still multiple gaps and challenges in making a firm diagnosis of HFpEF in many low-to-middle income Asian countries. In response to this unmet need, the Malaysian HFpEF Working Group (MY-HPWG) gathered and reviewed evidence surrounding the use of different diagnostic modalities indicated for patients with HFpEF to identify diagnostic tools that could be conveniently accessed across different healthcare settings. As a result, five recommendation statements were proposed and an accompanying algorithm was developed, with the aim of improving the diagnostic rate of HFpEF. The MY-HPWG recommends using more easily accessible and non-invasive tools, such as natriuretic peptide (NP) biomarkers and basic echocardiogram (ECHO), to ensure timely HFpEF diagnosis in the primary and secondary care settings, and prompt referral to a tertiary care centre for more comprehensive assessments in uncertain cases.
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Affiliation(s)
- Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Azmee Mohd Ghazi
- Cardiology Department, The National Heart Institute of Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Houng Bang Liew
- Cardiology Department, Queen Elizabeth Hospital II, Sabah, Malaysia
| | - Imran Zainal Abidin
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mei Lin Ong
- Cardiology Department, Gleneagles Hospital Penang, Pulau Pinang, Malaysia
| | - Noel Thomas Ross
- Medical Department, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Yee Ling Cham
- Cardiology Department, Sarawak Heart Centre, Sarawak, Malaysia
| | - Wing Sze Ho
- Novartis Corporation (Malaysia) Sdn. Bhd., Selangor, Malaysia
| | - Mayuresh Fegade
- Novartis Corporation (Malaysia) Sdn. Bhd., Selangor, Malaysia
| | - David Soon Ping Chew
- Cardiology Department, Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
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Gotsman I, Leibowitz D, Keren A, Amir O, Zwas DR. Echocardiographic Characteristics and Clinical Outcomes of the Hyperdynamic Heart: A 'Super-Normal' Heart is not a Normal Heart. Am J Cardiol 2023; 187:119-126. [PMID: 36459734 DOI: 10.1016/j.amjcard.2022.10.029] [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] [Received: 08/05/2022] [Revised: 09/18/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
A hyperdynamic heart is defined as a left ventricular (LV) with an ejection fraction (EF) above the normal range. Is this favorable? We looked at the diastolic properties of subjects with a hyperdynamic heart and its impact on outcome. Consecutive echocardiography examinations during 5 years were evaluated by EF subgroups, including a hyperdynamic heart (EF >70%). All examinations with significant LV hypertrophy or valve disease were excluded. The study included 16,994 subjects. A total of 720 subjects (4.2%) had a hyperdynamic heart. Subjects with a hyperdynamic heart were older, more likely to be women, and more likely to have hypertension, diabetes, and obesity. A total of 20% of patients had a diagnosis of heart failure. This group had a higher heart rate, smaller ventricular size, and the highest relative wall thickness. All indexes of diastolic dysfunction were significantly more prevalent in the hyperdynamic group. This included a higher LV mass, larger left atrial volume, reduced relaxation (smaller mitral e'), longer deceleration time, and higher LV end-diastolic pressures (high mitral E/e' ratio) and peak tricuspid regurgitation gradient. Diastolic dysfunction, defined by an abnormal functional or structural parameter, was present in 78% of the subjects. Survival was significantly lower in the group with a hyperdynamic heart. The Cox regression analysis after adjustment demonstrated reduced survival during a median 9-year follow-up in the hyperdynamic group compared with those with a normal EF (hazard ratio 1.56, 95% confidence interval 1.38 to 1.76, p <0.001). In conclusion, subjects with a hyperdynamic systolic function have increased prevalence of diastolic dysfunction and reduced survival. A hyperdynamic heart is not a normally functioning heart.
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Affiliation(s)
- Israel Gotsman
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - David Leibowitz
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Andre Keren
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Offer Amir
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Donna R Zwas
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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29
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Stassen J, Ewe SH, Pio SM, Pibarot P, Redfors B, Leipsic J, Genereux P, Van Mieghem NM, Kuneman JH, Makkar R, Hahn RT, Playford D, Marsan NA, Delgado V, Ben-Yehuda O, Leon MB, Bax JJ. Managing Patients With Moderate Aortic Stenosis. JACC Cardiovasc Imaging 2023:S1936-878X(22)00741-0. [PMID: 36881428 DOI: 10.1016/j.jcmg.2022.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/02/2022] [Accepted: 12/02/2022] [Indexed: 02/10/2023]
Abstract
Current guidelines recommend that clinical surveillance for patients with moderate aortic stenosis (AS) and aortic valve replacement (AVR) may be considered if there is an indication for coronary revascularization. Recent observational studies, however, have shown that moderate AS is associated with an increased risk of cardiovascular events and mortality. Whether the increased risk of adverse events is caused by associated comorbidities, or to the underlying moderate AS itself, is incompletely understood. Similarly, which patients with moderate AS need close follow-up or could potentially benefit from early AVR is also unknown. In this review, the authors provide a comprehensive overview of the current literature on moderate AS. They first provide an algorithm that helps to diagnose moderate AS correctly, especially when discordant grading is observed. Although the traditional focus of AS assessment has been on the valve, it is increasingly acknowledged that AS is not only a disease of the aortic valve but also of the ventricle. The authors therefore discuss how multimodality imaging can help to evaluate the left ventricular remodeling response and improve risk stratification in patients with moderate AS. Finally, they summarize current evidence on the management of moderate AS and highlight ongoing trials on AVR in moderate AS.
