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Schmitt A, Behnes M, Weidner K, Abumayyaleh M, Reinhardt M, Abel N, Lau F, Forner J, Ayoub M, Mashayekhi K, Akin I, Schupp T. Prognostic impact of prior LVEF in patients with heart failure with mildly reduced ejection fraction. Clin Res Cardiol 2024:10.1007/s00392-024-02443-0. [PMID: 38619579 DOI: 10.1007/s00392-024-02443-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
AIMS As there is limited evidence regarding the prognostic impact of prior left ventricular ejection fraction (LVEF) in patients with heart failure with mildly reduced ejection fraction (HFmrEF), this study investigates the prognostic impact of longitudinal changes in LVEF in patients with HFmrEF. METHODS Consecutive patients with HFmrEF (i.e. LVEF 41-49% with signs and/or symptoms of HF) were included retrospectively in a monocentric registry from 2016 to 2022. Based on prior LVEF, patients were categorized into three groups: stable LVEF, improved LVEF, and deteriorated LVEF. The primary endpoint was 30-months all-cause mortality (median follow-up). Secondary endpoints included in-hospital and 12-months all-cause mortality, as well as HF-related rehospitalization at 12 and 30 months. Kaplan-Meier and multivariable Cox proportional regression analyses were applied for statistics. RESULTS Six hundred eighty-nine patients with HFmrEF were included. Compared to their prior LVEF, 24%, 12%, and 64% had stable, improved, and deteriorated LVEF, respectively. None of the three LVEF groups was associated with all-cause mortality at 12 (p ≥ 0.583) and 30 months (31% vs. 37% vs. 34%; log rank p ≥ 0.376). In addition, similar rates of 12- (p ≥ 0.533) and 30-months HF-related rehospitalization (21% vs. 23% vs. 21%; log rank p ≥ 0.749) were observed. These findings were confirmed in multivariable regression analyses in the entire study cohort. CONCLUSION The transition from HFrEF and HFpEF towards HFmrEF is very common. However, prior LVEF was not associated with prognosis, likely due to the persistently high dynamic nature of LVEF in the follow-up period.
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Affiliation(s)
- Alexander Schmitt
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Kathrin Weidner
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marielen Reinhardt
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Noah Abel
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Felix Lau
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jan Forner
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Centre University of Bochum, Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, Lahr, Germany
| | - Ibrahim Akin
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Kroshian G, Joseph J, Kinlay S, Peralta AO, Hoffmeister PS, Singh JP, Yuyun MF. Atrial fibrillation and risk of adverse outcomes in heart failure with reduced, mildly reduced, and preserved ejection fraction: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2024; 35:715-726. [PMID: 38348517 DOI: 10.1111/jce.16209] [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: 10/16/2023] [Revised: 01/03/2024] [Accepted: 01/28/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Heart failure (HF) and atrial fibrillation (AF) frequently co-exist. Contemporary classification of HF categorizes it into HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). Aggregate data comparing the risk profile of AF between these three HF categories are lacking. METHODS We conducted a systematic review and meta-analysis aimed at determining any significant differences in AF-associated all-cause mortality, HF hospitalizations, cardiovascular mortality (CV), and stroke between HFrEF, HFmrEF, and HFpEF. A systematic search of PubMed, EMBASE, and Cochrane Library databases until February 28, 2023. Data were combined using DerSimonian-Laird random effects model. RESULTS A total of 22 studies comprising 248 323 patients were retained: HFrEF 123 331 (49.7%), HFmrEF 40 995 (16.5%), and HFpEF 83 997 (33.8%). Pooled baseline AF prevalence was 36% total population, 30% HFrEF, 36% HFmrEF, and 42% HFpEF. AF was associated with a higher risk of all-cause mortality in the total population with pooled hazard ratio (HR) = 1.13 (95% confidence interval [CI] = 1.07-1.21), HFmrEF (HR = 1.25, 95% CI = 1.05-1.50) and HFpEF (HR = 1.16, 95% CI = 1.09-1.24), but not HFrEF (HR = 1.03, 95% CI = 0.93-1.14). AF was associated with a higher risk of HF hospitalizations in the total population (HR = 1.29, 95% CI = 1.14-1.46), HFmrEF (HR = 1.64, 95% CI = 1.20-2.24), and HFpEF (HR = 1.46, 95% CI = 1.17-1.83), but not HFrEF (HR = 1.01, 95% CI = 0.87-1.18). AF was only associated with CV in the HFpEF subcategory but was associated with stroke in all three HF subtypes. CONCLUSIONS AF appears to be associated with a higher risk of all-cause mortality and HF hospitalization in HFmrEF and HFpEF. With these findings, the paucity of data and treatment guidelines on AF in the HFmrEF subgroup becomes even more significant and warrant further investigations.
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Affiliation(s)
- Garen Kroshian
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Jacob Joseph
- VA Providence Healthcare System, Providence, Rhode Island, USA
- Department of Medicine, Brown University, Providence, Rhode Island, USA
- VA Boston Healthcare System, Boston, USA
| | - Scott Kinlay
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, Boston, USA
- Harvard Medical School, Boston, USA
- Brigham and Women's Hospital, Boston, USA
| | - Adelqui O Peralta
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, Boston, USA
- Harvard Medical School, Boston, USA
| | - Peter S Hoffmeister
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, Boston, USA
- Harvard Medical School, Boston, USA
| | - Jagmeet P Singh
- Harvard Medical School, Boston, USA
- Massachusetts General Hospital, Boston, USA
| | - Matthew F Yuyun
- Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- VA Boston Healthcare System, Boston, USA
- Harvard Medical School, Boston, USA
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Schmitt A, Schupp T, Reinhardt M, Abel N, Lau F, Forner J, Ayoub M, Mashayekhi K, Weiß C, Akin I, Behnes M. Prognostic impact of acute decompensated heart failure in patients with heart failure with mildly reduced ejection fraction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:225-241. [PMID: 37950915 DOI: 10.1093/ehjacc/zuad139] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023]
Abstract
AIMS This study sought to determine the prognostic impact of acute decompensated heart failure (ADHF) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). ADHF is a major complication in patients with heart failure (HF). However, the prognostic impact of ADHF in patients with HFmrEF has not yet been clarified. METHODS AND RESULTS Consecutive patients hospitalized with HFmrEF (i.e. left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. The prognosis of patients with ADHF was compared with those without (i.e. non-ADHF). The primary endpoint was long-term all-cause mortality. Secondary endpoints included in-hospital all-cause mortality and long-term HF-related re-hospitalization. Kaplan-Meier, multivariable Cox proportional regression, and propensity score matched analyses were performed for statistics. Long-term follow-up was set at 30 months. A total of 2184 patients with HFmrEF were included, ADHF was present in 22%. The primary endpoint was higher in ADHF compared to non-ADHF patients with HFmrEF [50% vs. 26%; hazard ratio (HR) = 2.269; 95% confidence interval (CI) 1.939-2.656; P = 0.001]. Accordingly, the secondary endpoint of long-term HF-related re-hospitalization was significantly higher (27% vs. 10%; HR = 3.250; 95% CI 2.565-4.118; P = 0.001). A history of previous ADHF before the index hospitalization was associated with higher rates of long-term HF-related re-hospitalization (42% vs. 23%; HR = 2.073; 95% CI 1.420-3.027; P = 0.001), but not with long-term all-cause mortality (P = 0.264). CONCLUSION ADHF is a common finding in patients with HFmrEF associated with an adverse impact on long-term prognosis.
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Affiliation(s)
- Alexander Schmitt
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Tobias Schupp
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Marielen Reinhardt
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Noah Abel
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Felix Lau
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Jan Forner
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Centre University of Bochum, Bad Oeynhausen 32545, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, MediClin Heart Centre Lahr, Lahr, Germany
| | - Christel Weiß
- Faculty of Medicine Mannheim, Institute of Biomathematics and Medical Statistics, University Medical Centre, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Michael Behnes
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
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Pokhrel Bhattarai S, Block RC, Xue Y, Rodriguez DH, Tucker RG, Carey MG. Integrative review of electrocardiographic characteristics in patients with reduced, mildly reduced, and preserved heart failure. Heart Lung 2024; 63:142-158. [PMID: 37913557 DOI: 10.1016/j.hrtlng.2023.10.012] [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: 07/27/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Electrocardiographic (ECG) changes in heart failure with reduced, mildly reduced, and preserved ejection fractions can be critical in clinical assessment while waiting to perform echocardiograms or when it is unavailable. This integrative review aimed to identify ECG characteristics among hospitalized patients demonstrating three types of heart failure during acute decompensation. METHODS We searched an electronic database of PubMed, Web of Science, EMBASE, Scopus, Google Scholar, and ClinicalTrials.gov using medical subject headings (MeSH) terms and keywords. Sixteen studies were synthesized and reported. RESULTS Heart failure with reduced ejection fraction (HFrEF) was more common in men, comorbid with coronary artery diseases and diabetes mellitus, higher BNP/Pro-BNP, wide QRS, and left bundle branch block on ECG. On average, clients with heart failure with preserved ejection fraction (HFpEF) were older and more likely to have a history of atrial fibrillation, valvular heart diseases, hypertension, chronic obstructive pulmonary, and atrial fibrillation (AF) on ECG. Patients with mildly reduced (HFmrEF) were more similar to HFpEF in older patients, comorbid with hypertension, AF and valvular diseases, and AF on ECG. CONCLUSIONS ECG characteristics might be related to left ventricular ejection fraction. Demographics, BNP/Pro-BNP, and ECG changes might help differentiate different heart failure types. Therefore, ECG might be a prognostic tool while caring for heart failure patients when highly skilled resources are unavailable. These identified ECG characteristics help generate research hypotheses and warrant validation in future research.
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Affiliation(s)
- Sunita Pokhrel Bhattarai
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States.
| | | | - Ying Xue
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States
| | - Darcey H Rodriguez
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States; University of Rochester Medical Center, United States
| | - Rebecca G Tucker
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States
| | - Mary G Carey
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States; University of Rochester Medical Center, United States
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Pagnesi M, Metra M, Cohen-Solal A, Edwards C, Adamo M, Tomasoni D, Lam CSP, Chioncel O, Diaz R, Filippatos G, Ponikowski P, Sliwa K, Voors AA, Kimmoun A, Novosadova M, Takagi K, Barros M, Damasceno A, Saidu H, Gayat E, Pang PS, Celutkiene J, Cotter G, Mebazaa A, Davison B. Uptitrating Treatment After Heart Failure Hospitalization Across the Spectrum of Left Ventricular Ejection Fraction. J Am Coll Cardiol 2023; 81:2131-2144. [PMID: 37257948 DOI: 10.1016/j.jacc.2023.03.426] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Acute heart failure (AHF) is associated with a poor prognosis regardless of left ventricular ejection fraction (LVEF). STRONG-HF showed the efficacy and safety of a strategy of rapid uptitration of oral treatment for heart failure (HF) and close follow-up (high-intensity care), compared with usual care, in patients recently hospitalized for AHF and enrolled independently from their LVEF. OBJECTIVES In this study, we sought to assess the impact of baseline LVEF on the effects of high-intensity care vs usual care in STRONG-HF. METHODS The STRONG-HF trial enrolled patients hospitalized for AHF with any LVEF and not treated with full doses of renin-angiotensin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists. High-intensity care with uptitration of oral medications was performed independently from LVEF. The primary endpoint was the composite of HF rehospitalization or all-cause death at day 180. RESULTS Among the 1,078 patients randomized, 731 (68%) had LVEF ≤40% and 347 (32%) had LVEF >40%. The treatment benefit of high-intensity care vs usual care on the primary endpoint was consistent across the whole LVEF spectrum (interaction P with LVEF as a continuous variable = 0.372). Mean difference in the EQ-5D visual analog scale change from baseline to day 90 between treatment arms was slightly greater at higher LVEF values, but with no interaction between LVEF as a continuous variable and the treatment strategy (interaction P = 0.358). Serious adverse events were also independent from LVEF. CONCLUSIONS Rapid uptitration of oral medications for HF and close follow-up reduce 180-day death and HF rehospitalization after AHF hospitalization independently from LVEF. (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-ProBNP Testing, of Heart Failure Therapies [STRONG-HF]; NCT03412201).
