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Kadado AJ, Pervaiz A, Gobeil K, Shikari S, Elder P, Battisha A, Walia R, Hiser W, Lagu T, Pack QR. Electrocardiogram changes as predictors for new imaging findings in repeat transthoracic echocardiography. Future Cardiol 2023; 19:487-495. [PMID: 37721317 PMCID: PMC10599417 DOI: 10.2217/fca-2023-0045] [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: 03/23/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Aim: To determine if electrocardiogram (EKG) findings may be a useful tool to predict changes in repeat transthoracic echocardiogram (TTE). Methods: We evaluated patients who underwent TTE during hospitalization and their EKGs, and whether findings differed between studies. Results: Of 229 hospitalized patients who underwent repeat TTE, 183 (80%) were abnormal. Each minor and major EKG abnormality resulted in a 1.8 (1.2 to 2.6; p = 0.002) and 2.1 (1.3 to 3.3; p < 0.001) increased odds of abnormal imaging on TTE, respectively. The negative likelihood ratio for an unchanged EKG to predict an unchanged TTE was 0.68 (95% CI = 0.62 to 0.73). Conclusion: Among hospitalized patients with prior imaging results, an unchanged EKG predicts an unchanged TTE.
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Affiliation(s)
- Anis John Kadado
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, USA
| | - Abdullah Pervaiz
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, USA
| | - Kyle Gobeil
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Saima Shikari
- Division of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington, KY 40536, USA
| | - Petal Elder
- Department of Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, USA
| | - Ayman Battisha
- Department of Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, USA
| | - Ritika Walia
- Department of Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, USA
| | - William Hiser
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, USA
| | - Tara Lagu
- Division of Hospital Medicine, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Quinn R Pack
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, USA
- Institute for Healthcare Delivery & Population Science at University of Massachusetts Medical School – Baystate, Springfield, MA 01199, USA
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Abou Kamar S, Aga YS, de Bakker M, van den Berg VJ, Strachinaru M, Bowen D, Frowijn R, Akkerhuis KM, Brugts JJ, Manintveld O, Umans V, Geleijnse M, de Boer RA, Boersma E, Kardys I, van Dalen BM. Prognostic value of temporal patterns of left atrial reservoir strain in patients with heart failure with reduced ejection fraction. Clin Res Cardiol 2023:10.1007/s00392-023-02244-x. [PMID: 37311973 DOI: 10.1007/s00392-023-02244-x] [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: 03/24/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND We investigated whether repeatedly measured left atrial reservoir strain (LASr) in heart failure with reduced ejection fraction (HFrEF) patients provides incremental prognostic value over a single baseline LASr value, and whether temporal patterns of LASr provide incremental prognostic value over temporal patterns of other echocardiographic markers and NT-proBNP. METHODS In this prospective observational study, 153 patients underwent 6-monthly echocardiography, during a median follow-up of 2.5 years. Speckle tracking echocardiography was used to measure LASr. Hazard ratios (HRs) were calculated for LASr from Cox models (baseline) and joint models (repeated measurements). The primary endpoint (PEP) comprised HF hospitalization, left ventricular assist device, heart transplantation, and cardiovascular death. RESULTS Mean age was 58 ± 11 years, 76% were men, 82% were in NYHA class I/II, mean LASr was 20.9% ± 11.3%, and mean LVEF was 29% ± 10%. PEP was reached by 50 patients. Baseline and repeated measurements of LASr (HR per SD change (95% CI) 0.20 (0.10-0.41) and (0.13 (0.10-0.29), respectively) were both significantly associated with the PEP, independent of both baseline and repeated measurements of other echo-parameters and NT-proBNP. Although LASr was persistently lower over time in patients with PEP, temporal trajectories did not diverge in patients with versus without the PEP as the PEP approached. CONCLUSION LASr was associated with adverse events in HFrEF patients, independent of baseline and repeated other echo-parameters and NT-proBNP. Temporal trajectories of LASr showed decreased but stable values in patients with the PEP, and do not provide incremental prognostic value for clinical practice compared to single measurements of LASr.