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Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonathon Leipsic
- Departments of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philippe Genereux
- Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jurrien H Kuneman
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Raj Makkar
- Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca T Hahn
- Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - David Playford
- Department of Cardiology, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ori Ben-Yehuda
- Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
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30
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Chan YK, Stickland N, Stewart S. An inevitable or modifiable trajectory towards heart failure in high-risk individuals: insights from the nurse-led intervention for less chronic heart failure (NIL-CHF) study. Eur J Cardiovasc Nurs 2023; 22:33-42. [PMID: 35986905 DOI: 10.1093/eurjcn/zvac036] [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: 07/29/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/20/2023]
Abstract
AIMS We extended follow-up of a heart failure (HF) prevention study to determine if initially positive findings of improved cardiac recovery were translated into less de novo HF and/or all-cause mortality (primary endpoint) in the longer term. METHODS AND RESULTS The Nurse-led Intervention for Less Chronic HF (NIL-CHF) study was a single-centre randomized trial of nurse-led prevention involving cardiac inpatients without HF. At 3 years, 454 survivors (aged 66 ± 11 years, 71% men and 68% coronary artery disease) had the following: (i) a normal echocardiogram (128 cases/28.2%), (ii) structural heart disease (196/43.2%), or (iii) left ventricular diastolic dysfunction/left ventricular systolic dysfunction (LVDD/LVSD: 130/28.6%). Outcomes were examined during median 8.3 (interquartile range 7.8-8.8) years according to these hierarchal groups and change in cardiac status from baseline to 3 years. Overall, 109 (24.0%) participants had a de novo HF admission or died while accumulating 551 cardiovascular-related admissions/3643 days of hospital stay. Progressively worse cardiac status correlated with increased hospitalizations (P < 0.001). The mean rate (95% confidence interval) of cardiovascular admissions/days of hospital stay being 0.09 (0.05-0.12) admissions/0.33 (0.13-0.54) days vs. 0.27 (0.20-0.34) admissions/2.20 (1.36-3.04) days per annum for those with a normal echocardiogram vs. LVDD/LVSD at 3 years. With progressively higher event rates, the adjusted hazard ratio for a de novo HF admission and/or death associated with a structural abnormality (24.5% of cases) and LVDD/LVSD (36.2%) at 3 years was 1.57 (0.82-3.01; P = 0.173) and 2.07 (1.05-4.05; P = 0.035) compared with a normal echocardiogram (10.9%). Mortality also mirrored the direction/extent of cardiac status/trajectory. CONCLUSIONS These data suggest the positive initial effects of NIL-CHF intervention on cardiac recovery contributed to better long-term outcomes among patients at high risk of HF. However, prevention of HF remains challenging.
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Affiliation(s)
- Yih-Kai Chan
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Nerolie Stickland
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Simon Stewart
- Center for Cardiopulmonary Health, Torrens University Australia, Adelaide, SA 5000, Australia.,Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
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31
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Prevalence and prognostic impact of tricuspid regurgitation in patients with cardiac implantable electronic devices: From the national echocardiography database of Australia. Int J Cardiol 2023; 370:338-344. [PMID: 36346256 DOI: 10.1016/j.ijcard.2022.10.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/25/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
AIMS We sought to analyse the distribution of TR severity and survival in a large cohort of adults with CIED leads. METHODS The distribution of TR severity was analysed in 18,797 adults (mean age 73.8+/-13.9, 63.3% men) with CIED leads undergoing echocardiography across 25 centres. Survival status and cause of death were linked and the relationship between TR severity and mortality during 2.6 (interquartile range 1.1-4.6) years follow-up examined. Data from 439,558 individuals (mean age 62.1 ±17.8 years, 51.5% men) without a CIED were subsequently incorporated in a pooled cohort analysis. RESULTS Overall, 8,824/18,797 individuals (47%) with a CIED had no/trivial TR; 5,490 (29.2%) mild TR; 3,068 (16.3%) moderate TR; and 1,415 (7.5%) severe TR. Moderate or greater TR was independently associated with age, female sex, atrial fibrillation and significant left heart disease (p<0.001 for all). 8,868 individuals (47.2%) died from any cause (43.2% from cardiovascular causes). Individuals with moderate or severe TR had a 1.6 to 2.5-fold increased risk of all-cause mortality in adjusted models, compared to those with no TR (p<0.001 for both). In the pooled cohort analysis, CIEDs were associated with a near 2-fold (95% CI 1.81-1.99; p<0.001) increased probability of moderate or greater TR, on adjusted basis. However, the mortality associated with moderate or greater TR did not differ significantly with respect to the presence or absence of a device lead. CONCLUSIONS Moderate or greater TR is more prevalent in those with CIED's, even in adjusted models, and was independently associated with incremental risks for all-cause and cardiovascular mortality.