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Affiliation(s)
- Matteo Pagnesi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Alain Cohen-Solal
- Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Department of Cardiology, Lariboisière University Hospital, AP-HP Nord, Paris, France
| | | | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore; Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases "Prof C.C. Iliescu," University of Medicine "Carol Davila," Bucharest, Romania
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Gerasimos Filippatos
- School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine and Cardiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Antoine Kimmoun
- Université de Lorraine, INSERM, Défaillance Circulatoire Aigue et Chronique, and Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | | | - Koji Takagi
- Momentum Research, Durham, North Carolina, USA
| | | | | | - Hadiza Saidu
- Murtala Muhammed Specialist Hospital/Bayero University Kano, Kano, Nigeria
| | - Etienne Gayat
- Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, AP/HP Nord, Paris, France
| | - Peter S Pang
- Department of Emergency Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gad Cotter
- Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Momentum Research, Durham, North Carolina, USA
| | - Alexandre Mebazaa
- Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, AP/HP Nord, Paris, France
| | - Beth Davison
- Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Momentum Research, Durham, North Carolina, USA
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Sonaglioni A, Lonati C, Behring MT, Nicolosi GL, Lombardo M, Harari S. Ejection fraction at hospital admission stratifies mortality risk in HFmrEF patients aged ≥ 70 years: a retrospective analysis from a tertiary university institution. Aging Clin Exp Res 2023:10.1007/s40520-023-02454-3. [PMID: 37277547 PMCID: PMC10241373 DOI: 10.1007/s40520-023-02454-3] [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: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND During the last few years, increasing focus has been placed on heart failure with mildly reduced ejection fraction (HFmrEF), an intermediate phenotype from preserved to reduced ejection fraction (EF). However, clinical features and outcome of HFmrEF in elderly patients aged ≥ 70 yrs have been poorly investigated. METHODS The present study retrospectively included all consecutive patients aged ≥ 70 yrs discharged from our Institution with a first diagnosis of HFmrEF, between January 2020 and November 2020. All patients underwent transthoracic echocardiography. The primary outcome was all-cause mortality, while the secondary one was the composite of all-cause mortality + rehospitalization for all causes over a mid-term follow-up. RESULTS The study included 107 HFmrEF patients (84.3 ± 7.4 yrs, 61.7% females). Patients were classified as "old" (70-84 yrs, n = 55) and "oldest-old" (≥ 85 yrs, n = 52) and separately analyzed. As compared to the "oldest-old" patients, the "old" ones were more commonly males (58.2% vs 17.3%, p < 0.001), with history of coronary artery disease (CAD) (54.5% vs 15.4%, p < 0.001) and significantly lower EF (43.5 ± 2.7% vs 47.3 ± 3.6%, p < 0.001) at hospital admission. Mean follow-up was 1.8 ± 1.1 yrs. During follow-up, 29 patients died and 45 were re-hospitalized. Male sex (HR 6.71, 95% CI 1.59-28.4), history of CAD (HR 5.37, 95% CI 2.04-14.1) and EF (HR 0.48, 95% CI 0.34-0.68) were independently associated with all-cause mortality in the whole study population. EF also predicted the composite of all-cause mortality + rehospitalization for all causes. EF < 45% was the best cut-off value to predict both outcomes. CONCLUSIONS EF at hospital admission is independently associated with all-cause mortality and rehospitalization for all causes in elderly HFmrEF patients over a mid-term follow-up.
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Affiliation(s)
| | - Chiara Lonati
- Division of Internal Medicine, IRCCS MultiMedica, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy.
| | | | | | | | - Sergio Harari
- Division of Internal Medicine, IRCCS MultiMedica, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy
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Zhang X, Sun Y, Zhang Y, Wang N, Sha Q, Yu S, Lv X, Ding Z, Zhang Y, Tse G, Liu Y. Efficacy of guideline-directed medical treatment in heart failure with mildly reduced ejection fraction. ESC Heart Fail 2023; 10:1035-1042. [PMID: 36519802 PMCID: PMC10053349 DOI: 10.1002/ehf2.14199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/19/2022] [Accepted: 10/02/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS Heart failure with mildly reduced ejection fraction (HFmrEF) has received increasing attention following the publication of the latest ESC guidelines in 2021. However, it remains unclear whether patients with HFmrEF could benefit from guideline-directed medical treatment (GDMT), referring the combination of ACEI/ARB/ARNI, β-blockers, and MRAs, which are recommended for those with reduced ejection fraction. This study explored the efficacy of GDMT in HFmrEF patients. METHODS This was a retrospective cohort study of HFmrEF patients admitted to The First Affiliated Hospital of Dalian Medical University between 1 September 2015 and 30 November 2019. Propensity score matching (1:2) between patients receiving triple-drug therapy (TT) and non-triple therapy (NTT) based on age and sex was performed. The primary outcome was all cause death, cardiac death, rehospitalization from any cause, and rehospitalization due to worsening heart failure. RESULTS Of the 906 patients enrolled in the matched cohort (TT group, n = 302; NTT group, N = 604), 653 (72.08%) were male, and mean age was 61.1 ± 11.92. Survival analysis suggested that TT group experienced a significantly lower incidence of prespecified primary endpoints than NTT group. Multivariable Cox regression showed that TT group had a lower risk of all-cause mortality (HR 0.656, 95% CI 0.447-0.961, P = 0.030), cardiac death (HR 0.599, 95% CI 0.380-0.946, P = 0.028), any-cause rehospitalization (HR 0.687, 95% CI 0.541-0.872, P = 0.002), and heart failure rehospitalization (HR 0.732, 95% CI 0.565-0.948, P = 0.018). CONCLUSIONS In patients with HFmrEF, combined use of neurohormonal antagonists produces remarkable effects in reducing the occurrence of the primary outcome of rehospitalization and death. Thus, the treatment of HFmrEF should be categorized as HFrEF due to the similar benefit of neurohormonal blocking therapy in HFrEF and HFmrEF.
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Affiliation(s)
- Xinxin Zhang
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
| | - Yuxi Sun
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
- Department of Cardiology, West China HospitalSichuan UniversityChengduSichuan Province610041China
| | - Yunlong Zhang
- Department of Emergency Medicine, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing ChaoYang HospitalCapital Medical UniversityBeijing100020China
| | - Ning Wang
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
| | - Qiuyan Sha
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
| | - Songqi Yu
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
| | - Xin Lv
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
| | - Zijie Ding
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
| | - Yanli Zhang
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
| | - Gary Tse
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
- Kent and Medway Medical SchoolCanterburyKentCT2 7NTUK
| | - Ying Liu
- Heart Failure and Structural Cardiology WardThe First Affiliated Hospital of Dalian Medical UniversityDalianLiaoning Province116021China
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Kapłon-Cieślicka A, Benson L, Chioncel O, Crespo-Leiro MG, Coats AJS, Anker SD, Filippatos G, Ruschitzka F, Hage C, Drożdż J, Seferovic P, Rosano GMC, Piepoli M, Mebazaa A, McDonagh T, Lainscak M, Savarese G, Ferrari R, Maggioni AP, Lund LH. A comprehensive characterization of acute heart failure with preserved versus mildly reduced versus reduced ejection fraction - insights from the ESC-HFA EORP Heart Failure Long-Term Registry. Eur J Heart Fail 2022; 24:335-350. [PMID: 34962044 DOI: 10.1002/ejhf.2408] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/07/2021] [Accepted: 12/22/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS To perform a comprehensive characterization of acute heart failure (AHF) with preserved (HFpEF), versus mildly reduced (HFmrEF) versus reduced ejection fraction (HFrEF). METHODS AND RESULTS Of 5951 participants in the ESC HF Long-Term Registry hospitalized for AHF (acute coronary syndromes excluded), 29% had HFpEF, 18% HFmrEF, and 53% HFrEF. Hospitalization reasons were most commonly atrial fibrillation (more in HFmrEF and HFpEF), followed by ischaemia (HFmrEF), infection (HFmrEF and HFpEF), worsening renal function (HFrEF), and uncontrolled hypertension (HFmrEF and HFpEF). Hospitalization characteristics included lower blood pressure, more oedema and higher natriuretic peptides with lower ejection fraction, similar pulmonary congestion, more mitral regurgitation in HFrEF and HFmrEF and more tricuspid regurgitation in HFrEF. In-hospital mortality was 3.4% in HFrEF, 2.1% in HFmrEF and 2.2% in HFpEF. Intravenous diuretic (∼80%) and nitrate (∼15%) use was similar but inotrope use greater in HFrEF (16%, vs. HFmrEF 7.4% vs. HFpEF 5.3%). Weight loss and estimated glomerular filtration rate improvement were greater in HFrEF, whereas reduction in natriuretic peptides was similar. Over 1 year post-discharge, events per 100 patient-years (95% confidence interval) in HFrEF versus HFmrEF versus HFpEF were: all-cause death 22 (20-24) versus 17 (14-20) versus 17 (15-20); cardiovascular (CV) death 12 (10-13) versus 8.6 (6.6-11) versus 8.4 (6.9-10); non-CV death 2.4 (1.8-3.1) versus 3.3 (2.1-4.8) versus 4.5 (3.5-5.9); all-cause hospitalization 48 (45-51) versus 35 (31-40) versus 42 (39-46); HF hospitalization 29 (27-32) versus 19 (16-22) versus 17 (15-20); and non-CV hospitalization 7.7 (6.6-8.9) versus 9.6 (7.5-12) versus 15 (13-17). CONCLUSION In AHF, HFrEF is more severe and has greater in-hospital mortality. Post-discharge, HFrEF has greater CV risk, HFpEF greater non-CV risk, and HFmrEF lower overall risk.
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Affiliation(s)
| | - Lina Benson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu' and University of Medicine Carol Davila, Bucharest, Romania
| | - Maria G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna (CHUAC), INIBIC, UDC, CIBERCV, La Coruna, Spain
| | - Andrew J S Coats
- Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece, and University of Cyprus, School of Medicine, Shacolas Educational Centre for Clinical Medicine, Nicosia, Cyprus
| | - Frank Ruschitzka
- Department of Cardiology, University Clinic of Zurich, Zurich, Switzerland
| | - Camilla Hage
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jarosław Drożdż
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, and Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe M C Rosano
- St George's Hospitals NHS Trust University of London, University San Raffaele and IRCCS San Raffaele, Rome, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Alexandre Mebazaa
- Université de Paris, MASCOT, Inserm, and Department of Anesthesia, Burn and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | | | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Roberto Ferrari
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, and Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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9
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The Role of Deep Learning-Based Echocardiography in the Diagnosis and Evaluation of the Effects of Routine Anti-Heart-Failure Western Medicines in Elderly Patients with Acute Left Heart Failure. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4845792. [PMID: 34422243 PMCID: PMC8371608 DOI: 10.1155/2021/4845792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/13/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022]
Abstract
Objective The role of deep learning-based echocardiography in the diagnosis and evaluation of the effects of routine anti-heart-failure Western medicines was investigated in elderly patients with acute left heart failure (ALHF). Methods A total of 80 elderly patients with ALHF admitted to Affiliated Hangzhou First People's Hospital from August 2017 to February 2019 were selected as the research objects, and they were divided randomly into a control group and an observation group, with 40 cases in each group. Then, a deep convolutional neural network (DCNN) algorithm model was established, and image preprocessing was carried out. The binarized threshold segmentation was used for denoising, and the image was for illumination processing to balance the overall brightness of the image and increase the usable data of the model, so as to reduce the interference of subsequent feature extraction. Finally, the detailed module of deep convolutional layer network algorithm was realized. Besides, the patients from the control group were given routine echocardiography, and the observation group underwent echocardiography based on deep learning algorithm. Moreover, the hospitalization status of patients from the two groups was observed and recorded, including mortality rate, rehospitalization rate, average length of hospitalization, and hospitalization expenses. The diagnostic accuracy of the two examination methods was compared, and the electrocardiogram (ECG) and echocardiographic parameters as well as patients' quality of life were recorded in both groups at the basic state and 5 months after drug treatment. Results After comparison, the rehospitalization rate and mortality rate of the observation group were lower than the rates of the control group, but the diagnostic accuracy was higher than that of the control group. However, the difference between the two groups of patients was not statistically marked (P > 0.05). The length and expenses of hospitalization of the observation group were both less than those of the control group. The specificity, sensitivity, and accuracy of the examination methods in the observation group were higher than those of the control group, and the differences were statistically marked (P < 0.05). There was a statistically great difference between the interventricular delay (IVD) of the echocardiographic parameters of patients from the two groups at the basic state and the left ventricular electromechanical delay (LVEMD) parameter values after 5 months of treatment (P < 0.05), but there was no significant difference in the other parameters. After treatment, the quality of life of patients from the two groups was improved, while the observation group was more marked than the control group (P < 0.05). Conclusion Echocardiography based on deep learning algorithm had high diagnostic accuracy and could reduce the possibility of cardiovascular events in patients with heart failure, so as to decrease the mortality rate and diagnosis and treatment costs. Moreover, it had an obvious diagnostic effect, which was conducive to the timely detection and treatment of clinical diseases.