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Affiliation(s)
- S Abou Kamar
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Y S Aga
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - M de Bakker
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - V J van den Berg
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Strachinaru
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - D Bowen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - R Frowijn
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - K M Akkerhuis
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - J J Brugts
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - O Manintveld
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - V Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - M Geleijnse
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - R A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - E Boersma
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - I Kardys
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - B M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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3
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Aga YS, Abou Kamar S, Chin JF, van den Berg VJ, Strachinaru M, Bowen D, Frowijn R, Akkerhuis MK, Constantinescu AA, Umans V, Geleijnse ML, Boersma E, Brugts JJ, Kardys I, van Dalen BM. Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure. ESC Heart Fail 2023. [PMID: 37157926 PMCID: PMC10375167 DOI: 10.1002/ehf2.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
AIMS In a large proportion of heart failure with reduced ejection fraction (HFrEF) patients, echocardiographic estimation of left atrial pressure (LAP) is not possible when the ratio of the peak early left ventricular filling velocity over the late filling velocity (E/A ratio) is not available, which may occur due to several potential causes. Left atrial reservoir strain (LASr) is correlated with LV filling pressures and may serve as an alternative parameter in these patients. The aim of this study was to determine whether LASr can be used to estimate LAP in HFrEF patients in whom E/A ratio is not available. METHODS AND RESULTS Echocardiograms of chronic HFrEF patients were analysed and LASr was assessed with speckle tracking echocardiography. LAP was estimated using the current ASE/EACVI algorithm. Patients were divided into those in whom LAP could be estimated using this algorithm (LAPe) and into those in whom this was not possible because E/A ratio was not available (LAPne). We assessed the prognostic value of LASr on the primary endpoint (PEP), which comprised the composite of hospitalization for the management of acute or worsened HF, left ventricular assist device implantation, cardiac transplantation, and cardiovascular death, whichever occurred first in time. We studied 153 patients with a mean age of 58 years of whom 76% men and 82% who were in NYHA class I-II. A total of 86 were in the LAPe group and 67 in the LAPne group. LASr was significantly lower in the LAPne group as compared with the LAPe group (15.8% vs. 23.8%, P < 0.001). PEP-free survival at a median follow-up of 2.5 years was 78% in LAPe versus 51% in LAPne patients. An increase in LASr was significantly associated with a reduced risk of the PEP in LAPne patients (adjusted hazard ratio: 0.91 per %, 95% confidence interval 0.84-0.98). An abnormal LASr (<18%) was associated with a five-fold increase in reaching the PEP. CONCLUSIONS In HFrEF patients in whom echocardiographic estimation of LAP is not possible due to due to unavailability of E/A ratio, assessing LASr potentially carries added clinical and prognostic value.
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Affiliation(s)
- Yaar S Aga
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Sabrina Abou Kamar
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jie Fen Chin
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Victor J van den Berg
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mihai Strachinaru
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Bowen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rene Frowijn
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martijn K Akkerhuis
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Victor Umans
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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Field RJ, Adamson C, Jhund P, Lewsey J. Joint modelling of longitudinal processes and time-to-event outcomes in heart failure: systematic review and exemplar examining the relationship between serum digoxin levels and mortality. BMC Med Res Methodol 2023; 23:94. [PMID: 37076796 PMCID: PMC10114381 DOI: 10.1186/s12874-023-01918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Joint modelling combines two or more statistical models to reduce bias and increase efficiency. As the use of joint modelling increases it is important to understand how and why it is being applied to heart failure research. METHODS A systematic review of major medical databases of studies which used joint modelling within heart failure alongside an exemplar; joint modelling repeat measurements of serum digoxin with all-cause mortality using data from the Effect of Digoxin on Mortality and Morbidity in Patients with Heart Failure (DIG) trial. RESULTS Overall, 28 studies were included that used joint models, 25 (89%) used data from cohort studies, the remaining 3 (11%) using data from clinical trials. 21 (75%) of the studies used biomarkers and the remaining studies used imaging parameters and functional parameters. The exemplar findings show that a per unit increase of square root serum digoxin is associated with the hazard of all-cause mortality increasing by 1.77 (1.34-2.33) times when adjusting for clinically relevant covariates. CONCLUSION Recently, there has been a rise in publications of joint modelling being applied to heart failure. Where appropriate, joint models should be preferred over traditional models allowing for the inclusion of repeated measures while accounting for the biological nature of biomarkers and measurement error.