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Tomasoni D, Adamo M, Metra M. January 2023 at a glance: focus on acute heart failure and medical therapy. Eur J Heart Fail 2023; 25:1-3. [PMID: 36715130 DOI: 10.1002/ejhf.2786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/20/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Strange G, Stewart S, Playford D, Strom JB. Risk for Mortality with Increasingly Severe Aortic Stenosis: An International Cohort Study. J Am Soc Echocardiogr 2023; 36:60-68.e2. [PMID: 36208655 PMCID: PMC9822866 DOI: 10.1016/j.echo.2022.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is the most common valvular heart disease in high-income countries. Adjusted for clinical confounders, the risk associated with increasing AS severity across the spectrum of AS severity remains uncertain. METHODS The authors conducted an international, multicenter, parallel-cohort study of 217,599 Australian (mean age, 76.0 ± 7.3 years; 49.3% women) and 30,865 US (mean age, 77.4 ± 7.3 years; 52.2% women) patients aged ≥65 years who underwent echocardiography. Patients with previous aortic valve replacement were excluded. The risk of increasing AS severity, quantified by peak aortic velocity (Vmax), was assessed through linkage to 97,576 and 14,481 all-cause deaths in Australia and the United States, respectively. RESULTS The distribution of AS severity (mean Vmax, 1.7 ± 0.7 m/sec) was similar in both cohorts. Compared with those with Vmax of 1.0 to 1.49 m/sec, those with Vmax of 2.50 to 2.99 m/sec (US cohort) or Vmax of 3.0 to 3.49 m/sec (Australian cohort) had a 1.5-fold increase in mortality risk within 10 years, adjusting for age, sex, presence of left heart disease, and left ventricular ejection fraction. Overall, the adjusted risk for mortality plateaued (1.75- to 2.25-fold increased risk) above a Vmax of 3.5 m/sec. This pattern of mortality persisted despite adjustment for a comprehensive list of comorbidities and treatments within the US cohort. CONCLUSIONS Within large, parallel patient cohorts managed in different health systems, similar patterns of mortality linked to increasingly severe AS were observed. These findings support ongoing clinical trials of aortic valve replacement in patients with nonsevere AS and suggest the need to develop and apply more proactive surveillance strategies in this high-risk population.
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Affiliation(s)
- Geoff Strange
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Institute of Health Research, University of Notre Dame, Fremantle, Australia; Heart Research Institute, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Simon Stewart
- Institute of Health Research, University of Notre Dame, Fremantle, Australia; School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - David Playford
- Institute of Health Research, University of Notre Dame, Fremantle, Australia
| | - Jordan B Strom
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Docherty KF, Bayes-Genis A, Butler J, Coats AJS, Drazner MH, Joyce E, Lam CSP. The four pillars of HFrEF therapy: is it time to treat heart failure regardless of ejection fraction? Eur Heart J Suppl 2022; 24:L10-L19. [PMID: 36545228 PMCID: PMC9762881 DOI: 10.1093/eurheartjsupp/suac113] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The syndrome of heart failure (HF) has historically been dichotomized based on clinical trial inclusion criteria into patients with a reduced or preserved left ventricular ejection fraction (LVEF) using a cut-off of above or below 40%. The majority of trial evidence for the benefits of disease-modifying pharmacological therapy has been in patients with HF with reduced ejection fraction (HFrEF), i.e. those with an LVEF ≤40%. Recently, the sodium-glucose co-transporter 2 inhibitors empagliflozin and dapagliflozin have been shown to be the first drugs to improve outcomes in HF across the full spectrum of LVEF. There is, however, growing evidence that the benefits of many of the neurohumoral modulators shown to be beneficial in patients with HFrEF may extend to those with a higher LVEF above 40% but still below the normal range, i.e. HF with mildly reduced ejection fraction (HFmrEF). Whether the benefits of some of these medications also extend to patients with HF and preserved ejection fraction (HFpEF) is an area of ongoing debate. This article will review the evidence for HF treatments across the full spectrum of LVEF, provide an overview of recently updated clinical practice guidelines, and address the question whether it may now be time to treat HF with some therapies regardless of ejection fraction.