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10
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Zhang X, Sun Y, Zhang Y, Chen F, Zhang S, He H, Song S, Tse G, Liu Y. Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis. Front Cardiovasc Med 2021; 8:697221. [PMID: 34409076 PMCID: PMC8364975 DOI: 10.3389/fcvm.2021.697221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/29/2021] [Indexed: 01/21/2023] Open
Abstract
Aims: Evidence-based guidelines for heart failure management depend mainly on current left ventricular ejection fraction (LVEF). However, fewer studies have examined the impact of prior LVEF. Patients may enter the heart failure with midrange ejection fraction (HFmrEF) category when heart failure with preserved ejection fraction (HFpEF) deteriorates or heart failure with reduced ejection fraction (HFrEF) improves. In this study, we examined the association between change in LVEF and adverse outcomes. Methods: HFmrEF patients with at least two or more echocardiograms 3 months apart at the First Affiliated Hospital of Dalian Medical University between September 1, 2015 and November 30, 2019 were identified. According to the prior LVEF, the subjects were divided into improved group (prior LVEF < 40%), stable group (prior LVEF between 40 and 50%), and deteriorated group (prior LVEF ≥ 50%). The primary outcomes were cardiovascular death, all-cause mortality, hospitalization for worsening heart failure, and composite event of all-cause mortality or all-cause hospitalization. Results: A total of 1,168 HFmrEF patients (67.04% male, mean age 63.60 ± 12.18 years) were included. The percentages of improved, stable, and deteriorated group were 310 (26.54%), 334 (28.60%), and 524 (44.86%), respectively. After a period of follow-up, 208 patients (17.81%) died and 500 patients met the composite endpoint. The rates of all-cause mortality were 35 (11.29%), 55 (16.47%), and 118 (22.52%), and the composite outcome was 102 (32.90%), 145 (43.41%), and 253 (48.28%) for the improved, stable, and deteriorated groups, respectively. Cox regression analysis showed that the deterioration group had higher risk of cardiovascular death (HR: 1.707, 95% CI: 1.064–2.739, P = 0.027), all-cause death (HR 1.948, 95% CI 1.335–2.840, P = 0.001), and composite outcome (HR 1.379, 95% CI 1.096–1.736, P = 0.006) compared to the improvement group. The association still remained significant after fully adjusted for both all-cause mortality (HR = 1.899, 95% CI 1.247–2.893, P = 0.003) and composite outcome (HR: 1.324, 95% CI: 1.020–1.718, P = 0.035). Conclusion: HFmrEF patients are heterogeneous with three different subsets identified, each with different outcomes. Strategies for managing HFmrEF should include previously measured LVEF to allow stratification based on direction changes in LVEF to better optimize treatment.
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Affiliation(s)
- Xinxin Zhang
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuxi Sun
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanli Zhang
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Feifei Chen
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuyuan Zhang
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongyan He
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuang Song
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Kent and Medway Medical School, Canterbury, United Kingdom
| | - Ying Liu
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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11
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Zhou Q, Li P, Zhao H, Xu X, Li S, Zhao J, Xu D, Zeng Q. Heart Failure With Mid-range Ejection Fraction: A Distinctive Subtype or a Transitional Stage? Front Cardiovasc Med 2021; 8:678121. [PMID: 34113665 PMCID: PMC8185203 DOI: 10.3389/fcvm.2021.678121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/29/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure with mid-range ejection fraction (HFmrEF) was first proposed by Lam and Solomon in 2014, and was listed as a new subtype of heart failure (HF) in 2016 European Society of Cardiology guidelines. Since then, HFmrEF has attracted an increasing amount of attention, and the number of related studies on this topic has grown rapidly. The diagnostic criteria on the basis of left ventricular ejection fraction (LVEF) are straightforward; however, LVEF is not a static parameter, and it changes dynamically during the course of HF. Thus, HFmrEF may not be an independent disease with a uniform pathophysiological process, but rather a collection of patients with different characteristics. HFmrEF is often associated with various cardiovascular and non-cardiovascular diseases. Thus, the pathophysiological mechanisms of HFmrEF are particularly complex, and its clinical phenotypes are diverse. The complexity and heterogeneity of HFmrEF may be one reason for inconsistent results between clinical studies. In fact, whether HFmrEF is a distinctive subtype or a transitional stage between HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) is controversial. In this review, we discuss the clinical characteristics, treatment and prognosis of patients with HFmrEF, as well as the differences among HFmrEF, HFrEF, and HFpEF.
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Affiliation(s)
- Qing Zhou
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China.,Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Peixin Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Hengli Zhao
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Xingbo Xu
- Department of Cardiology and Pneumology, University Medical Center of Göttingen, Georg-August-University, Göttingen, Germany
| | - Shaoping Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China
| | - Jing Zhao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
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12
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Palazzuoli A, Beltrami M. Are HFpEF and HFmrEF So Different? The Need to Understand Distinct Phenotypes. Front Cardiovasc Med 2021; 8:676658. [PMID: 34095263 PMCID: PMC8175976 DOI: 10.3389/fcvm.2021.676658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
Traditionally, patients with heart failure (HF) are divided according to ejection fraction (EF) threshold more or <50%. In 2016, the ESC guidelines introduced a new subgroup of HF patients including those subjects with EF ranging between 40 and 49% called heart failure with midrange EF (HFmrEF). This group is poorly represented in clinical trials, and it includes both patients with previous HFrEF having a good response to therapy and subjects with initial preserved EF appearance in which systolic function has been impaired. The categorization according to EF has recently been questioned because this variable is not really a representative of the myocardial contractile function and it could vary in relation to different hemodynamic conditions. Therefore, EF could significantly change over a short-term period and its measurement depends on the scan time course. Finally, although EF is widely recognized and measured worldwide, it has significant interobserver variability even in the most accredited echo laboratories. These assumptions imply that the same patient evaluated in different periods or by different physicians could be classified as HFmrEF or HFpEF. Thus, the two HF subtypes probably subtend different responses to the underlying pathophysiological mechanisms. Similarly, the adaptation to hemodynamic stimuli and to metabolic alterations could be different for different HF stages and periods. In this review, we analyze similarities and dissimilarities and we hypothesize that clinical and morphological characteristics of the two syndromes are not so discordant.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital University of Siena, Siena, Italy
| | - Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Florence, Italy
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13
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Takabayashi K, Kitaguchi S, Yamamoto T, Fujita R, Takenaka K, Takenaka H, Okuda M, Nakajima O, Koito H, Terasaki Y, Kitamura T, Nohara R. Association Between Physical Status and the Effects of Combination Therapy With Renin-Angiotensin System Inhibitors and β-Blockers in Patients With Acute Heart Failure. Circ Rep 2021; 3:217-226. [PMID: 33842727 PMCID: PMC8024019 DOI: 10.1253/circrep.cr-20-0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 11/09/2022] Open
Abstract
Background: This study investigated whether combination therapy (CT) with renin-angiotensin system inhibitors and β-blockers improved endpoints in acute heart failure (AHF). Methods and Results: AHF patients were recruited to this prospective multicenter cohort study between April 2015 and August 2017. Patients were divided into 3 categories based on ejection fraction (EF), namely heart failure (HF) with reduced EF (HFrEF), HF with midrange EF (HFmrEF), and HF with preserved EF (HFpEF), and a further into 2 groups according to physical status (those who could walk independently outdoors and those who could not). The composite endpoint included all-cause mortality and hospitalization for HF. Data at the 1-year follow-up were available for 1,018 patients. The incidence of the composite endpoint was significantly lower in the CT than non-CT group for HFrEF patients, but not among HFmrEF and HFpEF patients. For patients who could walk independently outdoors, a significantly lower rate of the composite endpoint was recorded only in the HFrEF group. The differences were maintained even after adjustment for comorbidities and prescriptions, with hazard ratios (95% confidence intervals) of 0.39 (0.20-0.76) and 0.48 (0.22-0.99), respectively. Conclusions: In this study, CT was associated with the prevention of adverse outcomes in patients with HFrEF. Moreover, CT prevented adverse events only among patients without a physical disorder, not among those with a physical disorder.
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Affiliation(s)
| | | | | | - Ryoko Fujita
- Department of Cardiology, Hirakata Kohsai Hospital Osaka Japan
| | - Kotoe Takenaka
- Department of Cardiology, Hirakata Kohsai Hospital Osaka Japan
| | | | - Miyuki Okuda
- Department of Internal Medicine, Osaka Hospital Osaka Japan
| | - Osamu Nakajima
- Department of Cardiology, Hirakata City Hospital Osaka Japan
| | - Hitoshi Koito
- Department of Cardiology, Otokoyama Hospital Kyoto Japan
| | - Yuka Terasaki
- Department of Internal Medicine, Arisawa General Hospital Osaka Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University Osaka Japan
| | - Ryuji Nohara
- Department of Cardiology, Hirakata Kohsai Hospital Osaka Japan
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14
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Petersen LC, Danzmann LC, Bartholomay E, Bodanese LC, Donay BG, Magedanz EH, Azevedo AV, Porciuncula GF, Miglioranza MH. Survival of Patients with Acute Heart Failure and Mid-range Ejection Fraction in a Developing Country - A Cohort Study in South Brazil. Arq Bras Cardiol 2021; 116:14-23. [PMID: 33566960 PMCID: PMC8159506 DOI: 10.36660/abc.20190427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Heart Failure with mid-range Ejection Fraction (HFmEF) was recently described by European and Brazilian guidelines on Heart Failure (HF). The ejection fraction (EF) is an important parameter to guide therapy and prognosis. Studies have shown conflicting results without representative data from developing countries. OBJECTIVE To analyze and compare survival rate in patients with HFmEF, HF patients with reduced EF (HFrEF), and HF patients with preserved EF (HFpEF), and to evaluate the clinical characteristics of these patients. METHODS A cohort study that included adult patients with acute HF admitted through the emergency department to a tertiary hospital, reference in cardiology, in south Brazil from 2009 to 2011. The sample was divided into three groups according to EF: reduced, mid-range and preserved. A Kaplan-Meier curve was analyzed according to the EF, and a logistic regression analysis was done. Statistical significance was established as p < 0.05. RESULTS A total of 380 patients were analyzed. Most patients had HFpEF (51%), followed by patients with HFrEF (32%) and HFmEF (17%). Patients with HFmEF showed intermediate characteristics related to age, blood pressure and ventricular diameters, and most patients were of ischemic etiology. Median follow-up time was 4.0 years. There was no statistical difference in overall survival or cardiovascular mortality (p=.0031) between the EF groups (reduced EF: 40.5% mortality; mid-range EF 39.7% and preserved EF 26%). Hospital mortality was 7.6%. CONCLUSION There was no difference in overall survival rate between the EF groups. Patients with HFmEF showed higher mortality from cardiovascular diseases in comparison with HFpEF patients. (Arq Bras Cardiol. 2021; 116(1):14-23).
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Affiliation(s)
- Lucas Celia Petersen
- Hospital São Lucas, Porto Alegre, RS - Brasil.,Hospital Universitário da Universidade Luterana do Brasil, Canoas, RS - Brasil.,Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Luiz Claudio Danzmann
- Hospital São Lucas, Porto Alegre, RS - Brasil.,Hospital Universitário da Universidade Luterana do Brasil, Canoas, RS - Brasil
| | - Eduardo Bartholomay
- Hospital São Lucas, Porto Alegre, RS - Brasil.,Hospital Universitário da Universidade Luterana do Brasil, Canoas, RS - Brasil
| | | | | | | | | | | | - Marcelo Haertel Miglioranza
- Instituto de Cardiologia do Rio Grande do Sul - Laboratório de Pesquisa e Inovação em Imagem Cardiovascular, Porto Alegre, RS - Brasil.,Prevencor - Hospital Mãe de Deus, Porto Alegre, RS - Brasil
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15
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Koufou EE, Arfaras-Melainis A, Rawal S, Kalogeropoulos AP. Treatment of Heart Failure with Mid-Range Ejection Fraction: What Is the Evidence. J Clin Med 2021; 10:E203. [PMID: 33429888 PMCID: PMC7827304 DOI: 10.3390/jcm10020203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
In this review, we briefly outline our current knowledge on the epidemiology, outcomes, and pathophysiology of heart failure (HF) with mid-range ejection fraction (HFmrEF), and discuss in more depth the evidence on current treatment options for this group of patients. In most studies, the clinical background of patients with HFmrEF is intermediate between that of patients with HF and reduced ejection fraction (HFrEF) and patients with HF and preserved ejection fraction (HFpEF) in terms of demographics and comorbid conditions. However, the current evidence, stemming from observational studies and post hoc analyses of randomized controlled trials, suggests that patients with HFmrEF benefit from medications that target the neurohormonal axes, a pathophysiological behavior that resembles that of HFrEF. Use of β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and sacubitril/valsartan is reasonable in patients with HFmrEF, whereas evidence is currently scarce for other therapies. In clinical practice, patients with HFmrEF are treated more like HFrEF patients, potentially because of history of systolic dysfunction that has partially recovered. Assessment of left ventricular systolic function with contemporary noninvasive modalities, e.g., echocardiographic strain imaging, is promising for the selection of patients with HFmrEF who will benefit from neurohormonal antagonists and other HFrEF-targeted therapies.
