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Kaze AD, Bertoni AG, Fox ER, Hall ME, Mentz RJ, Echouffo-Tcheugui JB. Metabolic dysfunction and incidence of heart failure subtypes among Black individuals: The Jackson Heart Study. Eur J Heart Fail 2024. [PMID: 39225160 DOI: 10.1002/ejhf.3447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
AIMS The extent to which metabolic syndrome (MetS) severity influences subclinical myocardial remodelling, heart failure (HF) incidence and subtypes, remains unclear. We assessed the association of MetS with incident HF (including ejection fraction subtypes) among Black individuals. METHODS AND RESULTS We included 4069 Jackson Heart Study participants (mean age 54.4 years, 63.8% women, 37.2% with MetS) without HF. We categorized participants based on MetS status and MetS severity scores (based on waist circumference [MetS-Z-WC] and body mass index [MetS-Z-BMI]). We assessed the associations of MetS indices with echocardiographic parameters, biomarkers of myocardial damage (high-sensitivity cardiac troponin I [hs-cTnI] and B-type natriuretic peptide [BNP]) and incident HF hospitalizations including HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). MetS severity was associated with subclinical cardiac remodelling (assessed by echocardiographic measures and biomarkers of myocardial damage). Over a median of 12 years, 319 participants developed HF (157 HFpEF, 149 HFrEF and 13 HF of unknown type). MetS was associated with a twofold greater risk of HF (hazard ratio [HR] 2.07, 95% confidence interval [CI] 1.64-2.61). Compared to the lowest quartile (Q1) of MetS-Z-WC, the highest quartile (Q4) conferred a higher risk of HF (HR 2.35, 95% CI 1.67-3.30), with a stronger association for HFpEF (Q4 vs. Q1: HR 4.94, 95% CI 2.67-9.14) vs. HFrEF (HR 1.69, 95% CI 1.06-2.70). CONCLUSIONS Metabolic syndrome severity was associated with both HF subtypes among Black individuals, highlighting the importance of optimal metabolic health for preventing HF.
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Affiliation(s)
- Arnaud D Kaze
- Department of Medicine, Division of Cardiology, Banner-University Medical Center Phoenix, The University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ervin R Fox
- Department of Medicine, Division of Cardiology, University of Mississippi Medical Center Jackson, Jackson, MS, USA
| | - Michael E Hall
- Department of Medicine, Division of Cardiology, University of Mississippi Medical Center Jackson, Jackson, MS, USA
| | - Robert J Mentz
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Prevention Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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Brown S, Biswas D, Wu J, Ryan M, Bernstein BS, Fairhurst N, Kaye G, Baral R, Cannata A, Searle T, Melikian N, Sado D, Lüscher TF, Teo J, Dobson R, Bromage DI, McDonagh TA, Vazir A, Shah AM, O’Gallagher K. Race- and Ethnicity-Related Differences in Heart Failure With Preserved Ejection Fraction Using Natural Language Processing. JACC. ADVANCES 2024; 3:101064. [PMID: 39050815 PMCID: PMC11268103 DOI: 10.1016/j.jacadv.2024.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/02/2024] [Accepted: 05/15/2024] [Indexed: 07/27/2024]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) is the predominant form of HF in older adults. It represents a heterogenous clinical syndrome that is less well understood across different ethnicities. Objectives This study aimed to compare the clinical presentation and assess the diagnostic performance of existing HFpEF diagnostic tools between ethnic groups. Methods A validated Natural Language Processing (NLP) algorithm was applied to the electronic health records of a large London hospital to identify patients meeting the European Society of Cardiology criteria for a diagnosis of HFpEF. NLP extracted patient demographics (including self-reported ethnicity and socioeconomic status), comorbidities, investigation results (N-terminal pro-B-type natriuretic peptide, H2FPEF scores, and echocardiogram reports), and mortality. Analyses were stratified by ethnicity and adjusted for socioeconomic status. Results Our cohort consisted of 1,261 (64%) White, 578 (29%) Black, and 134 (7%) Asian patients meeting the European Society of Cardiology HFpEF diagnostic criteria. Compared to White patients, Black patients were younger at diagnosis and more likely to have metabolic comorbidities (obesity, diabetes, and hypertension) but less likely to have atrial fibrillation (30% vs 13%; P < 0.001). Black patients had lower N-terminal pro-B-type natriuretic peptide levels and a lower frequency of H2FPEF scores ≥6, indicative of likely HFpEF (26% vs 44%; P < 0.0001). Conclusions Leveraging an NLP-based artificial intelligence approach to quantify health inequities in HFpEF diagnosis, we discovered that established markers systematically underdiagnose HFpEF in Black patients, possibly due to differences in the underlying comorbidity patterns. Clinicians should be aware of these limitations and its implications for treatment and trial recruitment.
