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Nakagawa A, Yasumura Y, Yoshida C, Okumura T, Tateishi J, Yoshida J, Seo M, Yano M, Hayashi T, Nakagawa Y, Tamaki S, Yamada T, Kurakami H, Sotomi Y, Nakatani D, Hikoso S, Sakata Y. Predictors and Outcomes of Heart Failure With Preserved Ejection Fraction in Patients With a Left Ventricular Ejection Fraction Above or Below 60. J Am Heart Assoc 2022; 11:e025300. [PMID: 35904209 PMCID: PMC9375469 DOI: 10.1161/jaha.122.025300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although potential therapeutic candidates for heart failure with preserved ejection fraction (HFpEF) are emerging, it is still unclear whether they will be effective in patients with left ventricular ejection fraction (LVEF) of 60% or higher. Our aim was to identify the clinical characteristics of these patients with HFpEF by comparing them to patients with LVEF below 60%. Methods and Results From a multicenter, prospective, observational cohort (PURSUIT-HFpEF [Prospective Multicenter Obsevational Study of Patients with Heart Failure with Preserved Ejection Fraction]), we investigated 812 consecutive patients (median age, 83 years; 57% women), including 316 with 50% ≤ LVEF <60% and 496 with 60% ≤ LVEF, and compared the clinical backgrounds of the 2 groups and their prognoses for cardiac mortality or HF readmission. Two hundred four adverse outcomes occurred at a median of 366 days. Multivariable Cox regression tests adjusted for age, sex, heart rate, atrial fibrillation, estimated glomerular filtration rate, N-terminal pro-B-type natriuretic peptide, and prior heart failure hospitalization revealed that systolic blood pressure (hazard ratio [HR], 0.925 [95% CI, 0.862-0.992]; P=0.028), high-density lipoprotein to C-reactive protein ratio (HR, 0.975 [95% CI, 0.944-0.995]; P=0.007), and left ventricular end-diastolic volume index (HR, 0.870 [95% CI, 0.759-0.997]; P=0.037) were uniquely associated with outcomes among patients with 50% ≤ LVEF <60%, whereas only the ratio of peak early mitral inflow velocity to velocity of mitral annulus early diastolic motion e'(HR, 1.034 [95% CI, 1.003-1.062]; P=0.034) was associated with outcomes among patients with 60% ≤ LVEF. Conclusions Prognostic factors show distinct differences between patients with HFpEF with 50% ≤ LVEF <60% and with 60% ≤ LVEF. These findings suggest that the 2 groups have different inherent pathophysiology. Registration URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024414; Unique identifier: UMIN000021831 PURSUIT-HFpEF.
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Affiliation(s)
- Akito Nakagawa
- Division of Cardiovascular Medicine Amagasaki-Chuo Hospital Amagasaki Hyogo Japan.,Department of Medical Informatics Osaka University Graduate School of Medicine Suita Osaka Japan
| | - Yoshio Yasumura
- Division of Cardiovascular Medicine Amagasaki-Chuo Hospital Amagasaki Hyogo Japan
| | - Chikako Yoshida
- Division of Cardiovascular Medicine Amagasaki-Chuo Hospital Amagasaki Hyogo Japan
| | - Takahiro Okumura
- Division of Cardiovascular Medicine Amagasaki-Chuo Hospital Amagasaki Hyogo Japan
| | - Jun Tateishi
- Division of Cardiovascular Medicine Amagasaki-Chuo Hospital Amagasaki Hyogo Japan
| | - Junichi Yoshida
- Division of Cardiovascular Medicine Amagasaki-Chuo Hospital Amagasaki Hyogo Japan
| | - Masahiro Seo
- Division of Cardiology Osaka General Medical Center Osaka Osaka Japan
| | - Masamichi Yano
- Division of Cardiology Osaka Rosai Hospital Sakai Osaka Japan
| | | | - Yusuke Nakagawa
- Division of Cardiology Kawanishi City Hospital Kawanishi Hyogo Japan
| | - Shunsuke Tamaki
- Department of Cardiology Rinku General Medical Center Izumisano Osaka Japan
| | - Takahisa Yamada
- Division of Cardiology Osaka General Medical Center Osaka Osaka Japan
| | - Hiroyuki Kurakami
- Department of Medical Innovation Osaka University Hospital Suita Osaka Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita Osaka Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita Osaka Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita Osaka Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita Osaka Japan
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Murayama M, Iwano H, Obokata M, Harada T, Omote K, Kagami K, Tsujinaga S, Chiba Y, Ishizaka S, Motoi K, Tamaki Y, Aoyagi H, Nakabachi M, Nishino H, Yokoyama S, Tanemura A, Okada K, Kaga S, Nishida M, Nagai T, Kurabayashi M, Anzai T. Visual echocardiographic scoring system of the left ventricular filling pressure and outcomes of heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2021; 23:616-626. [PMID: 34694368 PMCID: PMC9016355 DOI: 10.1093/ehjci/jeab208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 12/31/2022] Open
Abstract
Aims Elevated left ventricular filling pressure (LVFP) is a powerful indicator of worsening clinical outcomes in heart failure with preserved ejection fraction (HFpEF); however, detection of elevated LVFP is often challenging. This study aimed to determine the association between the newly proposed echocardiographic LVFP parameter, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, and clinical outcomes of HFpEF. Methods and results We retrospectively investigated 310 well-differentiated HFpEF patients in stable conditions. VMT was scored from 0 to 3 using two-dimensional echocardiographic images, and VMT ≥2 was regarded as a sign of elevated LVFP. The primary endpoint was a composite of cardiac death or heart failure hospitalization during the 2 years after the echocardiographic examination. In all patients, Kaplan–Meier curves showed that VMT ≥2 (n = 54) was associated with worse outcomes than the VMT ≤1 group (n = 256) (P < 0.001). Furthermore, VMT ≥2 was associated with worse outcomes when tested in 100 HFpEF patients with atrial fibrillation (AF) (P = 0.026). In the adjusted model, VMT ≥2 was independently associated with the primary outcome (hazard ratio 2.60, 95% confidence interval 1.46–4.61; P = 0.001). Additionally, VMT scoring provided an incremental prognostic value over clinically relevant variables and diastolic function grading (χ2 10.8–16.3, P = 0.035). Conclusions In patients with HFpEF, the VMT score was independently and incrementally associated with adverse clinical outcomes. Moreover, it could also predict clinical outcomes in HFpEF patients with AF.
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Affiliation(s)
- Michito Murayama
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo 060-8648, Japan
| | - Hiroyuki Iwano
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo 060-8648, Japan.,Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan.,Division of Cardiology, Hakodate Municipal Hospital, 1-10-1, Minatocho, Hakodate 041-8680, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
| | - Kazuki Kagami
- Division of Cardiovascular Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
| | - Yasuyuki Chiba
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
| | - Ko Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
| | - Yoji Tamaki
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
| | - Hiroyuki Aoyagi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
| | - Masahiro Nakabachi
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo 060-8648, Japan
| | - Hisao Nishino
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo 060-8648, Japan
| | - Shinobu Yokoyama
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo 060-8648, Japan
| | - Asuka Tanemura
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo 060-8648, Japan
| | - Kazunori Okada
- Faculty of Health Sciences, Hokkaido University, N12, W5, Kita-ku, Sapporo 060-0812, Japan
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University, N12, W5, Kita-ku, Sapporo 060-0812, Japan
| | - Mutsumi Nishida
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo 060-8648, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
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