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Affiliation(s)
| | - Angelos Arfaras-Melainis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA;
| | - Sahil Rawal
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY 11794, USA;
| | - Andreas P. Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY 11794, USA
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16
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Lombardi C, Peveri G, Cani D, Latta F, Bonelli A, Tomasoni D, Sbolli M, Ravera A, Carubelli V, Saccani N, Specchia C, Metra M. In-hospital and long-term mortality for acute heart failure: analysis at the time of admission to the emergency department. ESC Heart Fail 2020; 7:2650-2661. [PMID: 32588981 PMCID: PMC7524058 DOI: 10.1002/ehf2.12847] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Acute heart failure (AHF) leads to a drastic increase in mortality and rehospitalization. The aim of the study was to identify prognostic variables in a real-life population of AHF patients admitted to the emergency department with acute shortness of breath. METHODS AND RESULTS We evaluated potential predictors of mortality in 728 consecutive patients admitted to the emergency department with AHF. Possible predictors of all-cause and cardiovascular (CV) mortality were investigated by Cox and Fine and Gray models at multivariable analysis. Among the 728 patients, 256 died during the entire follow-up, 142 of these due to CV cause. The 1 year mortality rate was 20%, with the highest risk of death during the index hospitalization (with 8% estimate in-hospital mortality at 30 days). A higher risk of events during the index hospitalization was more evident for the CV deaths, for which we found a cumulative 1 year incidence of 12% with a cumulative incidence in the first 30 days of hospitalization of about 5%. At multivariable analysis, age (P < 0.001), New York Heart Association (NYHA) class IV vs. I-II-III (P = 0.001), systolic blood pressure (P < 0.001), non-cardiac co-morbidities (≥3 vs. 0, P = 0.05), oxygen saturation (P = 0.03), serum creatinine (P < 0.001), and left ventricular ejection fraction (LVEF) (40-49% vs. <40%, P = 0.004; ≥50% vs. <40%, P = 0.003) were independent predictors of all-cause mortality during the entire follow-up. Age (P = 0.03), systolic blood pressure (P = 0.01), oxygen saturation (P = 0.03), serum creatinine (P = 0.02), and LVEF (40-49% vs. <40%, P = 0.03; ≥50% vs. <40%, P = 0.004) were independent predictors of CV mortality during the entire follow-up. NYHA class IV vs. I-II-III (P < 0.001), serum creatinine (P = 0.01), and LVEF (40-49% vs. <40%, P = 0.02; ≥50% vs. <40%, P < 0.001) remained independent predictors for in-hospital death, while only serum creatinine (P = 0.04), LVEF (40-49% vs. <40%: 0.32, P = 0.04; ≥50% vs. <40%, P < 0.001), and NYHA class vs. I-II-III (P = 0.02) remained predictors for in-hospital CV mortality. CONCLUSIONS In this real-life cohort of patients with AHF, the results showed a similar mortality rate comparing with other analysis and with the most important registries. Age, NYHA class IV, systolic blood pressure, creatinine levels, sodium levels, and ejection fraction were independent predictors of 1 year mortality, while LVEF <40% was the only predictor of both all-cause mortality and CV mortality.
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Affiliation(s)
- Carlo Lombardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
| | - Giulia Peveri
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Dario Cani
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
| | - Federica Latta
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
| | - Andrea Bonelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
| | - Daniela Tomasoni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
| | - Marco Sbolli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
| | - Alice Ravera
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
| | - Valentina Carubelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
| | - Nicola Saccani
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
| | - Claudia Specchia
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health UniversityUniversity of Brescia Spedali Civili of BresciaBresciaItaly
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Xu HX, Zhu YM, Hua Y, Huang YH, Lu Q. Association between atrial fibrillation and heart failure with different ejection fraction categories and its influence on outcomes. Acta Cardiol 2020; 75:423-432. [PMID: 31141463 DOI: 10.1080/00015385.2019.1610834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The important role of atrial fibrillation (AF) in different types of heart failure (HF) according to ejection fraction (EF) is much less explored. In this study, we compared AF in HF with preserved (HFpEF), mid-range (HFmrEF) and reduced (HFrEF) EF with regard to prevalence, association, and prognostic role.Methods and results: A total of 405 inpatients with HF between February 2014 and June 2016 were prospectively analysed in this study. Patients were divided into three groups: HFrEF group (n = 109, 26.9%), HFmrEF group (n = 94, 23.2%), and HFpEF group (n = 202, 49.8%). There was a higher prevalence of AF in patients in the HFpEF and HFmrEF groups than in patients in the HFrEF. Several baseline variables were found to be independently associated with AF, including age, coronary heart disease, heart rate, left atrial diameter, and left ventricular (LV) end-diastolic diameter, regardless of EF category after multivariable adjustment. In addition, AF was found to be a more powerful predictor of all-cause mortality, HF rehospitalisation, and the composite event of all-cause mortality or rehospitalisation in HFpEF and HFmrEF patients, but not in HFrEF patients.Conclusions: HFmrEF resembled HFpEF rather than HFrEF with regard to both a higher prevalence of AF and a greater risk of all-cause mortality, HF rehospitalisation, and the composite event of all-cause mortality or rehospitalisation.
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Affiliation(s)
- Hai-Xia Xu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
| | - Yan-Min- Zhu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
| | - Ying Hua
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
| | - Yin-Hao Huang
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
| | - Qi Lu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, PR China
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Velagaleti RS, Larson MG, Enserro D, Song RJ, Vasan RS. Clinical course after a first episode of heart failure: insights from the Framingham Heart Study. Eur J Heart Fail 2020; 22:1768-1776. [DOI: 10.1002/ejhf.1918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/21/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Raghava S. Velagaleti
- Framingham Heart Study Framingham MA USA
- Cardiology Section, Department of Medicine Boston VA Healthcare System West Roxbury MA USA
| | - Martin G. Larson
- Framingham Heart Study Framingham MA USA
- Department of Mathematics and Statistics Boston University Boston MA USA
| | - Danielle Enserro
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics Roswell Park Comprehensive Cancer Center Buffalo NY USA
| | - Rebecca J. Song
- Department of Epidemiology Boston University School of Public Health Boston MA USA
| | - Ramachandran S. Vasan
- Framingham Heart Study Framingham MA USA
- Preventive Medicine and Cardiology Sections, Department of Medicine, School of Medicine, and Department of Epidemiology, School of Public Health Boston University Boston MA USA
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Abstract
Heart failure is associated with a range of comorbidities that have the potential to impair both quality of life and clinical outcome. Unfortunately, noncardiac diseases are underrepresented in large randomized clinical trials, and their management remains poorly understood. In clinical practice, the prevalence of comorbidities in heart failure is high. Although the prognostic impact of comorbidities is well known, their prevalence and impact in specific heart failure settings have been overlooked. Many studies have described specific single noncardiac conditions, but few have examined their overall burden and grading in patients with multiple comorbidities. The risk of comorbidities in patients with heart failure rises with more advanced disease, older age, and increased frailty-three conditions that are poorly represented in clinical trials. The pathogenic links between comorbidities and heart failure involve many pathways and include neurohormonal overdrive, inflammatory activation, oxidative stress, and endothelial dysfunction. Such interactions may worsen prognoses, but details of these relationships are still under investigation. We propose a shift from cardiac-focused care to a more systemic approach that considers all noncardiac diseases and related medications. Some new drugs class such as ARNI or SGLT2 inhibitors could change prognosis by acting directly or indirectly on metabolic disorders and related vascular consequences.
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20
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Special prognostic phenomenon for patients with mid-range ejection fraction heart failure: a systematic review and meta-analysis. Chin Med J (Engl) 2020; 133:452-461. [PMID: 31985503 PMCID: PMC7046254 DOI: 10.1097/cm9.0000000000000653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Clinical features and outcomes of heart failure (HF) with mid-range ejection fraction (HFmrEF) remain controversial. Thus, we systematically reviewed literatures of clinical research to assess and analyze characteristics and prognosis of patients with HFmrEF. METHODS PubMed, Embase, and Web of Science were searched for cohort studies up to April 23, 2019. Clinical features and multivariate adjusted hazard ratios (HRs) of endpoints of short-term all-cause mortality (SAM), long-term all-cause mortality (LAM), long-term cardiovascular death (LCD) and long-term HF rehospitalization (LHR) among patients with HFmrEF and HF with preserved ejection fraction (HFpEF), HF with reduced ejection fraction (HFrEF) were well addressed. The primary outcome was LAM. RESULTS Totally 19 studies were included in this study with 164,678 patients enrolled. The follow-up time of LAM was 3.6 ± 2.5 years. HRs of LAM, SAM, LCD, LHR indicated that the risks of patients with HFmrEF were higher than HFpEF patients but lower than HFrEF patients, as for LAM, HFmrEF:HFpEF (reference) HR: 1.07, 95% confidence interval (CI): 1.00-1.15 (I = 63%, P = 0.0005); HFmrEF:HFrEF (reference) HR: 0.80, 95% CI: 0.73-0.88 (I = 70%, P < 0.0001). However, HFmrEF patients had the lowest rate in LAM (30.94%), SAM (2.73%), LCD (17.45%), LHR (26.36%) compared with the other two groups. CONCLUSIONS This systematic review and meta-analysis compared features and prognosis between patients with HFmrEF and HFpEF, HFrEF by HRs. There appeared a special "separation phenomenon" showing rates of endpoints were inconsistent with their hazards in patients with HFmrEF compared with HFpEF patients.
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21
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Sinan U, Gurbuz D, Celik O, Cakmak H, Kilic S, Inci S, Gok G, Kucukokglu M, Zoghi M. The clinical characteristics of acute heart failure patients with mid-range ejection fraction in Turkey: A subgroup analysis from journey HF-TR study. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2020. [DOI: 10.4103/ijca.ijca_43_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Gender disparities in heart failure with mid-range and preserved ejection fraction: Results from APOLLON study. Anatol J Cardiol 2019; 21:242-252. [PMID: 31062760 PMCID: PMC6528519 DOI: 10.14744/anatoljcardiol.2019.71954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: This study aimed to examine gender-based differences in epidemiology, clinical characteristics, and management of consecutive patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Methods: The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is a multicenter, cross-sectional, and observational study. Consecutive patients with HFmrEF or HFpEF who were admitted to the cardiology clinics were included (NCT03026114). Herein, we performed a post-hoc analysis of data from the APOLLON trial. Results: The study population included 1065 (mean age of 67.1±10.6 years, 54% women) patients from 11 sites in Turkey. Compared with men, women were older (68 years vs. 67 years, p<0.001), had higher body mass index (29 kg/m2 vs. 27 kg/m2, p<0.001), and had higher heart rate (80 bpm vs. 77.5 bpm, p<0.001). Women were more likely to have HFpEF (82% vs. 70.9%, p<0.001), and they differ from men having a higher prevalence of hypertension (78.7% vs. 73.2%, p=0.035) and atrial fibrillation (40.7% vs. 29.9%, p<0.001) but lower prevalence of coronary artery disease (29.5% vs. 54.9%, p<0.001). Women had higher N-terminal pro-B-type natriuretic peptide (691 pg/mL vs. 541 pg/mL, p=0.004), lower hemoglobin (12.7 g/dL vs. 13.8 g/dL, p<0.001), and serum ferritin (51 ng/mL vs. 64 ng/mL, p=0.001) levels, and they had worse diastolic function (E/e’=10 vs. 9, p<0.001). The main cause of heart failure (HF) in women was atrial fibrillation, while it was ischemic heart disease in men. Conclusion: Clinical characteristics, laboratory findings, and etiological factors are significantly different in female and male patients with HFmrEF and HFpEF. This study offers a broad perspective for increased awareness about this patient profile in Turkey.
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23
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Cameli M, Pastore MC, De Carli G, Henein MY, Mandoli GE, Lisi E, Cameli P, Lunghetti S, D’Ascenzi F, Nannelli C, Rizzo L, Valente S, Mondillo S. ACUTE HF score, a multiparametric prognostic tool for acute heart failure: A real-life study. Int J Cardiol 2019; 296:103-108. [DOI: 10.1016/j.ijcard.2019.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 12/20/2022]
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CMR Tissue Characterization in Patients with HFmrEF. J Clin Med 2019; 8:jcm8111877. [PMID: 31694263 PMCID: PMC6912482 DOI: 10.3390/jcm8111877] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/19/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022] Open
Abstract
The characteristics and optimal management of heart failure with a moderately reduced ejection fraction (HFmrEF, LV-EF 40–50%) are still unclear. Advanced cardiac MRI offers information about function, fibrosis and inflammation of the myocardium, and might help to characterize HFmrEF in terms of adverse cardiac remodeling. We, therefore, examined 17 patients with HFpEF, 18 with HFmrEF, 17 with HFrEF and 17 healthy, age-matched controls with cardiac MRI (Phillips 1.5 T). T1 and T2 relaxation time mapping was performed and the extracellular volume (ECV) was calculated. Global circumferential (GCS) and longitudinal strain (GLS) were derived from cine images. GLS (−15.7 ± 2.1) and GCS (−19.9 ± 4.1) were moderately reduced in HFmrEF, resembling systolic dysfunction. Native T1 relaxation times were elevated in HFmrEF (1027 ± 40 ms) and HFrEF (1033 ± 54 ms) compared to healthy controls (972 ± 31 ms) and HFpEF (985 ± 32 ms). T2 relaxation times were elevated in HFmrEF (55.4 ± 3.4 ms) and HFrEF (56.0 ± 6.0 ms) compared to healthy controls (50.6 ± 2.1 ms). Differences in ECV did not reach statistical significance. HFmrEF differs from healthy controls and shares similarities with HFrEF in cardiac MRI parameters of fibrosis and inflammation.