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Affiliation(s)
- Sam Brown
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Dhruva Biswas
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Jack Wu
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Matthew Ryan
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Brett S. Bernstein
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Natalie Fairhurst
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - George Kaye
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ranu Baral
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Antonio Cannata
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Tom Searle
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Narbeh Melikian
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Daniel Sado
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Thomas F. Lüscher
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - James Teo
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Richard Dobson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel I. Bromage
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Theresa A. McDonagh
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Ali Vazir
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ajay M. Shah
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Kevin O’Gallagher
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
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Lopez-Candales A, Asif T, Sawalha K, Norgard NB. Heart Failure with Preserved Left Ventricular Ejection Fraction: A Complex Conundrum Simply Not Limited to Diastolic Dysfunction. Cardiovasc Ther 2023; 2023:1552826. [PMID: 37496726 PMCID: PMC10368509 DOI: 10.1155/2023/1552826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023] Open
Abstract
Over the last two decades, the changing paradigm of heart failure with preserved ejection fraction (HFpEF) has transformed our understanding not only of the pathophysiology of this clinical entity but also the diagnostic and therapeutic approaches aimed at treating this complex patient population. No longer HFpEF should be seen as simply left ventricular diastolic dysfunction but as a group of that in addition of having small and thick left ventricles with abnormal diastolic filling patterns as their main pathophysiologic abnormality; they also have whole host of different abnormalities. In fact, this heterogeneous clinical entity embodies numerous mechanisms and is linked to multiorgan dysfunction, with hypertension and obesity playing a major role. Although we have gained an enormous amount of understanding not only on the causes but also the downstream effects of HFpEF, there is still much to be learned before we can fully comprehend this complex clinical entity. It is the main intention of this review to synthesize the most recent attributes, mechanism, diagnostic tools, and most useful therapeutic alternatives to be considered when evaluating patients either complaining of dyspnea on exertion as well as exercise intolerance or those recently admitted with HF symptoms but with normal LVEF in the absence of any other valvular abnormalities.
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Affiliation(s)
- Angel Lopez-Candales
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - Talal Asif
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - Khalid Sawalha
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - Nicholas B. Norgard
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
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Li Y, Kubo H, Yu D, Yang Y, Johnson JP, Eaton DM, Berretta RM, Foster M, McKinsey TA, Yu J, Elrod JW, Chen X, Houser SR. Combining three independent pathological stressors induces a heart failure with preserved ejection fraction phenotype. Am J Physiol Heart Circ Physiol 2023; 324:H443-H460. [PMID: 36763506 PMCID: PMC9988529 DOI: 10.1152/ajpheart.00594.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is defined as HF with an ejection fraction (EF) ≥ 50% and elevated cardiac diastolic filling pressures. The underlying causes of HFpEF are multifactorial and not well-defined. A transgenic mouse with low levels of cardiomyocyte (CM)-specific inducible Cavβ2a expression (β2a-Tg mice) showed increased cytosolic CM Ca2+, and modest levels of CM hypertrophy, and fibrosis. This study aimed to determine if β2a-Tg mice develop an HFpEF phenotype when challenged with two additional stressors, high-fat diet (HFD) and Nω-nitro-l-arginine methyl ester (l-NAME, LN). Four-month-old wild-type (WT) and β2a-Tg mice were given either normal chow (WT-N, β2a-N) or HFD and/or l-NAME (WT-HFD, WT-LN, WT-HFD-LN, β2a-HFD, β2a-LN, and β2a-HFD-LN). Some animals were treated with the histone deacetylase (HDAC) (hypertrophy regulators) inhibitor suberoylanilide hydroxamic acid (SAHA) (β2a-HFD-LN-SAHA). Echocardiography was performed monthly. After 4 mo of treatment, terminal studies were performed including invasive hemodynamics and organs weight measurements. Cardiac tissue was collected. Four months of HFD plus l-NAME treatment did not induce a profound HFpEF phenotype in FVB WT mice. β2a-HFD-LN (3-Hit) mice developed features of HFpEF, including increased atrial natriuretic peptide (ANP) levels, preserved EF, diastolic dysfunction, robust CM hypertrophy, increased M2-macrophage population, and myocardial fibrosis. SAHA reduced the HFpEF phenotype in the 3-Hit mouse model, by attenuating these effects. The 3-Hit mouse model induced a reliable HFpEF phenotype with CM hypertrophy, cardiac fibrosis, and increased M2-macrophage population. This model could be used for identifying and preclinical testing of novel therapeutic strategies.NEW & NOTEWORTHY Our study shows that three independent pathological stressors (increased Ca2+ influx, high-fat diet, and l-NAME) together produce a profound HFpEF phenotype. The primary mechanisms include HDAC-dependent-CM hypertrophy, necrosis, increased M2-macrophage population, fibroblast activation, and myocardial fibrosis. A role for HDAC activation in the HFpEF phenotype was shown in studies with SAHA treatment, which prevented the severe HFpEF phenotype. This "3-Hit" mouse model could be helpful in identifying novel therapeutic strategies to treat HFpEF.