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Affiliation(s)
- Ryan J Field
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, 90 Byres Road, Glasgow, G12 8TB, UK.
| | - Carly Adamson
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Pardeep Jhund
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jim Lewsey
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, 90 Byres Road, Glasgow, G12 8TB, UK
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5
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Abou Kamar S, Aga YS, de Bakker M, van den Berg VJ, Strachinaru M, Bowen D, Frowijn R, Akkerhuis KM, Brugts J, Manintveld O, Umans V, Geleijnse ML, Boersma E, van Dalen BM, Kardys I. Prognostic value of temporal patterns of global longitudinal strain in patients with chronic heart failure. Front Cardiovasc Med 2023; 9:1087596. [PMID: 36712255 PMCID: PMC9878393 DOI: 10.3389/fcvm.2022.1087596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Background We investigated whether repeatedly measured global longitudinal strain (GLS) has incremental prognostic value over repeatedly measured left ventricular ejection fraction (LVEF) and N-terminal pro B-type natriuretic peptide (NT-proBNP), and a single "baseline" GLS value, in chronic heart failure (HF) patients. Methods In this prospective observational study, echocardiography was performed in 173 clinically stable chronic HF patients every six months during follow up. During a median follow-up of 2.7 years, a median of 3 (25th-75th percentile:2-4) echocardiograms were obtained per patient. The endpoint was a composite of HF hospitalization, left ventricular assist device, heart transplantation, cardiovascular death. We compared hazard ratios (HRs) for the endpoint from Cox models (used to analyze the first available GLS measurements) with HRs from joint models (which links repeated measurements to the time-to-event data). Results Mean age was 58 ± 11 years, 76% were men, 81% were in New York Heart Association functional class I/II, and all had LVEF < 50% (mean ± SD: 27 ± 9%). The endpoint was reached by 53 patients. GLS was persistently decreased over time in patients with the endpoint. However, temporal GLS trajectories did not further diverge in patients with versus without the endpoint and remained stable during follow-up. Both single measurements and temporal trajectories of GLS were significantly associated with the endpoint [HR per SD change (95%CI): 2.15(1.34-3.46), 3.54 (2.01-6.20)]. In a multivariable model, repeatedly measured GLS maintained its prognostic value while repeatedly measured LVEF did not [HR per SD change (95%CI): GLS:4.38 (1.49-14.70), LVEF:1.14 (0.41-3.23)]. The association disappeared when correcting for repeatedly measured NT-proBNP. Conclusion Temporal evolution of GLS was associated with adverse events, independent of LVEF but not independent of NT-proBNP. Since GLS showed decreased but stable values in patients with adverse prognosis, single measurements of GLS provide sufficient information for determining prognosis in clinical practice compared to repeated measurements, and temporal GLS patterns do not add prognostic information to NT-proBNP.