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Affiliation(s)
- Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Antoni Bayes-Genis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, CIBERCV, 08916 Badalona, Barcelona, Spain
| | - Javed Butler
- Baylor Scott and White Research Institute, 3434 Live Oak St Ste 501, Dallas, TX 75204, USA,Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Andrew J S Coats
- Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Mark H Drazner
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, 5323 Harry Hines Blvd., Dallas, TX 75390-9254, USA
| | - Emer Joyce
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, D07 R2WY, Ireland,School of Medicine, University College Dublin, Bellfield, Dublin 4, Ireland
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Riccardi M, Sammartino AM, Piepoli M, Adamo M, Pagnesi M, Rosano G, Metra M, von Haehling S, Tomasoni D. Heart failure: an update from the last years and a look at the near future. ESC Heart Fail 2022; 9:3667-3693. [PMID: 36546712 PMCID: PMC9773737 DOI: 10.1002/ehf2.14257] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.
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Affiliation(s)
- Mauro Riccardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Antonio Maria Sammartino
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San DonatoUniversity of MilanMilanItaly
- Department of Preventive CardiologyUniversity of WrocławWrocławPoland
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | | | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Goettingen Medical CenterGottingenGermany
- German Center for Cardiovascular Research (DZHK), Partner Site GöttingenGottingenGermany
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
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Tomasoni D, Adamo M, Metra M. November 2022 at a glance: focus on epidemiology, prognosis and comorbidities. Eur J Heart Fail 2022; 24:1997-1999. [PMID: 36482159 DOI: 10.1002/ejhf.2242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Xanthopoulos A, Giamouzis G, Skoularigis J, Triposkiadis F. Heart failure with reduced, mildly reduced, or preserved left ventricular ejection fraction: Has reasoning been lost? World J Cardiol 2022; 14:438-445. [PMID: 36161058 PMCID: PMC9350603 DOI: 10.4330/wjc.v14.i7.438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
Left ventricular (LV) ejection fraction (LVEF), defined as LV stroke volume divided by end-diastolic volume, has been systematically used for the diagnosis, classification, and management of heart failure (HF) over the last three decades. HF is classified as HF with reduced LVEF, HF with midrange or mildly reduced LVEF, and HF with preserved LVEF using arbitrary, continuously changing LVEF cutoffs. A prerequisite for using this LVEF-based terminology is knowledge of the LVEF normal range, which is lacking and may lead to erroneous conclusions in HF, especially at the higher end of the LVEF spectrum.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Grigorios Giamouzis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
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Reshaping Treatment of Heart Failure with Preserved Ejection Fraction. J Clin Med 2022; 11:jcm11133706. [PMID: 35806994 PMCID: PMC9267897 DOI: 10.3390/jcm11133706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023] Open
Abstract
Current data indicate that in the community, approximately 50% of patients with heart failure (HF) have preserved left ventricular (LV) ejection fraction (LVEF)—the so-called HFpEF. Treatment of HFpEF has been considered an unmet need for decades. We believe that the main underlying reasons have been (a) the ever-changing LVEF cut-offs used for HF classification; (b) controversies regarding the definition of the LVEF normal range; (c) the fact that HFpEF does not represent a phenotype, but a category of diseases with entirely different characteristics (hypertensive heart disease, valvular heart disease (VHD), hypertrophic cardiomyopathy (HCM) etc.); (d) the lack of recognition that hypertensive HFpEF is the most common and important HFpEF phenotype; (e) the assumption that neurohormonal overactivity is absent in HF patients with a LVEF > 45−50% which has been proven to be wrong. Current HFpEF trials, in which the vast majority of the participants suffered from hypertension (HTN), whereas VHD and HCM were absent, demonstrated that neurohormonal and sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective in HF patients over a wide LVEF range. Thus, restricting these lifesaving treatments to HF patients with reduced LVEF is not justified anymore and it should be additionally considered for HFpEF patients suffering from HTN.