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Affiliation(s)
- Yijia Li
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
| | - Hajime Kubo
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
| | - Daohai Yu
- Department of Biomedical Education and Data Science, Center for Biostatistics and Epidemiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
| | - Yijun Yang
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
| | - Jaslyn P Johnson
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
| | - Deborah M Eaton
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Remus M Berretta
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
| | - Michael Foster
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
| | - Timothy A McKinsey
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Consortium for Fibrosis Research and Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Jun Yu
- Department of Cardiovascular Sciences, Center for Metabolic Disease Research, Lewis Katz School of Medicine, Temple University, Cardiovascular Research Center, Philadelphia, Pennsylvania, United States
| | - John W Elrod
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
- Department of Cardiovascular Sciences, Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Cardiovascular Research Center, Philadelphia, Pennsylvania, United States
| | - Xiongwen Chen
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin, China
| | - Steven R Houser
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
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5
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Zhao K, Zhou J, Guo JT, Wu CH, Li SL, Zhang Q, Tian X, Shan WC, Ding ZJ, Yuan LS, Zheng Q, Gao XL, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Association between tricuspid annular systolic velocity and poor short-term prognosis in patients with acute decompensated heart failure. Ann Med 2022; 54:2898-2908. [PMID: 36259612 PMCID: PMC9624254 DOI: 10.1080/07853890.2022.2134585] [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] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is scant data on the association of the Pulsed wave-Doppler tissue imaging (PW-DTI)-derived tricuspid lateral annular peak systolic velocity (S') and poor short-term prognosis of patients with acute decompensated heart failure (ADHF). PATIENTS AND METHODS A total number of 732 participants from the Heb-ADHF registry in China were divided into three groups according to the corresponding status of tricuspid S'. Demographic characteristics, comorbidities, physical examinations, lab tests, and medications were compared among the different groups. Different logistic regression models were utilized to gauge the relationship between S' and the risk of a composite of short-term all-cause mortality or 30-day heart failure (HF)-related rehospitalization. RESULTS The number of composite outcome events identified in the study population was 85, with the short-term all-cause death coupled with 30-day HF readmission events reaching 23 and 62, respectively. As per the multivariable adjusted analysis, S' was inversely related to the risk of a composite outcome [<10 cm/s odds ratios (OR) 2.90, 95% confidence interval (CI):1.33-6.31; 10-11 cm/s OR 2.18, 95% CI: 1.10-4.33; p for trend = 0.006] in comparison with S' at >11 cm/s. When S' was analysed as a continuous variable, per 1 cm/s increase, the OR (95% CI) for a composite outcome was [0.87 (0.77-0.99), p = 0.028]. Area under curve (AUC) of S' for predicting outcome of ADHF was 0.631 (95%CI: 0.573-0.690, p < 0.01). Significant inverse association was also observed in left ventricular ejection fraction (LVEF) ≥40% subgroup. CONCLUSIONS Inspite of the potential confounders, a more impaired tricuspid annular peak systolic velocity is associated with a poorer short-term prognosis of patients with ADHF.