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25
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Pollesello P, Ben Gal T, Bettex D, Cerny V, Comin-Colet J, Eremenko AA, Farmakis D, Fedele F, Fonseca C, Harjola VP, Herpain A, Heringlake M, Heunks L, Husebye T, Ivancan V, Karason K, Kaul S, Kubica J, Mebazaa A, Mølgaard H, Parissis J, Parkhomenko A, Põder P, Pölzl G, Vrtovec B, Yilmaz MB, Papp Z. Short-Term Therapies for Treatment of Acute and Advanced Heart Failure-Why so Few Drugs Available in Clinical Use, Why Even Fewer in the Pipeline? J Clin Med 2019; 8:jcm8111834. [PMID: 31683969 PMCID: PMC6912236 DOI: 10.3390/jcm8111834] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 01/10/2023] Open
Abstract
Both acute and advanced heart failure are an increasing threat in term of survival, quality of life and socio-economical burdens. Paradoxically, the use of successful treatments for chronic heart failure can prolong life but-per definition-causes the rise in age of patients experiencing acute decompensations, since nothing at the moment helps avoiding an acute or final stage in the elderly population. To complicate the picture, acute heart failure syndromes are a collection of symptoms, signs and markers, with different aetiologies and different courses, also due to overlapping morbidities and to the plethora of chronic medications. The palette of cardio- and vasoactive drugs used in the hospitalization phase to stabilize the patient's hemodynamic is scarce and even scarcer is the evidence for the agents commonly used in the practice (e.g. catecholamines). The pipeline in this field is poor and the clinical development chronically unsuccessful. Recent set backs in expected clinical trials for new agents in acute heart failure (AHF) (omecamtiv, serelaxine, ularitide) left a field desolately empty, where only few drugs have been approved for clinical use, for example, levosimendan and nesiritide. In this consensus opinion paper, experts from 26 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, The Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Turkey, U.K. and Ukraine) analyse the situation in details also by help of artificial intelligence applied to bibliographic searches, try to distil some lesson-learned to avoid that future projects would make the same mistakes as in the past and recommend how to lead a successful development project in this field in dire need of new agents.
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Affiliation(s)
| | - Tuvia Ben Gal
- Heart Failure Unit, Rabin Medical Center, Tel Aviv University, Petah Tikva 4941492d, Israel.
| | - Dominique Bettex
- Institute of Anaesthesiology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Vladimir Cerny
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital, J.E. Purkinje University, 400 96 Usti nad Labem, Czech Republic.
| | - Josep Comin-Colet
- Heart Diseases Institute, Hospital Universitari de Bellvitge, 08015 Barcelona, Spain.
| | - Alexandr A Eremenko
- Department of Cardiac Intensive Care, Petrovskii National Research Centre of Surgery, Sechenov University, 119146 Moscow, Russia.
| | - Dimitrios Farmakis
- Department of Cardiology, Medical School, University of Cyprus, 1678 Nicosia, Cyprus.
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, 'La Sapienza' University of Rome, 00185 Rome, Italy.
| | - Cândida Fonseca
- Heart Failure Clinic of S. Francisco Xavier Hospital, CHLO, 1449-005 Lisbon, Portugal.
| | - Veli-Pekka Harjola
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland.
| | - Antoine Herpain
- Department of Intensive Care, Experimental Laboratory of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1050 Bruxelles, Belgium.
| | - Matthias Heringlake
- Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, 23562 Lübeck, Germany.
| | - Leo Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, location VUmc 081 HV, The Netherlands.
| | - Trygve Husebye
- Department of Cardiology, Oslo University Hospital Ullevaal, 0372 Oslo, Norway.
| | - Visnja Ivancan
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Centre, 10000 Zagreb, Croatia.
| | - Kristian Karason
- Transplant Institute, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
| | - Sundeep Kaul
- Intensive Care Unit, National Health Service, Leeds LS2 9JT, UK.
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, 87-100 Torun, Poland.
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Université de Paris and INSERM UMR-S 942-MASCOT, 75010 Paris, France.
| | - Henning Mølgaard
- Department of Cardiology, Århus University Hospital, 8200 Århus, Denmark.
| | - John Parissis
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece.
| | - Alexander Parkhomenko
- Emergency Cardiology Department, National Scientific Center M.D. Strazhesko Institute of Cardiology, 02000 Kiev, Ukraine.
| | - Pentti Põder
- Department of Cardiology, North Estonia Medical Center, 13419 Tallinn, Estonia.
| | - Gerhard Pölzl
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| | - Bojan Vrtovec
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, Ljubljana University Medical Center, SI-1000 Ljubljana, Slovenia.
| | - Mehmet B Yilmaz
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, 35340 Izmir, Turkey.
| | - Zoltan Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
- HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, 4001 Debrecen, Hungary.
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Omersa D, Erzen I, Lainscak M, Farkas J. Regional differences in heart failure hospitalizations, mortality, and readmissions in Slovenia 2004-2012. ESC Heart Fail 2019; 6:965-974. [PMID: 31264804 PMCID: PMC6816070 DOI: 10.1002/ehf2.12488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/26/2019] [Accepted: 06/01/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Heart failure (HF) burden is displaying significant inter-regional differences within Europe and within countries. Due to limited data focusing on regional differences, our aim was to evaluate HF hospitalizations, readmissions, and mortality burden in Slovenian statistical regions. METHODS AND RESULTS The Slovenian National Hospitalization Discharge Registry was searched for HF hospitalizations in patients 20 years or over in the period 2004-12. Annual sex and age-standardized HF hospitalizations, mortality, and HF readmissions rates were calculated for Slovenia and for each Slovenian statistical region. Trends were evaluated using ANOVA. Multiple mixed effect logistic regression models, which included statistical region, admission year, sex, age, intensive care unit treatment, and co-morbidities as a fixed effect and hospital identifier as a random effect, were calculated for mortality and readmissions. Overall, 156 859 HF hospitalizations (55 522 where HF was coded as a main diagnosis and 43 606 as first HF hospitalizations) were recorded. Annual standardized rates varied considerably between statistical regions for main (220-511) and first HF hospitalization (392-721), 30 day (12.6-27.1) and 1 year mortality (66-117), and 30 day (31-80.8) and 1 year readmission (99-24) (per 100 000 patient years in 2012). Yearly decline in HF hospitalization rates was seen for national main (3.6; 0.001) and first (8.4; 0.083) HF hospitalizations, while individual regional main and first HF hospitalization trends mostly did not reach statistical significance. No relevant differences in mortality and readmission endpoints for statistical regions were seen when adjusted for patient demographics and specific co-morbidities. CONCLUSIONS Significant regional differences in standardized HF hospitalization, mortality, and readmissions between the regions were seen. There were no differences in mortality and readmissions between statistical regions for individual similar patients.
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Affiliation(s)
- Daniel Omersa
- General Hospital JeseniceJeseniceSlovenia
- General Hospital Murska SobotaUlica dr. Vrbnjaka 6, Rakican9000Murska SobotaSlovenia
| | - Ivan Erzen
- National Institute of Public HealthLjubljanaSlovenia
| | - Mitja Lainscak
- General Hospital Murska SobotaUlica dr. Vrbnjaka 6, Rakican9000Murska SobotaSlovenia
- Faculty of Medicine, University of LjubljanaLjubljanaSlovenia
| | - Jerneja Farkas
- National Institute of Public HealthLjubljanaSlovenia
- General Hospital Murska SobotaUlica dr. Vrbnjaka 6, Rakican9000Murska SobotaSlovenia
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Mesquita ET, Barbetta LMDS, Correia ETDO. Heart Failure with Mid-Range Ejection Fraction - State of the Art. Arq Bras Cardiol 2019; 112:784-790. [PMID: 31314831 PMCID: PMC6636372 DOI: 10.5935/abc.20190079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/13/2019] [Indexed: 12/30/2022] Open
Abstract
In 2016, the European Society of Cardiology (ESC) recognized heart failure (HF) with ejection fraction between 40 and 49% as a new HF phenotype, HF with mid-range ejection fraction (HFmrEF), with the main purpose of encouraging studies on this new category. In 2018, the Brazilian Society of Cardiology adhered to this classification and introduced HFmrEF in Brazil. This paper presents a narrative review of what the literature has described about HFmrEF. The prevalence of patients with HFmrEF ranged from 13 to 24% of patients with HF. Analyzing the clinical characteristics, HFmrEF shows intermediate characteristics or is either similar to HF with preserved ejection fraction (HFpEF) or to HF with reduced fraction (HFrEF). Regarding the prognosis, HFmrEF's all-cause mortality is similar to HFpEF's and lower than HFrEF's. Studies that analyzed cardiac mortality concluded that there was no significant difference between HFmrEF and HFrEF, both of which were lower than HFpEF. Despite the significant increase of publications on HFmrEF, there is a great scarcity of prospective studies and clinical trials that allow delineating specific therapies for this new phenotype. To better treat HFmrEF patients, it is fundamental that cardiologists and internists understand the differences and similarities of this new phenotype.
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Rationale, Design, and Methodology of the APOLLON trial: A comPrehensive, ObservationaL registry of heart faiLure with midrange and preserved ejectiON fraction. Anatol J Cardiol 2019; 19:311-318. [PMID: 29724973 PMCID: PMC6280260 DOI: 10.14744/anatoljcardiol.2018.95595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: Although almost half of chronic heart failure (HF) patients have mid-range (HFmrEF) and preserved left-ventricular ejection fraction (HFpEF), no studies have been carried out with these patients in our country. This study aims to determine the demographic characteristics and current status of the clinical background of HFmrEF and HFpEF patients in a multicenter trial. Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejectiON fraction (APOLLON) trial will be an observational, multicenter, and noninterventional study conducted in Turkey. The study population will include 1065 patients from 12 sites in Turkey. All data will be collected at one point in time and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT03026114). Results: We will enroll all consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had New York Heart Association class II, III, or IV HF, elevated brain natriuretic peptide levels within the last 30 days, and an left ventricular ejection fraction (LVEF) of at least 40%. Patients fulfilling the exclusion criteria will not be included in the study. Patients will be stratified into two categories according to LVEF: mid-range EF (HFmrEF, LVEF 40%-49%) and preserved EF (HFpEF, LVEF ≥50%). Regional quota sampling will be performed to ensure that the sample was representative of the Turkish population. Demographic, lifestyle, medical, and therapeutic data will be collected by this specific survey. Conclusion: The APOLLON trial will be the largest and most comprehensive study in Turkey evaluating HF patients with a LVEF ≥40% and will also be the first study to specifically analyze the recently designated HFmrEF category.
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Age-dependent differences in clinical phenotype and prognosis in heart failure with mid-range ejection compared with heart failure with reduced or preserved ejection fraction. Clin Res Cardiol 2019; 108:1394-1405. [PMID: 30980205 DOI: 10.1007/s00392-019-01477-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/08/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND HFmrEF has been recently proposed as a distinct HF phenotype. How HFmrEF differs from HFrEF and HFpEF according to age remains poorly defined. We aimed to investigate age-dependent differences in heart failure with mid-range (HFmrEF) vs. preserved (HFpEF) and reduced (HFrEF) ejection fraction. METHODS AND RESULTS 42,987 patients, 23% with HFpEF, 22% with HFmrEF and 55% with HFrEF, enrolled in the Swedish heart failure registry were studied. HFpEF prevalence strongly increased, whereas that of HFrEF strongly decreased with higher age. All cardiac comorbidities and most non-cardiac comorbidities increased with aging, regardless of the HF phenotype. Notably, HFmrEF resembled HFrEF for ischemic heart disease prevalence in all age groups, whereas regarding hypertension it was more similar to HFpEF in age ≥ 80 years, to HFrEF in age < 65 years and intermediate in age 65-80 years. All-cause mortality risk was higher in HFrEF vs. HFmrEF for all age categories, whereas HFmrEF vs. HFpEF reported similar risk in ≥ 80 years old patients and lower risk in < 65 and 65-80 years old patients. Predictors of mortality were more likely cardiac comorbidities in HFrEF but more likely non-cardiac comorbidities in HFpEF and HFmrEF with < 65 years. Differences among HF phenotypes for comorbidities were less pronounced in the other age categories. CONCLUSION HFmrEF appeared as an intermediate phenotype between HFpEF and HFrEF, but for some characteristics such as ischemic heart disease more similar to HFrEF. With aging, HFmrEF resembled more HFpEF. Prognosis was similar in HFmrEF vs. HFpEF and better than in HFrEF.