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Ojji DB, Shedul GL, Sani M, Ogah OS, Dzudie A, Barasa F, Mondo C, Ingabire PM, Jones ESW, Rayner B, Albertino D, Ogola E, Smythe W, Hickman N, Francis V, Shahiemah P, Shedul G, Aje A, Sliwa K, Stewart S. A Differential Response to Antihypertensive Therapy in African Men and Women: Insights From the CREOLE Trial. Am J Hypertens 2022; 35:551-560. [PMID: 35134817 DOI: 10.1093/ajh/hpac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/29/2021] [Accepted: 02/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We sought to address the paucity of data to support the evidence-based management of hypertension to achieve optimal blood pressure (BP) control on a sex-specific basis in Africa. METHODS We undertook a post hoc analysis of the multicenter, randomized CREOLE (Comparison of Three Combination Therapies in Lowering Blood Pressure in Black Africans) Trial to test the hypothesis that there would be clinically important differences in office BP control between African men and women. We compared the BP levels of 397 and 238 hypertensive women (63%, 50.9 ± 10.5 years) and men (51.2 ± 11.3 years) from 10 sites across sub-Saharan Africa who completed baseline and 6-month profiling according to their randomly allocated antihypertensive treatment. RESULTS Overall, 442/635 (69.6%) participants achieved an office BP target of <140/90 mm Hg at 6 months; comprising more women (286/72.0%) than men (156/65.5%) (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.07-2.39; P = 0.023). Women randomized to amlodipine-hydrochlorothiazide (HCTZ) (adjusted OR 3.03, 95% CI 1.71-5.35; P < 0.001) or amlodipine-perindopril (adjusted OR 2.62, 95% CI 1.49-4.58; P = 0.01) were more likely to achieve this target compared with perindopril-HCTZ. Among men, there were no equivalent treatment differences-amlodipine-HCTZ (OR 1.54, 95% CI 0.76-3.12; P = 0.23) or amlodipine-perindopril (OR 1.32, 95% CI 0.65-2.67; P = 0.44) vs. perindopril-HCTZ. Among the 613 participants (97%) with 24-hour ambulatory BP monitoring, women had significantly lower systolic (124.1 ± 18.1 vs. 127.3 ± 16.9; P = 0.028) and diastolic (72.7 ± 10.4 vs. 75.1 ± 10.5; P = 0.007) BP levels at 6 months compared with men. CONCLUSIONS These data suggest clinically important differences in the therapeutic response to antihypertensive combination therapy among African women compared with African men.
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Affiliation(s)
- Dike B Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja & University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,Cardiovascular Research Unit, Department of Internal Medicine, University of Abuja, Abuja, Nigeria
| | - Gabriel L Shedul
- Cardiovascular Research Unit, Department of Internal Medicine, University of Abuja, Abuja, Nigeria.,Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Mahmoud Sani
- Department of Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Okechukwu S Ogah
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Anastase Dzudie
- Department of Medicine, Douala General Hospital, Douala, Cameroon
| | - Felix Barasa
- Department of Medicine, MOI University Hospital, Eldoret, Kenya
| | - Charles Mondo
- Department of Medicine, St Francis Hospital, Nsambya, Kampala, Uganda
| | | | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Brian Rayner
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Damasceno Albertino
- Department of Medicine, Eduardo Mondlane University Hospital, Maputo, Mozambique
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Wynand Smythe
- Department of Pharmacy, Life St. Vincent Pallotti Hospital in Cape Town, Cape Town, South Africa
| | - Nicky Hickman
- Clinical Research Centre, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Veronica Francis
- Department of Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Pandie Shahiemah
- Department of Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, Department of Internal Medicine, University of Abuja, Abuja, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Akinyemi Aje
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Institute for Health Research, University of Notre Dame, Australia, Fremantle, Australia
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Chandramouli C, Stewart S, Almahmeed W, Lam CSP. Clinical implications of the universal definition for the prevention and treatment of heart failure. Clin Cardiol 2022; 45 Suppl 1:S2-S12. [PMID: 35789016 PMCID: PMC9254673 DOI: 10.1002/clc.23842] [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: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of heart failure (HF) primarily relies on signs and symptoms that are neither sensitive nor specific. This impedes timely diagnosis and delays effective therapies or interventions, despite the availability of several evidence-based treatments for HF. Through monumental collaborative efforts from representatives of HF societies worldwide, the universal definition of HF was published in 2021, to provide the necessary standardized framework required for clinical management, clinical trials, and research. This review elaborates the key concepts of the new universal definition of HF, highlighting the key merits and potential avenues, which can be nuanced further in future iterations. We also discuss the key implications of the universal definition document from the perspectives of various stakeholders within the healthcare framework, including patients, care providers, system/payers and policymakers.