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Affiliation(s)
- Kai Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Jing Tao Guo
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Cai Hong Wu
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Sen Lin Li
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Qi Zhang
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Xiang Tian
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Wei Chao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Zhen Jiang Ding
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Lan Suo Yuan
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Xiao Li Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, China
| | - Hong Sen Tian
- Department of Cardiology, Handan Central Hospital, Handan, China
| | - Qing Min Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, China
| | - Xi Tian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Ying Kai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, China
| | - Xue Geng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Zhao L, Zierath R, John JE, Claggett BL, Hall ME, Clark D, Butler KR, Correa A, Shah AM. Subclinical Risk Factors for Heart Failure With Preserved and Reduced Ejection Fraction Among Black Adults. JAMA Netw Open 2022; 5:e2231878. [PMID: 36107422 PMCID: PMC9478780 DOI: 10.1001/jamanetworkopen.2022.31878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/30/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Sparse data exist regarding the contributions of subclinical impairments in cardiovascular and noncardiovascular function to incident heart failure (HF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) among Black US residents, limiting understanding of the etiology of HF subtypes. Objectives To identify subclinical cardiovascular and noncardiovascular risk factors associated with HFrEF and HFpEF in Black US residents. Design, Setting, and Participants This cohort study used cross-sectional and time-to-event analysis with data from the community-based Jackson Heart Study (JHS), a longitudinal cohort study with baseline data collected from 2000 to 2004 (visit 1) and 10-year follow-up for incident HF. Black US residents from the Jackson, Mississippi, metropolitan area enrolled in JHS; those with prevalent HF, with moderate or greater aortic or mitral valve diseases on visit 1, who died before 2005, and who had missing HF status on follow-up were excluded. The analysis included 4361 participants and was performed between June 2020 to August 2021. Exposures Quantitative measures of cardiovascular (left ventricular mass index [LVMI], left ventricular ejection fraction [LVEF], left atrial [LA] diameter, and pulse pressure) and noncardiovascular (percent predicted forced expiration volume in 1 second [FEV1 (percent predicted)], estimated glomerular filtration rate (eGFR), waist circumference, and hemoglobin A1c [HbA1c] level) organ function. Main Outcomes and Measures Incident HF, HFrEF, and HFpEF over 10-year follow-up. Results The 4361 participants had a mean (SD) age of 54 (13); 2776 (64%) were women; and there were 163 HFpEF and 146 HFrEF events. In multivariable models incorporating measures reflecting each organ system, factors associated with incident HFpEF included greater LA diameter (hazard ratio [HR], 1.23; 95% CI, 1.03-1.47; P = .02), higher pulse pressure (HR, 1.23; 95% CI, 1.05-1.44; P = .009), lower FEV1 (percent predicted) (HR, 1.22; 95% CI, 1.04-1.43; P = .02), lower eGFR (HR, 1.43; 95% CI, 1.19-1.72; P < .001), higher HbA1c level (HR, 1.25; 95% CI, 1.07-1.45; P = .005), and higher waist circumference (HR, 1.41; 95% CI, 1.18-1.69; P < .001). Factors associated with incident HFrEF included greater LVMI (HR, 1.25; 1.07-1.46; P = .005), lower LVEF (HR, 1.65; 95% CI, 1.42-1.91; P < .001), lower FEV1 (percent predicted) (HR, 1.19; 95% CI, 1.00-1.42; P = .047), and lower eGFR (HR, 1.27; 95% CI, 1.04-1.55; P = .02). Conclusions and Relevance In this community-based cohort study of Black US residents, subclinical impairments in cardiovascular and noncardiovascular organ function were differentially associated with risk of incident HFpEF and HFrEF.
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Affiliation(s)
- Li Zhao
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Cardiovascular Medicine, the Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Rani Zierath
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jenine E. John
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Brian Lee Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Donald Clark
- University of Mississippi Medical Center, Jackson
| | | | | | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Prevalence, risk factors, and survival associated with pulmonary hypertension and heart failure among patients with underlying coronary artery disease: a national prospective, multicenter registry study in China. Chin Med J (Engl) 2022; 135:1837-1845. [PMID: 36195993 PMCID: PMC9521769 DOI: 10.1097/cm9.0000000000002112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH. METHODS Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RHC), and other baseline clinical data were recorded. Patients were followed up and their survival was recorded. RESULTS One hundred and eighty-two CAD-HF patients were enrolled, including 142 with HF with a preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF]; left ventricular ejection fraction [LVEF] ≥50%) and 40 with a reduced ejection fraction (heart failure with reduced ejection fraction [HFrEF]; LVEF < 50%). PH was diagnosed with RHC in 77.5% of patients. Patients with PH showed worse hemodynamic parameters and higher mortality. HFrEF-PH patients had worse survival than HFpEF-PH patients. CAD-HF patients with an enlarged left ventricular end-diastolic diameter and reduced hemoglobin were at higher risk of PH. Nitrate treatment reduced the risk of PH. Elevated creatinine and mean pulmonary arterial pressure (mPAP), diastolic pressure gradient (DPG) ≥7 mmHg, and previous myocardial infarction (MI) entailed a higher risk of mortality in CAD-HF patients with PH. CONCLUSIONS PH is common in CAD-HF and worsens the hemodynamics and survival in these patients. Left ventricle enlargement and anemia increase the risk of PH in CAD-HF. Patients may benefit from nitrate medications. Renal impairment, elevated mPAP, DPG ≥7 mmHg, and previous MI are strong predictors of mortality in CAD-HF-PH patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT02164526.