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Anderson SG, Shoaib A, Myint PK, Cleland JG, Hardman SM, McDonagh TA, Dargie H, Keavney B, Garratt CJ, Mamas MA. Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit. Clin Res Cardiol 2019; 108:1276-1286. [PMID: 30963233 PMCID: PMC6805810 DOI: 10.1007/s00392-019-01463-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/19/2019] [Indexed: 12/11/2022]
Abstract
Background Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with acute heart failure (AHF). The presence of AF is associated with adverse prognosis in patients with chronic heart failure (CHF) but little is known about its impact in AHF. Methods Data were collected between April 2007 and March 2013 across 185 (> 95%) hospitals in England and Wales from patients with a primary death or a discharge diagnosis of AHF. We investigated the association between the presence of AF and all-cause mortality during the index hospital admission, at 30 days and 1 year post-discharge. Results Of 96,593 patients admitted with AHF, 44,642 (46%) were in sinus rhythm (SR) and 51,951 (54%) in AF. Patients with AF were older (mean age 79.8 (79.7–80) versus 74.7 (74.5–74.7) years; p < 0.001), than those in SR. In a multivariable analysis, AF was independently associated with mortality at all time points, in hospital (HR 1.15, 95% CI 1.09–1.21, p < 0.0001), 30 days (HR 1.13, 95% CI 1.08–1.19, p < 0.0001), and 1 year (HR 1.09, 95% CI 1.05–1.12, p < 0.0001). In subgroup analyses, AF was independently associated with worse 30-day outcome irrespective of sex, ventricular phenotype and in all age groups except in those aged between 55 and 74 years. Conclusion AF is independently associated with adverse prognosis in AHF during admission and up to 1 year post-discharge. As the clinical burden of concomitant AF and AHF increases, further refinement in the detection, treatment and prevention of AF-related complications may have a role in improving patient outcomes. Electronic supplementary material The online version of this article (10.1007/s00392-019-01463-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon G Anderson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Department of Cardiology, North West Heart Centre, University Hospitals of South, Manchester, UK.,The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Bridgetown, Barbados
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, University of Keele and Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Phyo Kyaw Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, Scotland, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Suzanna M Hardman
- Clinical and Academic Department of Cardiovascular Medicine, Whittington Hospital, London, UK
| | - Theresa A McDonagh
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Henry Dargie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Bernard Keavney
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Clifford J Garratt
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, University of Keele and Royal Stoke Hospital, Stoke-on-Trent, UK.
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Xin YG, Chen X, Zhao YN, Hu J, Sun Y, Hu WY. Outcomes of spironolactone treatment in patients in Northeast China suffering from heart failure with mid-range ejection fraction. Curr Med Res Opin 2019; 35:561-568. [PMID: 30183419 DOI: 10.1080/03007995.2018.1520695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM The treatment effects of spironolactone on heart failure with reduced (HFrEF LVEF <40%) and preserved (HFpEF LVEF ≥50%) ejection fraction are well characterized. It is not clear whether heart failure patients with mid-range ejection fraction (HFmrEF, LVEF 40-49%) benefit from spironolactone. The present study aims to evaluate the efficacy of spironolactone in HFmrEF patients. METHOD This study compared a high dosage of spironolactone (50 mg daily), a low dosage of spironolactone (25 mg daily), and an untreated group for the prevention of major adverse cardiovascular events (MACE) in 279 patients admitted to hospital diagnosed with HFmrEF. RESULTS With a mean follow-up duration of 1 year, the death and HF-rehospitalization rate demonstrated significantly lower incidence in those taking spironolactone, compared with the untreated group (21.3% vs 34.5%, p = .014, respectively). Further analysis showed no difference between two spironolactone groups (21.8% vs 20.7%, p = .861). Kaplan-Meier analysis of outcome-free survival illustrated a significant difference in survival rate among three groups (log-rank testing, p = .045). Compared with the baseline level, patients receiving 25 mg spironolactone had a lower physical score (p < .05) at 1-year follow-up. MLHFQ total scores in the two spironolactone groups markedly improved compared with the untreated group (p < .001); similar results were observed in the MLHFQ physical scores (p = .025, .001, respectively) and emotional sub-scale (p = .023, .011, respectively); however, paired comparison between the two spironolactone groups showed no difference. CONCLUSIONS In patients with HFmrEF, treatment with spironolactone significantly reduced the incidence of the primary composite outcomes of all-cause death, and rehospitalization for the management of heart failure compared with placebo, and a high dosage of spironolactone did not show trends of reduction in MACE.
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Affiliation(s)
- Yan-Guo Xin
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
- b Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Xin Chen
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
- c Department of Cardiology , Fuling Central Hospital , Chongqing , PR China
| | - Yi-Nan Zhao
- d Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, PR China
| | - Jian Hu
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
| | - Yingxian Sun
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
| | - Wen-Yu Hu
- a Department of Cardiology , The First Affiliated Hospital, China Medical University , Shenyang , PR China
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Montenegro Sá F, Carvalho R, Ruivo C, Santos LG, Antunes A, Soares F, Belo A, Morais J. Beta-blockers for post-acute coronary syndrome mid-range ejection fraction: a nationwide retrospective study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 8:599-605. [PMID: 30714389 DOI: 10.1177/2048872619827476] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with mid-range ejection fraction (40-49%) are in focus due to the newly defined entity of heart failure with mid-range ejection fraction. Acute coronary syndromes are a major aetiology for heart failure with mid-range ejection fraction. We aim to evaluate which therapeutic decisions are associated with inhospital survival benefit in post-acute coronary syndrome patients categorised according to the ejection fraction. METHODS AND RESULTS The authors analysed a cohort of a multicentre national registry enrolling acute coronary syndrome patients between 2010 and 2016, classified according to their ejection fraction before hospital discharge. Patients with previously known heart failure or with no ejection fraction evaluation were excluded. A total of 9429 patients were included and categorised in three groups: (a) ejection fraction of 50% or greater (n=6113, 65%); (b) ejection fraction of 40-49% (n=1926, 20%); and (c) ejection fraction less than 40% (n=1390, 15%). The primary endpoint was inhospital mortality. To eliminate confounding factors, a multivariate logistic regression analysis was conducted, including acute coronary syndrome type, baseline characteristics, pharmacological treatment, clinical data, laboratory data and coronary anatomy when known. The overall inhospital mortality was 2.8% (n=263): 0.9% (n=53) in group 1, 2.4% (n=37) in group 2 and 11.4% (n=159) in group 3. After multivariate analysis, an invasive strategy had a positive impact in all groups, inhospital beta-blocker administration had a positive impact for groups 2 and 3, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and spironolactone had a positive impact on group 3. CONCLUSION Post-acute coronary syndrome mid-range ejection fraction patients represent an intermediate risk group in which beta-blocker administration was associated with inhospital survival benefit. An invasive strategy was a survival predictor for all groups, regardless of ejection fraction category.
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Affiliation(s)
| | - Rita Carvalho
- Cardiology Department, Centro Hospitalar de Leiria, Portugal
| | - Catarina Ruivo
- Cardiology Department, Centro Hospitalar de Leiria, Portugal
| | | | | | | | | | - João Morais
- Cardiology Department, Centro Hospitalar de Leiria, Portugal
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- Portuguese Society of Cardiology, Portugal
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Xin Y, Chen X, Zhao Y, Hu W. The impact of heart rate on patients diagnosed with heart failure with mid-range ejection fraction. Anatol J Cardiol 2019; 21:68-74. [PMID: 30520426 PMCID: PMC6457424 DOI: 10.14744/anatoljcardiol.2018.38364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The relationship between prognosis and heart rate remains unclear among patients diagnosed with heart failure with mid-range ejection fraction (HFmrEF). The aim of the present study was to assess the effect of heart rate in this group of patients. METHODS Of the 197 patients diagnosed with HFmrEF, 92 had a heart rate <70 beats/min (bpm), and 105 had a heart rate ≥70 bpm. We analyzed the outcomes including all-cause death and HF-related hospitalization and evaluated the quality of life. RESULTS The outcome demonstrated a lower incidence in patients with heart rate <70 bpm. The outcome-free survival illustrated significant difference in survival rate (p=0.045). The Minnesota Living with Heart Failure Questionnaire total scores and physical subscale in the lower heart rate group decreased compared with the heart rate ≥70 bpm group (p=0.048 and p=0.03, respectively). In the following analysis of patients with sinus rhythm, beta blockers showed great positive effects on patients with heart rate <70 bpm (p=0.046), as for the quality of life in patients with beta blocker, heart rate <70 bpm showed lower total and physical scores (p=0.025 and p=0.017, respectively). CONCLUSION Our results showed that heart rate is an important prognostic factor in patients with HFmrEF. Patients with heart rate <70 bpm was related with a lower risk of outcomes and better quality of life. Beta blockers reduced the outcome rate in patients with sinus rhythm.
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Affiliation(s)
| | | | | | - Wenyu Hu
- Department of Cardiology, The First Affiliated Hospital, China Medical University; Shenyang-China.
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Miró Ò, Javaloyes P, Gil V, Martín-Sánchez FJ, Jacob J, Herrero P, Marco-Hernández J, Ríos J, Harjola VP, Torres-Gárate R, Alonso MI, Piñera P, Mecina AB, Escoda R, Müller C, Parissis J, Llorens P. Comparative Analysis of Short-Term Outcomes of Patients With Heart Failure With a Mid-Range Ejection Fraction After Acute Decompensation. Am J Cardiol 2019; 123:84-92. [PMID: 30360888 DOI: 10.1016/j.amjcard.2018.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/08/2018] [Accepted: 09/17/2018] [Indexed: 11/27/2022]
Abstract
To determine short-term outcomes after an episode of acute heart failure in patients with mid-range ejection fraction (40%-49%; HFmrEF) compared with patients with reduced (<40%) and preserved (>49%) ejection fractions (HFrEF and HFpEF, respectively) and according to their final destination after emergency department (ED) care. This is an exploratory, secondary analysis of the Epidemiology of Acute Heart Failure in the Emergency departments Registry, which includes consecutive acute heart failure patients diagnosed in 41 Spanish EDs. Patients with echocardiography data were included and divided into HFrEF, HFmrEF, and HFpEF. The primary outcome was 30-day all-cause mortality, and secondary outcomes were in-hospital all-cause mortality, hospital length of stay >10 days, and 30-day postdischarge ED revisit due to AHF and combined end point (ED revisit and/or death). We included 6,856 patients (age 79 [10]; 52.1% women): 21.6% had HFrEF, 14.3% HFmrEF, and 64.1% HFpEF. The main destinations for the 982 HFmrEF patients after ED management were internal medicine (293, 29.8%), cardiology (194, 19.9%) and not hospitalized (241, 24.5%), whereas the remaining 254 patients were admitted to other departments, including geriatric wards, short-stay units and intensive care units. Outcomes for HFmrEF did not differ compared with either HFrEF or HFpEF. Compared with HFmrEF admitted to cardiology, internal medicine admission or direct ED discharge increased the 30-day postdischarge ED revisit (hazard ratio [HR] 1.713, 95% confidence interval [CI] 1.042 to 2.816; and HR 1.683, 95% CI 1.046 to 2.708, respectively) and the 30-day postdischarge combined end point (HR 1.732, 95% CI 1.070 to 2.803; and HR 1.727, 95% CI 1.083 to 2.756, respectively). In conclusion, patients in the newly created HFmrEF category suffering from an acute decompensation have similar short-term outcomes as those in the classical HFrEF and HFpEF categories; nonetheless, HFmrEF patients handled in cardiology wards during decompensation obtain better outcomes, and reasons for these differences have to be unmasked and corrected.