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Affiliation(s)
- Chanchal Chandramouli
- National Heart Centre SingaporeSingaporeSingapore
- Duke‐National University of SingaporeSingaporeSingapore
| | - Simon Stewart
- Torrens University AustraliaAdelaideSouth AustraliaAustralia
- University of GlasgowGlasgowUK
- Institute of Health ResearchUniversity of Notre Dame AustraliaFremantleNew South WalesAustralia
| | - Wael Almahmeed
- Institute of Cardiac Science, Sheikh Khalifa Medical CityAbu DhabiUnited Arab Emirates
- Heart and Vascular Institute, Cleveland ClinicAbu DhabiUnited Arab Emirates
| | - Carolyn Su Ping Lam
- National Heart Centre SingaporeSingaporeSingapore
- Duke‐National University of SingaporeSingaporeSingapore
- University Medical Centre GroningenGroningenThe Netherlands
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Takada T, Matsuura K, Minami Y, Abe T, Yoshida A, Kishihara M, Watanabe S, Shirotani S, Jujo K, Hagiwara N. Prognosis and diastolic dysfunction predictors in patients with heart failure and recovered ejection fraction. Sci Rep 2022; 12:8768. [PMID: 35610337 PMCID: PMC9130289 DOI: 10.1038/s41598-022-12823-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/16/2022] [Indexed: 12/28/2022] Open
Abstract
There is limited data on whether diastolic dysfunction in patients with heart failure (HF) and recovered ejection fraction (HFrecEF) is associated with worse prognosis. We retrospectively assessed 96 patients diagnosed with HFrecEF and created ROC curve of their diastolic function at the 1-year follow-up for the composite endpoint of cardiovascular death and HF readmission after the follow-up. Eligible patients were divided into two groups according to the cutoff value of E/e′ ratio (12.1) with the highest AUC (0.70). Kaplan–Meier analysis showed that HFrecEF with high E/e′ group had a significantly poorer prognosis than the low E/e′ group (log-rank, p = 0.01). Multivariate Cox regression analysis revealed that the high E/e′ group was significantly related to the composite endpoint (hazard ratio 5.45, 95% confidence interval [CI] 1.23–24.1). The independent predictors at discharge for high E/e′ ratio at the 1-year follow-up were older age and female sex after adjustment for covariates (odds ratio [OR] 1.07, 95% CI 1.01–1.13 and OR 4.70, 95% CI 1.08–20.5). In conclusion, HFrecEF with high E/e′ ratio might be associated with a poor prognosis. Older age and female sex were independent predictors for a sustained high E/e′ ratio in patients with HFrecEF.
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Affiliation(s)
- Takuma Takada
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsuhisa Matsuura
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takuro Abe
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ayano Yoshida
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Makoto Kishihara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shonosuke Watanabe
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shota Shirotani
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Offen S, Playford D, Strange G, Stewart S, Celermajer DS. Adverse Prognostic Impact of Even Mild or Moderate Tricuspid Regurgitation: Insights from The National Echocardiography Database of Australia. J Am Soc Echocardiogr 2022; 35:810-817. [PMID: 35421545 DOI: 10.1016/j.echo.2022.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prevalence and prognostic impact of tricuspid regurgitation (TR) remains incompletely characterized. METHODS The distribution of TR severity was analyzed in 439,558 adults (mean age 62.1 ±17.8 years, 51.5% men) being investigated for heart disease, from 2000-2019, by 25 centers contributing to the National Echocardiography Database of Australia. Survival status and cause of death were ascertained, in all adults, from the National Death Index of Australia. The relationship between TR severity and mortality was examined. RESULTS Of those studied, 311,604 (70.9%) had no/trivial TR; 94,172 (21.4%) mild TR; 26,056 (5.9%) moderate TR; and 7,726 (1.8%) severe TR. During a median 4.1 years (interquartile range 2.2-7.0 years) follow up, 109,004 died (49% from cardiovascular causes). Moderate or greater TR was associated with older age and female sex (p<0.001). Individuals with moderate and severe TR had a 2.0- to 3.2-fold increased risk of all-cause long-term mortality after adjustment for age and sex, compared to those with no/trivial TR (p<0.001 for both comparisons). Even those with mild TR had a significantly increased risk for mortality (HR 1.29, 95% CI 1.27-1.31). In fully adjusted models, including for RV systolic pressure, atrial fibrillation and significant left-heart disease, there remained a 1.24 to 2.65-fold increased risk of mortality with mild (HR 1.24, 95% CI 1.23-1.26), moderate (HR 1.72, 95% CI 1.68-1.75) or severe TR (HR 2.65, 95% CI 2.57-2.73), compared to those with no/trivial TR (p<0.001 for all). CONCLUSIONS TR is a common condition in adults referred for echocardiography. Moreover, even in the presence of other cardiac disease, increasing grades of TR are independently associated with increasing risks of CV and all-cause mortality. Furthermore, we show that even mild TR is independently associated with a significant increase in mortality.