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8
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Left atrial structure and function in heart failure with reduced (HFrEF) versus preserved ejection fraction (HFpEF): systematic review and meta-analysis. Heart Fail Rev 2022; 27:1933-1955. [PMID: 35079942 PMCID: PMC9388424 DOI: 10.1007/s10741-021-10204-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 01/10/2023]
Abstract
Left atrial (LA) structure and function in heart failure with reduced (HFrEF) versus preserved ejection fraction (HFpEF) is only established in small studies. Therefore, we conducted a systematic review of LA structure and function in order to find differences between patients with HFrEF and HFpEF. English literature on LA structure and function using echocardiography was reviewed to calculate pooled prevalence and weighted mean differences (WMD). A total of 61 studies, comprising 8806 patients with HFrEF and 9928 patients with HFpEF, were included. The pooled prevalence of atrial fibrillation (AF) was 34.4% versus 42.8% in the acute inpatient setting, and 20.1% versus 33.1% in the chronic outpatient setting when comparing between HFrEF and HFpEF. LA volume index (LAVi), LA reservoir global longitudinal strain (LAGLSR), and E/e’ was 59.7 versus 52.7 ml/m2, 9.0% versus 18.9%, and 18.5 versus 14.0 in the acute inpatient setting, and 48.3 versus 38.2 ml/m2, 12.8% versus 23.4%, and 16.9 versus 13.5 in the chronic outpatient setting when comparing HFrEF versus HFpEF, respectively. The relationship between LAVi and LAGLSR was significant in HFpEF, but not in HFrEF. Also, in those studies that directly compared patients with HFrEF versus HFpEF, those with HFrEF had worse LAGLSR [WMD = 16.3% (22.05,8.61); p < 0.001], and higher E/e’ [WMD = −0.40 (−0.56, −0.24); p < 0.05], while LAVi was comparable. When focusing on acute hospitalized patients, E/e’ was comparable between patients with HFrEF and HFpEF. Despite the higher burden of AF in HFpEF, patients with HFrEF had worse LA global function. Left atrial myopathy is not specifically related to HFpEF.
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9
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Goldstein LB, Seshadri S, Sacco RL. Risk Factors and Prevention. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Obesity-associated cardiovascular risk in women: hypertension and heart failure. Clin Sci (Lond) 2021; 135:1523-1544. [PMID: 34160010 DOI: 10.1042/cs20210384] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/14/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
The pathogenesis of obesity-associated cardiovascular diseases begins long prior to the presentation of a cardiovascular event. In both men and women, cardiovascular events, and their associated hospitalizations and mortality, are often clinically predisposed by the presentation of a chronic cardiovascular risk factor. Obesity increases the risk of cardiovascular diseases in both sexes, however, the clinical prevalence of obesity, as well as its contribution to crucial cardiovascular risk factors is dependent on sex. The mechanisms via which obesity leads to cardiovascular risk is also discrepant in women between their premenopausal, pregnancy and postmenopausal phases of life. Emerging data indicate that at all reproductive statuses and ages, the presentation of a cardiovascular event in obese women is strongly associated with hypertension and its subsequent chronic risk factor, heart failure with preserved ejection fraction (HFpEF). In addition, emerging evidence indicates that obesity increases the risk of both hypertension and heart failure in pregnancy. This review will summarize clinical and experimental data on the female-specific prevalence and mechanisms of hypertension and heart failure in women across reproductive stages and highlight the particular risks in pregnancy as well as emerging data in a high-risk ethnicity in women of African ancestry (AA).
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11
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Sharma K, Mok Y, Kwak L, Agarwal SK, Chang PP, Deswal A, Shah AM, Kitzman DW, Wruck LM, Loehr LR, Heiss G, Coresh J, Rosamond WD, Solomon SD, Matsushita K, Russell SD. Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study. J Am Heart Assoc 2020; 9:e014669. [PMID: 32924735 PMCID: PMC7792380 DOI: 10.1161/jaha.119.014669] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure hospitalizations, with limited data on predictors of mortality by sex and race. We evaluated for differences in predictors of all‐cause mortality by sex and race among hospitalized patients with HFpEF in the ARIC (Atherosclerosis Risk in Communities) Community Surveillance Study. Methods and Results Adjudicated HFpEF hospitalization events from 2005 to 2013 were analyzed from the ARIC Community Surveillance Study, comprising 4 US communities. Comparisons between clinical characteristics and mortality at 1 year were made by sex and race. Of 4335 adjudicated acute decompensated heart failure cases, 1892 cases (weighted n=8987) were categorized as HFpEF. Men had an increased risk of 1‐year mortality compared with women in adjusted analysis (hazard ratio [HR], 1.27; 95% CI, 1.06–1.52 [P=0.01]). Black participants had lower mortality compared with White participants in unadjusted and adjusted analyses (HR, 0.79; 95% CI, 0.64–0.97 [P=0.02]). Age, heart rate, worsening renal function, and low hemoglobin were associated with increased mortality in all subgroups. Higher body mass index was associated with improved survival in men, with borderline interaction by sex. Higher blood pressure was associated with improved survival among all groups, with significant interaction by race. Conclusions In a diverse HFpEF population, men had worse survival compared with women, and Black participants had improved survival compared with White participants. Age, heart rate, and worsening renal function were associated with increased mortality across all subgroups; high blood pressure was associated with decreased mortality with interaction by race. These insights into sex‐ and race‐based differences in predictors of mortality may help strategize targeted management of HFpEF.