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Affiliation(s)
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- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
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35
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Wang N, Hales S, Barin E, Tofler G. Characteristics and outcome for heart failure patients with mid-range ejection fraction. J Cardiovasc Med (Hagerstown) 2018; 19:297-303. [PMID: 29570491 DOI: 10.2459/jcm.0000000000000653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare precipitants, presenting symptoms and outcomes of patients with heart failure and mid-range ejection fraction (HFmrEF), heart failure and preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) in an Australian cohort. METHODS We divided 5236 patients in the Management of Cardiac Failure program in Northern Sydney Australia, into HFmrEF (n = 780, 14.9%), HFpEF (n = 1956, 37.4%) and HFrEF (n = 2500, 47.8%), using a cutoff left ventricular ejection fraction of 40-49, at least 50 and less than 40%, respectively. RESULTS For most characteristics, the HFmrEF patients were intermediate. Hypertension among the HFrEF, HFmrEF and HFpEF groups was present in 50.6, 61.7 and 68.9%, respectively; age more than 85 years was present in 35.1, 37.6 and 42.2%; atrial fibrillation in 35.3, 44.2 and 49.9%; and elevated serum creatinine (>100 μmol/l) in 59.2, 55.6 and 51.0%. For ischemic heart disease and ischemia as a precipitant of admission, HFmrEF patients were similar to the HFrEF group, and more common than in HFpEF. Mortality rates were not significantly different between the three groups. Readmission rates were highest for HFpEF (40.2%), followed by HFmrEF (42.4%) and HFrEF (45.4%), largely due to differences in nonheart failure readmission. CONCLUSION Clinically, HFmrEF represents an intermediate phenotype, with the exception of resembling HFrEF with a higher incidence of ischemic heart disease.
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Affiliation(s)
- Nelson Wang
- Sydney Medical School, University of Sydney.,Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Susan Hales
- Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Edward Barin
- Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Geoffrey Tofler
- Sydney Medical School, University of Sydney.,Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Choi KH, Choi J, Jeon E, Lee GY, Choi D, Lee H, Kim J, Chae SC, Baek SH, Kang S, Yoo B, Kim KH, Cho M, Park H, Oh B. Guideline-Directed Medical Therapy for Patients With Heart Failure With Midrange Ejection Fraction: A Patient-Pooled Analysis From the Kor HF and Kor AHF Registries. J Am Heart Assoc 2018; 7:e009806. [PMID: 30608208 PMCID: PMC6404181 DOI: 10.1161/jaha.118.009806] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022]
Abstract
Background Although current guidelines now define heart failure with midrange ejection fraction ( HF mr EF ) as HF with a left ventricular EF of 40% to 49%, there are limited data on response to guideline-directed medical therapy in patients with HF mr EF . The current study aimed to evaluate the association between β-blocker, renin-angiotensin system blocker ( RASB ), or aldosterone antagonist ( AA ) treatment with clinical outcome in patients with HF mr EF . Methods and Results We performed a patient-level pooled analysis on 1144 patients with HF mr EF who were hospitalized for acute HF from the Kor HF (Korean Heart Failure) and Kor AHF (Korean Acute Heart Failure) registries. The study population was divided between use of β-blocker, RASB , or AA to evaluate the guideline-directed medical therapy in patients with HF mr EF . Sensitivity analyses, including propensity score matching and inverse-probability-weighted methods, were performed. The use of β-blocker in the discharge group showed significantly lower rates of all-cause mortality compared with those who did not use a β-blocker (β-blocker versus no β-blocker, 30.7% versus 38.2%; hazard ratio, 0.758; 95% confidence interval, 0.615-0.934; P=0.009). Similarly, the RASB use in the discharge group was associated with the lower risk of mortality compared with no use of RASB ( RASB versus no RASB , 31.9% versus 38.1%; hazard ratio, 0.76; 95% confidence interval, 0.618-0.946; P=0.013). However, there was no significant difference in all-cause mortality between AA and no AA in the discharge group ( AA versus no AA , 34.2% versus 34.0%; hazard ratio, 1.063; 95% confidence interval, 0.858-1.317; P=0.578). Multiple sensitivity analyses showed similar trends. Conclusions For treatment of acute HFmrEF after hospitalization, β-blocker and RASB therapies on discharge were associated with reduced risk of all-cause mortality. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01389843.
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Affiliation(s)
- Ki Hong Choi
- Sungkyunkwan University College of MedicineSeoulKorea
| | - Jin‐Oh Choi
- Sungkyunkwan University College of MedicineSeoulKorea
| | - Eun‐Seok Jeon
- Sungkyunkwan University College of MedicineSeoulKorea
| | - Ga Yeon Lee
- Sungkyunkwan University College of MedicineSeoulKorea
| | - Dong‐Ju Choi
- Seoul National University Bundang HospitalSeongnamKorea
| | - Hae‐Young Lee
- Department of Internal MedicineSeoul National University HospitalSeoulKorea
| | | | | | | | | | - Byung‐Su Yoo
- Yonsei University Wonju College of MedicineWonjuKorea
| | - Kye Hun Kim
- Heart Research Center of Chonnam National UniversityGwangjuKorea
| | - Myeong‐Chan Cho
- Chungbuk National University College of MedicineCheongjuKorea
| | | | - Byung‐Hee Oh
- Department of Internal MedicineSeoul National University HospitalSeoulKorea
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Yaku H, Ozasa N, Morimoto T, Inuzuka Y, Tamaki Y, Yamamoto E, Yoshikawa Y, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Su K, Kawato M, Sasaki K, Toyofuku M, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Shizuta S, Ono K, Sato Y, Kuwahara K, Kato T, Kimura T. Demographics, Management, and In-Hospital Outcome of Hospitalized Acute Heart Failure Syndrome Patients in Contemporary Real Clinical Practice in Japan ― Observations From the Prospective, Multicenter Kyoto Congestive Heart Failure (KCHF) Registry ―. Circ J 2018; 82:2811-2819. [DOI: 10.1253/circj.cj-17-1386] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Yasutaka Inuzuka
- Department of Cardiovascular Medicine, Shiga Medical Center for Adults
| | | | - Erika Yamamoto
- Department Cardiology Division, Massachusetts General Hospital and Harvard Medical School
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | | | | | | | | | | | | | | | | | | | | | | | - Kanae Su
- Japanese Red Cross Wakayama Medical Center
| | | | | | | | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | | | | | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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Kobayashi M, Rossignol P, Ferreira JP, Aragão I, Paku Y, Iwasaki Y, Watanabe M, Fudim M, Duarte K, Zannad F, Girerd N. Prognostic value of estimated plasma volume in acute heart failure in three cohort studies. Clin Res Cardiol 2018; 108:549-561. [DOI: 10.1007/s00392-018-1385-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022]
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39
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Borovac JA, Novak K, Bozic J, Glavas D. The midrange left ventricular ejection fraction (LVEF) is associated with higher all-cause mortality during the 1-year follow-up compared to preserved LVEF among real-world patients with acute heart failure: a single-center propensity score-matched analysis. Heart Vessels 2018; 34:268-278. [PMID: 30159656 DOI: 10.1007/s00380-018-1249-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/24/2018] [Indexed: 12/28/2022]
Abstract
The objectives of the study were to characterize and compare different acute heart failure (AHF) subgroups according to left-ventricular ejection fraction (LVEF) in terms of all-cause mortality and HF-related readmissions during the 1-year follow-up (FU). Three hundred and fifty-six AHF patients admitted to Cardiology ward and/or CCU were retrospectively included in the study and analyzed during the 1-year FU. Patients were stratified according to LVEF as those with preserved (HFpEF), midrange (HFmrEF) and reduced LVEF (HFrEF). During the FU period, 148 (43.3%) patients died, and 116 HF-related readmission events were recorded. HFmrEF group had significantly higher standardized all-cause mortality rate, unadjusted for age, compared to HFpEF group and significantly lower than HFrEF group (41 vs. 18 and 41 vs. 62.5 events per 100 patient-years; χ2 = 41.08, p < 0.001 and χ2 = 16.62, p < 0.001, respectively). A propensity score-matched analysis in which all HF groups were matched for age and other covariates confirmed that HFmrEF group had significantly higher all-cause mortality rate than HFpEF group (χ2 = 15.66, p < 0.001) while no significant differences in readmission rates were observed across all groups (p = NS). The hazard risk for a composite endpoint of death and readmission was highest in HFrEF group (HR 6.53, 95% CI 3.53-12.08, p < 0.001), followed by HFmrEF group (HR 3.30, 95% CI 1.86-5.87, p < 0.001) when compared to HFpEF group set as a reference. Among AHF patients, the HFmrEF phenotype was associated with significantly higher all-cause mortality compared to HFpEF, during the 1-year FU. This finding might implicate more stringent clinical approach towards this patient group.
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Affiliation(s)
- Josip Anđelo Borovac
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia.
| | - Katarina Novak
- Division of Cardiology, Department of Internal Medicine, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia
| | - Duska Glavas
- Division of Cardiology, Department of Internal Medicine, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia.,Working Group on Heart Failure - Croatian Cardiac Society, Kispaticeva 12, 10000, Zagreb, Croatia
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Kato M, Yamamoto K. Monitoring Changes in Ejection Fraction in Patients With Heart Failure and Mid-Range Ejection Fraction. Circ J 2018; 82:1991-1993. [DOI: 10.1253/circj.cj-18-0663] [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: 11/09/2022]
Affiliation(s)
- Masahiko Kato
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
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Zhu N, Jiang W, Wang Y, Wu Y, Chen H, Zhao X. Plasma levels of free fatty acid differ in patients with left ventricular preserved, mid-range, and reduced ejection fraction. BMC Cardiovasc Disord 2018; 18:104. [PMID: 29843618 PMCID: PMC5975423 DOI: 10.1186/s12872-018-0850-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/25/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Free fatty acids (FFAs) predicted the risk of heart failure (HF) and were elevated in HF with very low left ventricular ejection fraction (LVEF) compared to healthy subjects. The aim of this study was to investigate whether total levels of FFA in plasma differed in patients with HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF) and the association with the three categories. METHODS One hundred thirty-nine patients with HFpEF, HFmrEF and HFrEF were investigated in this study. Plasma FFA levels were measured using commercially available assay kits, and LVEF was calculated by echocardiography with the Simpson biplane method. Dyspnea ranked by New York Heart Association (NYHA) was also identified. RESULTS FFA concentrations were higher in HFrEF than in HFmrEF and HFpEF, respectively (689 ± 321.5 μmol/L vs. 537.9 ± 221.6 μmol/L, p = 0.036; 689 ± 321.5 μmol/L vs. 527.5 ± 185.5 μmol/L, p = 0.008). No significant differences in FFA levels were found between HFmrEF and HFpEF (537.9 ± 221.6 μmol/L vs. 527.5 ± 185.5 μmol/L, p = 0.619). In addition, we found a negative correlation between FFA levels and LVEF (regression coefficient: - 0.229, p = 0.004) and a positive correlation between FFAs and NYHA class (regression coefficient: 0.214, p = 0.014) after adjustment for clinical characteristic, medical history and therapies. ROC analysis revealed that FFAs predicted HFrEF across the three categories (AUC: 0.644, p = 0.005) and the optimal cut-off level to predict HFrEF was FFA levels above 575 μmol/L. CONCLUSIONS FFA levels differed across the three categories, which suggests that energy metabolism differs between HFpEF, HFmrEF and HFrEF.
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Affiliation(s)
- Ning Zhu
- Department of Cardiology, The Third Clinical College of Wenzhou Medical University, Wenzhou People’s Hospital, No. 57 Canghou Street, Wenzhou, 325000 Zhejiang Province People’s Republic of China
| | - Wenbing Jiang
- Department of Cardiology, The Third Clinical College of Wenzhou Medical University, Wenzhou People’s Hospital, No. 57 Canghou Street, Wenzhou, 325000 Zhejiang Province People’s Republic of China
| | - Yi Wang
- Department of Cardiology, The Third Clinical College of Wenzhou Medical University, Wenzhou People’s Hospital, No. 57 Canghou Street, Wenzhou, 325000 Zhejiang Province People’s Republic of China
| | - Youyang Wu
- Department of Cardiology, The Third Clinical College of Wenzhou Medical University, Wenzhou People’s Hospital, No. 57 Canghou Street, Wenzhou, 325000 Zhejiang Province People’s Republic of China
| | - Hao Chen
- Department of Cardiology, The Third Clinical College of Wenzhou Medical University, Wenzhou People’s Hospital, No. 57 Canghou Street, Wenzhou, 325000 Zhejiang Province People’s Republic of China
| | - Xuyong Zhao
- Department of Cardiology, The Third Clinical College of Wenzhou Medical University, Wenzhou People’s Hospital, No. 57 Canghou Street, Wenzhou, 325000 Zhejiang Province People’s Republic of China
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Marx N, Noels H, Jankowski J, Floege J, Fliser D, Böhm M. Mechanisms of cardiovascular complications in chronic kidney disease: research focus of the Transregional Research Consortium SFB TRR219 of the University Hospital Aachen (RWTH) and the Saarland University. Clin Res Cardiol 2018; 107:120-126. [PMID: 29728829 DOI: 10.1007/s00392-018-1260-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023]
Abstract
Patients with chronic kidney disease (CKD) exhibit a massively increased risk for cardiovascular (CV) events, and traditional strategies to improve CV outcome have largely failed in the context of CKD. This review article summarizes the current understanding of the pathophysiology of CVD in patients with CKD, defines the gaps in knowledge and describes the structure of the German Transregional Research Consortium SFB TRR219 which addresses "Mechanisms of Cardiovascular Complications in Chronic Kidney Disease".