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Affiliation(s)
- Sophie Offen
- Faculty of Medicine and Health, University of Sydney, NSW, Australia; Dept of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David Playford
- The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Geoff Strange
- Heart Research Institute, Sydney, NSW, Australia; The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Simon Stewart
- Torrens University Australia, Adelaide, SA, Australia; University of Glasgow, Glasgow, Scotland
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, NSW, Australia; Dept of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Heart Research Institute, Sydney, NSW, Australia.
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Stefan MS, Eltanbedawi A, Devoe NC, Khan S, Zhou Y, Latef T, Esposito A, Fatima A, Knee AB, Lagu TC. Death among patients hospitalized with symptomatic COVID-19: Implications for high-risk patients. J Hosp Med 2022; 17:252-258. [PMID: 35535924 PMCID: PMC9088345 DOI: 10.1002/jhm.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND We aimed to examine the role played by the COVID-19 infection in patients' death and to determine the proportion of patients for whom it was a major contributor to death. METHODS We included patients ≥50 years old who were hospitalized with COVID-19 infection and died between March 1, 2020 and September 30, 2020 in a tertiary medical center. We considered COVID-19 infection to be a major cause for death if the patient had well-controlled medical conditions and death was improbable without coronavirus infection, and a minor cause for death if the patient had serious illnesses and had an indication for palliative care. RESULTS Among 243 patients, median age was 80 (interquartile intervals: 72-86) and 40% were female. One in two had moderate or severe frailty and 41% had dementia. Nearly 60% of the patients were classified as having advanced, serious illnesses present prior to the hospitalization, with death being expected within 12 months, and among this group 39% were full code at admission. In the remaining 40% of patients, deaths were classified as unexpected based on patients' prior conditions, suggesting that COVID-19 infection complications were the primary contributor to death. CONCLUSIONS For slightly less than half (40%) of patients who died of complications of COVID-19, death was an unexpected event. Among the 60% of patients for whom death was not a surprise, our findings identify opportunities to improve end-of-life discussions and implement shared decision-making in high-risk patients early on or prior to hospitalization.
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Affiliation(s)
- Mihaela S. Stefan
- Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Ahmed Eltanbedawi
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Neil C. Devoe
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Sabiha Khan
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Ya Zhou
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Taroob Latef
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Anthony Esposito
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Anum Fatima
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Alexander B. Knee
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Academic Affairs, Epidemiology/Biostatistics Research CoreOffice of Research, Baystate Medical CenterSpringfieldMassachusettsUSA
| | - Tara C. Lagu
- Center for Health Services and Outcomes Research, Institute of Public Health and MedicineNorthwestern Feinberg School of MedicineChicagoIllinoisUSA
- Department of Medicine, Division of Hospital MedicineNorthwestern Feinberg School of MedicineChicagoIllinoisUSA
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JG, Coats AJ, Crespo-Leiro MG, Farmakis D, Gilard M, Heyman S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CS, Lyon AR, McMurray JJ, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GM, Ruschitzka F, Skibelund AK. Guía ESC 2021 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Triposkiadis F, Starling RC. Chronic Heart Failure: Diagnosis and Management beyond LVEF Classification. J Clin Med 2022; 11:jcm11061718. [PMID: 35330043 PMCID: PMC8951412 DOI: 10.3390/jcm11061718] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/17/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Filippos Triposkiadis
- Department of Cardiology, University of Thessaly, Larissa University General Hospital, 41110 Larissa, Greece
- Correspondence: (F.T.); (R.C.S.)
| | - Randall C. Starling
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
- Correspondence: (F.T.); (R.C.S.)
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Stewart S, Stewart AR, Waite L, Beilby J. Out with the Old and In with the New: Primary Care Management of Heart Failure with Preserved Ejection Fraction. Card Fail Rev 2022; 8:e04. [PMID: 35284093 PMCID: PMC8900131 DOI: 10.15420/cfr.2021.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022] Open
Abstract
Primary care plays an integral role in the management of complex, chronic disease states such as heart failure. However, there is a disconnect between the characteristics of those recruited into clinical trials and those managed in the real world, which means the contribution and consideration of primary care in current guidelines is suboptimal. In this article, the authors explore key issues in the diagnosis and management of heart failure that need to be addressed from a primary care perspective. This article focuses on the issue of heart failure with preserved ejection fraction and the integration of new clinical epidemiology and trial evidence into clinical practice. In response, the authors advocate for dedicated guidelines for the primary care management of heart failure, the development of strategies to facilitate communications between health professionals in acute and community care and a renewed focus on researching optimal models of heart failure care in the community.