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Affiliation(s)
- Kavita Sharma
- Division of Cardiology The Johns Hopkins Hospital Baltimore MD
| | - Yejin Mok
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Lucia Kwak
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | | | - Patricia P Chang
- Department of Medicine University of North Carolina Chapel Hill NC
| | - Anita Deswal
- Section of Cardiology Michael E. DeBakey VA Medical Center Baylor College of Medicine Houston TX
| | - Amil M Shah
- Cardiovascular Division Brigham and Women's Hospital Boston MA
| | - Dalane W Kitzman
- Cardiology and Geriatrics Sections Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC
| | - Lisa M Wruck
- Duke Clinical Research InstituteCenter for Predictive Medicine Durham NC
| | - Laura R Loehr
- Department of Epidemiology University of North Carolina Chapel Hill NC
| | - Gerardo Heiss
- Department of Epidemiology University of North Carolina Chapel Hill NC
| | - Josef Coresh
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Wayne D Rosamond
- Department of Epidemiology University of North Carolina Chapel Hill NC
| | - Scott D Solomon
- Cardiovascular Division Brigham and Women's Hospital Boston MA
| | - Kunihiro Matsushita
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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12
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DesJardin JT, Healy MJ, Nah G, Vittinghoff E, Agarwal A, Marcus GM, Velez JMG, Tseng ZH, Parikh NI. Placental Abruption as a Risk Factor for Heart Failure. Am J Cardiol 2020; 131:17-22. [PMID: 32718545 DOI: 10.1016/j.amjcard.2020.06.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
Complications of pregnancy present an opportunity to identify women at high risk of cardiovascular disease (CVD). Placental abruption is a severe and understudied pregnancy complication, and its relationship with CVD is poorly understood. The California Healthcare Cost and Utilization Project database was used to identify women with hospitalized pregnancies in California between 2005 and 2009, with follow-up through 2011. Pregnancies, exposures, covariates, and outcomes were defined by International Classification of Diseases Ninth Revision codes. Cox proportional-hazards regression was used to examine the association between placental abruption and myocardial infarction (MI), stroke, and heart failure (HF). Multivariate models controlling for age, race, medical co-morbidities, pregnancy complications, psychiatric and substance use disorders, and socioeconomic factors were employed. Among over 1.5 million pregnancies, placental abruption occurred in 14,881 women (1%). Median follow-up time from delivery to event or censoring was 4.87 (interquartile range 3.54 to 5.96) years. In unadjusted models, placental abruption was associated with risk of HF, but not MI or stroke. In fully-adjusted models, placental abruption remained significantly associated with HF (Hazard ratio 1.44; 95% confidence interval 1.09 to 1.90). Among women with placental abruptions, hypertensive disorders of pregnancy and preterm birth respectively modified and mediated the association between placental abruption and HF. In conclusion, placental abruption is a risk factor for HF, particularly in women who also experience hypertensive disorders of pregnancy and preterm birth. Placental abruption is a specific adverse pregnancy outcome associated with risk of HF.
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13
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Dzhioeva O, Belyavskiy E. Diagnosis and Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): Current Perspectives and Recommendations. Ther Clin Risk Manag 2020; 16:769-785. [PMID: 32904123 PMCID: PMC7450524 DOI: 10.2147/tcrm.s207117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major global public health problem. Diagnosis of HFpEF is still challenging and built based on the comprehensive echocardiographic analysis. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. This review attempts to summarize the current advances in the diagnosis of HFpEF and provide future directions of the patients´ management with this very widespread, heterogeneous clinical syndrome.