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Affiliation(s)
- Nikolaus Marx
- Department of Internal Medicine I, University Hospital, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Heidi Noels
- Institute for Molecular Cardiovascular Research, RWTH Aachen University, Aachen, Germany
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research, RWTH Aachen University, Aachen, Germany
| | - Jürgen Floege
- Department of Internal Medicine II, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Danilo Fliser
- Internal Medicine IV, Saarland University Medical Centre, Homburg, Germany
| | - Michael Böhm
- Internal Medicine III, Saarland University Medical Centre, Homburg, Germany
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Gwag HB, Lee GY, Choi JO, Lee HY, Kim JJ, Hwang KK, Chae SC, Baek SH, Kang SM, Choi DJ, Yoo BS, Kim KH, Park HY, Cho MC, Oh BH, Jeon ES. Fate of Acute Heart Failure Patients With Mid-Range Ejection Fraction. Circ J 2018; 82:2071-2078. [PMID: 29681584 DOI: 10.1253/circj.cj-17-1389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The outcomes of heart failure (HF) with mid-range ejection fraction (HFmrEF) have been rarely studied, and follow-up data on left ventricular ejection fraction (LVEF) are scarse.Methods and Results:Patients were selected from a prospective multicenter registry of patients hospitalized for acute HF and then classified in the improved group if they exhibited %LVEF change ≥5 with follow-up LVEF ≥50%. Follow-up LVEF reported at least 90 days after discharge was used for classification. Of the 3,085 patients with acute HF, 454 were classified in the HFmrEF, and 276 had follow-up data. Of these 276 patients, 34.1% were classified in the improved group. Multivariate analysis revealed that hypertension, higher heart rate, lower serum sodium level, and maintenance therapy with β-blocker were associated with improved LVEF. The survival rate was significantly higher in the improved group than in the other groups. Young age and maintenance therapy with renin-angiotensin system blockers or aldosterone antagonists were significantly associated with better survival in HFmrEF. CONCLUSIONS One-third of HFmrEF patients showed improved LVEF; moreover, the survival rate in the improved group was higher than the other groups. Renin-angiotensin system blockers and aldosterone antagonists could improve the survival of HFmrEF patients.
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Affiliation(s)
- Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ga Yeon Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital
| | | | | | | | | | | | | | | | - Kye Hun Kim
- Heart Research Center of Chonnam National University
| | | | | | - Byung-Hee Oh
- Department of Internal Medicine, Seoul National University Hospital
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Hamatani Y, Nagai T, Shiraishi Y, Kohsaka S, Nakai M, Nishimura K, Kohno T, Nagatomo Y, Asaumi Y, Goda A, Mizuno A, Yasuda S, Ogawa H, Yoshikawa T, Anzai T. Long-Term Prognostic Significance of Plasma B-Type Natriuretic Peptide Level in Patients With Acute Heart Failure With Reduced, Mid-Range, and Preserved Ejection Fractions. Am J Cardiol 2018; 121:731-738. [PMID: 29394996 DOI: 10.1016/j.amjcard.2017.12.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
Plasma B-type natriuretic peptide (BNP) is an important prognostic marker in patients with acute heart failure (AHF). However, it is unclear which BNP parameter, on admission, at discharge, or change during hospitalization, has the highest predictive performance for long-term adverse outcomes, and whether its prognostic impact differs according to the new European heart failure (HF) phenotype classification by left ventricular ejection fraction: heart failure with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). We examined 1,792 patients with AHF consisting of 860 (48%) HFrEFs, 318 (18%) HFmrEFs, and 614 (34%) HFpEFs. Prognostic performance of each BNP parameter was assessed by the Harrell c-index. During a median follow-up of 664 days, 344 (19%) patients died. Discharge BNP had the highest c-index (0.69) for mortality among all BNP parameters (p <0.001). In multivariate Cox proportional hazard modeling, discharge BNP was associated with mortality in HFrEF, HFmrEF, and HFpEF patients with significant interaction (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.57 to 2.41; HR 1.76, 95% CI 1.10 to 2.82; HR 1.46, 95% CI 1.12 to 1.91, respectively; p = 0.011 for interaction). Moreover, the c-index of discharge BNP for mortality in HFrEF patients (0.72) was higher than that in HFmrEF patients (0.68) and HFpEF patients (0.65). Similar results were obtained for mortality or HF rehospitalization as alternative outcomes, except there was no statistically significant interaction among HF phenotypes. In conclusion, discharge BNP is a more reliable marker than other BNP parameters on long-term outcome prediction in patients with AHF, but its prognostic impact may be weakened in HFmrEF and HFpEF compared with HFrEF.
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Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF. Clin Res Cardiol 2018. [PMID: 29532155 DOI: 10.1007/s00392-018-1221-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) can be used to assess pulmonary congestion by imaging B-lines ('comets') for patients with acute heart failure (AHF). OBJECTIVES Investigate relationship of B-lines, plasma concentrations of B-type natriuretic peptide (BNP), and echocardiographic left ventricular (LV) function measured at admission and discharge and their relationship to prognosis for AHF with preserved (HFpEF) or reduced (HFrEF) LV ejection fraction. METHODS Patients with AHF had the above tests done at admission and discharge. The primary outcome was re-hospitalization for heart failure or death at 6 months. RESULTS Of 162 patients enrolled, 95 had HFrEF and 67 had HFpEF, median age was 80 [77-85] years, and 85 (52%) were women. The number of B-lines at admission (median 31 [27-36]) correlated with respiratory rate (r = 0.75; p < 0.001), BNP (r = 0.43; p < 0.001), clinical congestion score (r = 0.25; p = 0.001), and systolic pulmonary artery pressure (r = 0.42; p < 0.001). At discharge, B-lines were also correlated with BNP (r = 0.69; p < 0.001) and congestion score (r = 0.57; p < 0.001). B-line count at discharge predicted outcome (AUC 0.83 [0.77-0.90]; univariate HR 1.12 [1.09-1.16]; p < 0.001; multivariable HR 1.16 [1.11-1.21]; p < 0.001). Results were similar for HFpEF and HFrEF. CONCLUSIONS LUS appears a useful method to assess severity and monitor the resolution of lung congestion. At hospital admission, B-lines are strongly related to respiratory rate, which may be a key component of the sensation of dyspnea. Measurement of lung congestion at discharge provides prognostic information for patients with either HFpEF or HFrEF.
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Abstract
The introduction of heart failure (HF) with mid-range ejection fraction (HFmrEF) as a distinct phenotype has achieved its aim of stimulating research into the underlying characteristics, pathophysiology and treatment of HF patients with left ventricular ejection fraction of 40-49 %. Comparison of clinical characteristics, comorbidities, outcomes and prognosis among patients with HF with preserved ejection fraction, HFmrEF and HF with reduced ejection fraction allowed consideration of HFmrEF as an intermediate phenotype, which often resembles HF with reduced ejection fraction more than HF with preserved ejection fraction. The latest findings suggest that patients with HFmrEF seem to benefit from therapies that have been shown to improve outcomes in HF with reduced ejection fraction.
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Affiliation(s)
- Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd, Russia
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Mortality after an episode of acute heart failure in a cohort of patients with intermediate ventricular function: Global analysis and relationship with admission department. Med Clin (Barc) 2017; 151:223-230. [PMID: 29279134 DOI: 10.1016/j.medcli.2017.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/06/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare the outcome of patients with acute heart failure (AHF) with a mid-range left ventricular ejection fraction (HFmrEF) with patients with a reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction. PATIENTS AND METHOD A prospective observational study included patients diagnosed with AHF in 41 emergency departments. Patients were divided into 3 groups: HFrEF<40%, HFmrEF 40-49% and HFpEF≥50%. We collected 38 independent variables and the adjusted and crude all-cause mortality at one-year in the HFmrEF group was compared with that of the HFrEF and HFpEF groups. The analysis was stratified according to patient destination following ED care. RESULTS Three thousand nine hundred and fifty-eight patients were included: 580 HFmrEF (14.6%), 929 HFrEF (23.5%) and 2,449 HFpEF (61.9%). Global mortality at one year was 28.5%. The crude mortality of the HFmrEF group was similar to that of the HFpEF group (HR 1.009; 95% CI 0.819-1.243; P=.933) and lower than the HFrEF group (HR 0.800; 95% CI 0.635-1.008; P=.058), but after adjustment for discordant basal characteristics among groups, the mortality of the HFmrEF group did not differ from that of the HFpEF (HRa 1.025; 95% CI 0.825-1.275; P=.821) or HFrEF group (HRa 0.924; 95% CI 0.720-1.186; P=.535). Neither were significant differences found between the HFmrEF group and the other 2 groups in the analysis stratified according to admission or discharge direct from the emergency department. CONCLUSION Mortality at one-year after an AHF episode in patients with HFmrEF does not differ from that of patients with HFpEF or HfrEF, either globally or based on the main destinations after emergency department care.
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Farré N, Lupon J, Roig E, Gonzalez-Costello J, Vila J, Perez S, de Antonio M, Solé-González E, Sánchez-Enrique C, Moliner P, Ruiz S, Enjuanes C, Mirabet S, Bayés-Genís A, Comin-Colet J. Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain). BMJ Open 2017; 7:e018719. [PMID: 29273666 PMCID: PMC5778274 DOI: 10.1136/bmjopen-2017-018719] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyse baseline characteristics and outcome of patients with heart failure and mid-range left ventricular ejection fraction (HFmrEF, left ventricular ejection fraction (LVEF) 40%-49%) and the effect of 1-year change in LVEF in this group. SETTING Multicentre prospective observational study of ambulatory patients with HF followed up at four university hospitals with dedicated HF units. PARTICIPANTS Fourteen per cent (n=504) of the 3580 patients included had HFmrEF. INTERVENTIONS Baseline characteristics, 1-year LVEF and outcomes were collected. All-cause death, HF hospitalisation and the composite end-point were the primary outcomes. RESULTS Median follow-up was 3.66 (1.69-6.04) years. All-cause death, HF hospitalisation and the composite end-point were 47%, 35% and 59%, respectively. Outcomes were worse in HF with preserved ejection fraction (HFpEF) (LVEF>50%), without differences between HF with reduced ejection fraction (HFrEF) (LVEF<40%) and HFmrEF (all-cause mortality 52.6% vs 45.8% and 43.8%, respectively, P=0.001). After multivariable Cox regression analyses, no differences in all-cause death and the composite end-point were seen between the three groups. HF hospitalisation and cardiovascular death were not statistically different between patients with HFmrEF and HFrEF. At 1-year follow-up, 62% of patients with HFmrEF had LVEF measured: 24% had LVEF<40%, 43% maintained LVEF 40%-49% and 33% had LVEF>50%. While change in LVEF as continuous variable was not associated with better outcomes, those patients who evolved from HFmrEF to HFpEF did have a better outcome. Those who remained in the HFmrEF and HFrEF groups had higher all-cause mortality after adjustment for age, sex and baseline LVEF (HR 1.96 (95% CI 1.08 to 3.54, P=0.027) and HR 2.01 (95% CI 1.04 to 3.86, P=0.037), respectively). CONCLUSIONS Patients with HFmrEF have a clinical profile in-between HFpEF and HFrEF, without differences in all-cause mortality and the composite end-point between the three groups. At 1 year, patients with HFmrEF exhibited the greatest variability in LVEF and this change was associated with survival.
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Affiliation(s)
- Nuria Farré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
| | - Josep Lupon
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
| | - Eulàlia Roig
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
- Heart Failure Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Gonzalez-Costello
- Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL (Bellvitge Biomedical Reserach Institute), Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Vila
- Cardiovascular Epidemiology and Genetics (EGEC), REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBERESP, CIBER Epidemiología y Salud Publica, Barcelona, Spain
| | - Silvia Perez
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
- Cardiovascular Epidemiology and Genetics (EGEC), REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Marta de Antonio
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eduard Solé-González
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
- Heart Failure Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Sánchez-Enrique
- Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL (Bellvitge Biomedical Reserach Institute), Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Sonia Ruiz
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - C Enjuanes
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL (Bellvitge Biomedical Reserach Institute), Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Badalona, Spain
| | - Sonia Mirabet
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
- Heart Failure Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antoni Bayés-Genís
- Department of Medicine, Universitat Autònoma de Barcelona, Catalunya, Spain
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- CIBERCV, CIBER Enfermedades Cardiovasculares, Barcelona, Spain
| | - Josep Comin-Colet
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL (Bellvitge Biomedical Reserach Institute), Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Badalona, Spain
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Association of mineralocorticoid receptor antagonist use and in-hospital outcomes in patients with acute heart failure. Clin Res Cardiol 2017; 107:76-86. [DOI: 10.1007/s00392-017-1161-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 09/13/2017] [Indexed: 12/12/2022]
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