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Affiliation(s)
| | | | - Laura Waite
- South Eastern Melbourne Primary Health Network, Melbourne, Australia
| | - Justin Beilby
- orrens University Australia, Adelaide, Australia; Highbury Family Practice, Adelaide, Australia
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022; 24:4-131. [PMID: 35083827 DOI: 10.1002/ejhf.2333] [Citation(s) in RCA: 838] [Impact Index Per Article: 419.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes-Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens-Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online.
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Santas E, Palau P, Llácer P, de la Espriella R, Miñana G, Núñez‐Marín G, Lorenzo M, Heredia R, Sanchis J, Chorro FJ, Bayés‐Genís A, Núñez J. Sex-Related Differences in Mortality Following Admission for Acute Heart Failure Across the Left Ventricular Ejection Fraction Spectrum. J Am Heart Assoc 2021; 11:e022404. [PMID: 34927464 PMCID: PMC9075214 DOI: 10.1161/jaha.121.022404] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Following a heart failure (HF)‐decompensation, there is scarce data about sex‐related prognostic differences across left ventricular ejection fraction (LVEF) status. We sought to evaluate sex‐related differences in 6‐month mortality risk across LVEF following admission for acute HF. Methods and Results We retrospectively evaluated 4812 patients consecutively admitted for acute HF in a multicenter registry from 3 hospitals. Study end points were all‐cause, cardiovascular, and HF‐related mortality at 6‐month follow‐up. Multivariable Cox regression models were fitted to investigate sex‐related differences across LVEF. A total of 2243 (46.6%) patients were women, 2569 (53.4%) were men, and 2608 (54.2%) showed LVEF≥50%. At 6‐month follow‐up, 645 patients died (13.4%), being 544 (11.3%) and 416 (8.6%) cardiovascular and HF‐related deaths, respectively. LVEF was not independently associated with mortality (HR, 1.02; 95% CI 0.99–1.05; P=0.135). After multivariable adjustment, we found no sex‐related differences in all‐cause mortality (P value for interaction=0.168). However, a significant interaction between sex and cardiovascular and HF mortality risks was found across LVEF (P value for interaction=0.030 and 0.007, respectively). Compared with men, women had a significantly lower risk of cardiovascular and HF‐mortality at LVEF<25% and <43%, respectively. On the contrary, women showed a higher risk of HF‐mortality at the upper extreme of LVEF (>80%). Conclusions Following an admission for acute HF, no sex‐related differences were found in all‐cause mortality risk. However, when compared with men, women showed a lower risk of cardiovascular and HF‐mortality at the lower extreme of LVEF. On the contrary, they showed a higher risk of HF death at the upper extreme.
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Affiliation(s)
- Enrique Santas
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Patricia Palau
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
| | - Pau Llácer
- Servicio de Medicina InternaHospital Universitario Ramón y CajalMadridSpain
| | - Rafael de la Espriella
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Gema Miñana
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
| | - Gonzalo Núñez‐Marín
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Miguel Lorenzo
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Raquel Heredia
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
| | - Juan Sanchis
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
- CIBERCVMadridSpain
| | - Francisco Javier Chorro
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
| | - Antoni Bayés‐Genís
- CIBERCVMadridSpain
- Servicio de CardiologíaHospital Germans Trias i PujolUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Julio Núñez
- Servicio de CardiologíaHospital Clínico UniversitarioUniversitat de ValènciaINCLIVAValenciaSpain
- Universitat de ValènciaValenciaSpain
- CIBERCVMadridSpain
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, de Boer RA, Christian Schulze P, Abdelhamid M, Aboyans V, Adamopoulos S, Anker SD, Arbelo E, Asteggiano R, Bauersachs J, Bayes-Genis A, Borger MA, Budts W, Cikes M, Damman K, Delgado V, Dendale P, Dilaveris P, Drexel H, Ezekowitz J, Falk V, Fauchier L, Filippatos G, Fraser A, Frey N, Gale CP, Gustafsson F, Harris J, Iung B, Janssens S, Jessup M, Konradi A, Kotecha D, Lambrinou E, Lancellotti P, Landmesser U, Leclercq C, Lewis BS, Leyva F, Linhart A, Løchen ML, Lund LH, Mancini D, Masip J, Milicic D, Mueller C, Nef H, Nielsen JC, Neubeck L, Noutsias M, Petersen SE, Sonia Petronio A, Ponikowski P, Prescott E, Rakisheva A, Richter DJ, Schlyakhto E, Seferovic P, Senni M, Sitges M, Sousa-Uva M, Tocchetti CG, Touyz RM, Tschoepe C, Waltenberger J, Adamo M, Baumbach A, Böhm M, Burri H, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gardner RS, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Piepoli MF, Price S, Rosano GMC, Ruschitzka F, Skibelund AK. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab368 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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