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Affiliation(s)
- Olga Dzhioeva
- Department of Fundamental and Applied Aspects of Obesity, National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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14
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Pagel PS, Tawil JN, Boettcher BT, Izquierdo DA, Lazicki TJ, Crystal GJ, Freed JK. Heart Failure With Preserved Ejection Fraction: A Comprehensive Review and Update of Diagnosis, Pathophysiology, Treatment, and Perioperative Implications. J Cardiothorac Vasc Anesth 2020; 35:1839-1859. [PMID: 32747202 DOI: 10.1053/j.jvca.2020.07.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023]
Abstract
Almost three-quarters of all heart failure patients who are older than 65 have heart failure with preserved ejection fraction (HFpEF). The proportion and hospitalization rate of patients with HFpEF are increasing steadily relative to patients in whom heart failure occurs as result of reduced ejection fraction. The predominance of the HFpEF phenotype most likely is explained by the prevalence of medical conditions associated with an aging population. A multitude of age-related, medical, and lifestyle risk factors for HFpEF have been identified as potential causes for the sustained low-grade proinflammatory state that accelerates disease progression. Profound left ventricular (LV) systolic and diastolic stiffening, elevated LV filling pressures, reduced arterial compliance, left atrial hypertension, pulmonary venous congestion, and microvascular dysfunction characterize HFpEF, but pulmonary arterial hypertension, right ventricular dilation and dysfunction, and atrial fibrillation also frequently occur. These cardiovascular features make patients with HFpEF exquisitely sensitive to the development of hypotension in response to acute declines in LV preload or afterload that may occur during or after surgery. With the exception of symptom mitigation, lifestyle modifications, and rigorous control of comorbid conditions, few long-term treatment options exist for these unfortunate individuals. Patients with HFpEF present for surgery on a regular basis, and anesthesiologists need to be familiar with this heterogeneous and complex clinical syndrome to provide successful care. In this article, the authors review the diagnosis, pathophysiology, and treatment of HFpEF and also discuss its perioperative implications.
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Affiliation(s)
- Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Justin N Tawil
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Brent T Boettcher
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - David A Izquierdo
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy J Lazicki
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - George J Crystal
- Department of Anesthesiology, University of Illinois College of Medicine, Chicago, IL
| | - Julie K Freed
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
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15
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Weight Reduction for Obesity-Induced Heart Failure with Preserved Ejection Fraction. Curr Hypertens Rep 2020; 22:47. [DOI: 10.1007/s11906-020-01074-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Ferdinand KC, Harrison D, Johnson A. The NEW-HOPE study and emerging therapies for difficult-to-control and resistant hypertension. Prog Cardiovasc Dis 2020; 63:64-73. [DOI: 10.1016/j.pcad.2019.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 12/29/2019] [Indexed: 12/11/2022]
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17
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Jones NR, Roalfe AK, Adoki I, Hobbs FDR, Taylor CJ. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis. Eur J Heart Fail 2019; 21:1306-1325. [PMID: 31523902 PMCID: PMC6919428 DOI: 10.1002/ejhf.1594] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022] Open
Abstract
Aim To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting. Methods and results We searched in relevant databases from inception to August 2018 for non‐interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta‐analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3–96.9), 86.5% (85.4–87.6), 72.6% (67.0–76.6), 56.7% (54.0–59.4) and 34.9% (24.0–46.8), respectively. The 5‐year survival rates improved between 1970–1979 and 2000–2009 across healthcare settings, from 29.1% (25.5–32.7) to 59.7% (54.7–64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co‐morbidities, and treatment rates. Conclusion These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence‐based treatments. Further research exploring the barriers and facilitators to treatment is recommended.
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Affiliation(s)
- Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ibiye Adoki
- Foundation Training Programme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare J Taylor
- Foundation Training Programme, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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18
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Abstract
Approximately half of the patients with signs and symptoms of heart failure have a left ventricular ejection fraction that is not markedly abnormal. Despite the historically initial surprise, heightened risks for heart failure specific major adverse events occur across the broad range of ejection fraction, including normal. The recognition of the magnitude of the problem of heart failure with preserved ejection fraction in the past 20 years has spurred an explosion of clinical investigation and growing intensity of informative outcome trials. This article addresses the historic development of this component of the heart failure syndrome, including the epidemiology, pathophysiology, and existing and planned therapeutic studies. Looking forward, more specific phenotyping and even genotyping of subpopulations should lead to improvements in outcomes from future trials.