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Affiliation(s)
- Sabrina Abou Kamar
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands,Netherlands Heart Institute, Utrecht, Netherlands
| | - Yaar S. Aga
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands,Department of Cardiology, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands
| | - Marie de Bakker
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Victor J. van den Berg
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands,Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands,Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mihai Strachinaru
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Dan Bowen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - René Frowijn
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - K. Martijn Akkerhuis
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jasper Brugts
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Olivier Manintveld
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Victor Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Marcel L. Geleijnse
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bas M. van Dalen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands,Netherlands Heart Institute, Utrecht, Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands,*Correspondence: Isabella Kardys,
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Dini FL, Ballo P, Pugliese NR, Bytyçi I, D'Agostino A, Bajraktari G, Pedrinelli R, Henein MY. Improved diastolic dysfunction is associated with higher forward flow and better prognosis in chronic heart failure. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:727-737. [PMID: 34727251 DOI: 10.1007/s10554-021-02457-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023]
Abstract
The benefit of repeat assessment of left ventricular (LV) systolic and diastolic function in heart failure (HF) remains uncertain. We assessed the prognostic value of repeat echocardiographic assessment of LV filling pressure (LVFP) and its interaction with cardiac index (CI) in ambulatory patients with chronic HF and reduced ejection fraction (HFrEF). We enrolled 357 patients (age 68 ± 11 years; 22% female) with chronic HFrEF. Patients underwent a clinical and echocardiographic examination at baseline. LVFP as assessed by the 2016 Guidelines and Doppler-derived CI were estimated. After the second echocardiographic examination, patients were followed for a median time of 30 months. The study endpoint included all-cause death and hospitalization for worsening HF. Patients who normalized LVFP or showed persistently normal LVFP at the follow-up examination had a significantly lower mortality rate than those with worsening or persistently raised LVFP (p < 0.0001). After stratification by CI, patients with elevated LVFP and CI < 2.0 l/min/m2 had a further worse outcome than those with elevated LVFP and CI ≥ 2.0 l/min/m2 (p < 0.0001). Multivariate survival analysis confirmed an independent prognostic impact of changes in LVFP, incremental to that of established clinical, laboratory and echocardiographic predictors. Repeat assessment of LVFP and CI significantly improved risk stratification of chronic HFrEF outpatients compared to baseline evaluation.
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Affiliation(s)
- Frank Lloyd Dini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Piercarlo Ballo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| | - Ibadete Bytyçi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Andreina D'Agostino
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Gani Bajraktari
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Roberto Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Michael Y Henein
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
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7
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Ghio S, Carluccio E, Scardovi AB, Dini FL, Rossi A, Falletta C, Scelsi L, Greco A, Temporelli PL. Prognostic relevance of Doppler echocardiographic re-assessment in HFrEF patients. Int J Cardiol 2020; 327:111-116. [PMID: 33220364 DOI: 10.1016/j.ijcard.2020.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current guidelines do not recommend periodically repeating echocardiograms in the follow-up of stable heart failure patients with reduced ejection fraction (HFrEF). The objective of the study was to verify the additional prognostic information provided by a comprehensive re-assessment of their cardiac function and hemodynamic profile at Doppler echocardiography in HFrEF patients. METHODS Retrospective analysis of 769 stable HFrEF outpatients who underwent two complete echocardiograms, at baseline and at re-assessment. Main candidate predictors of prognosis were: left ventricular (LV) filling pattern, pulmonary artery systolic pressure (PASP) and right ventricular function (TAPSE). Age, LV ejection fraction, mitral regurgitation severity, NYHA class, brain natriuretic peptide plasma levels at baseline, and their changes at 12 months, were used as covariates. Median follow-up was 30 months. All-cause death was the study end-point. RESULTS At baseline, restrictive filling pattern and low TAPSE were significant predictors of poor prognosis. At re-evaluation, persistently restrictive/worsened filling pattern, persistently-low/worsened TAPSE and worsened PASP, were associated with poorer survival. A significant interaction between changes in TAPSE, PASP and LV filling pattern was observed: in the restrictive pattern subgroup, survival was poorer in worsened/persistently low TAPSE (p < 0.01); in non-restrictive pattern subgroup, survival was poorer in worsened/persistently elevated PASP (p = 0.01). The re-assessment model improved the C-index from 0.69 to 0.74 (P < 0.01) compared to baseline model. CONCLUSIONS Doppler echocardiographic re-assessment of LV filling pattern, PASP and TAPSE allows a better prognostic stratification of HFrEF outpatients than baseline evaluation and is additional to changes in BNP and NYHA class.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S.Maria della Misericordia", Perugia, Italy
| | | | - Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Italy
| | - Andrea Rossi
- Department of Biomedical and Surgical Sciences, Cardiology Section, University of Verona, Verona, Italy
| | - Calogero Falletta
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, I.R.C.C.S. - ISMETT, Palermo, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Alessandra Greco
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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