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Affiliation(s)
- Marc A. Pfeffer
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amil M. Shah
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Barry A. Borlaug
- Cardiovascular Medicine Division, Mayo Clinic, Rochester, Minnesota
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19
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Antihyperglycemic and Blood Pressure Effects of Empagliflozin in Black Patients With Type 2 Diabetes Mellitus and Hypertension. Circulation 2019; 139:2098-2109. [DOI: 10.1161/circulationaha.118.036568] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Brewster LM. Underuse of hydralazine and isosorbide dinitrate for heart failure in patients of African ancestry: a cross-European survey. ESC Heart Fail 2019; 6:487-498. [PMID: 30892835 PMCID: PMC6487721 DOI: 10.1002/ehf2.12421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/27/2019] [Indexed: 01/06/2023] Open
Abstract
Aims Population data indicate that one in 25 persons of African ancestry has heart failure, a condition with relatively high mortality of around 50% in 5 years. Combined hydralazine and isosorbide dinitrate added to conventional therapy in African ancestry patients with heart failure and reduced ejection fraction improves quality of life and reduces the rate of first hospitalization for heart failure by 33% and annual mortality by 43%. The objectives of this study were to quantify the use of this guideline‐recommended therapy in Europe and the potential effect of implementation gaps on mortality. Methods and results Prescription drug registration and utilization databases and population statistics were analysed in a cross‐European survey without language restriction. Main outcomes were the number of unique patients prescribed the fixed combination hydralazine–isosorbide dinitrate (primary) or both drugs (secondary) in Europe in 2015, and the excess mortality related to prescribing practices was estimated. The survey indicates that around 12 million persons of African ancestry live in Europe. It is estimated that 480 000 persons of this population group have heart failure, with 120 000 eligible for hydralazine and isosorbide dinitrate therapy. However, single‐pill hydralazine–isosorbide dinitrate is not authorized and therefore not dispensed in Europe in 2015. Out of the 25 European nations surveyed, the UK and the Netherlands are the only countries with major African ancestry populations where both hydralazine and isosorbide dinitrate are available for oral use, aside Norway, Sweden, and Finland. Hydralazine and isosorbide dinitrate are prescribed to <500 European patients in 2015. Thus, despite the recommendations of the European Society of Cardiology, the large majority of African‐European patients with heart failure do not receive this drug combination, potentially resulting in 4800 to 5800 excess deaths yearly. Conclusions The life‐saving, guideline‐recommended, adjunctive therapy for heart failure in African ancestry patients with hydralazine and isosorbide dinitrate is rarely used in Europe. This major evidence‐practice gap should urgently be overcome to reduce excess mortality in African‐European patients with heart failure.
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Affiliation(s)
- Lizzy M Brewster
- Creatine Kinase Foundation Amsterdam, PO Box 23639, 1100 EC, Amsterdam, The Netherlands
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21
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Is leptin protective against heart failure with preserved ejection fraction? A complex interrelationship among leptin, obesity, and left ventricular hypertrophy. Hypertens Res 2018; 42:141-142. [PMID: 30420723 DOI: 10.1038/s41440-018-0135-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/08/2022]
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22
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Roy C, Slimani A, de Meester C, Amzulescu M, Pasquet A, Vancraeynest D, Beauloye C, Vanoverschelde JL, Gerber BL, Pouleur AC. Associations and prognostic significance of diffuse myocardial fibrosis by cardiovascular magnetic resonance in heart failure with preserved ejection fraction. J Cardiovasc Magn Reson 2018; 20:55. [PMID: 30086783 PMCID: PMC6081897 DOI: 10.1186/s12968-018-0477-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 07/19/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Increased myocardial fibrosis may play a key role in heart failure with preserved ejection fraction (HFpEF) pathophysiology. The study aim was to evaluate the presence, associations, and prognostic significance of diffuse fibrosis in HFpEF patients compared to age- and sex-matched controls. METHODS We prospectively included 118 consecutive HFpEF patients. Diffuse myocardial fibrosis was estimated by extracellular volume (ECV) quantified by cardiovascular magnetic resonance with the modified Look-Locker inversion recovery sequence. We determined an ECV age- and sex-adjusted cutoff value (33%) in 26 controls. RESULTS Mean ECV was significantly higher in HFpEF patients versus healthy controls (32.9 ± 4.8% vs 28.2 ± 2.4%, P < 0.001). Multivariate logistic regression showed that body mass index (BMI) (odds ratio (OR) =0.92 [0.86-0.98], P = 0.011), diabetes (OR = 2.62 [1.11-6.18], P = 0.028), and transmitral peak E wave velocity (OR = 1.02 [1.00-1.03], P = 0.022) were significantly associated with abnormal ECV value. During a median follow-up of 11 ± 6 months, the primary outcome (all-cause mortality or first heart failure hospitalization) occurred in 38 patients. In multivariate Cox regression analysis, diabetes (hazard ratio (HR) =1.98 [1.04; 3.76], P = 0.038) and hemoglobin level (HR = 0.81 [0.67; 0.98], P = 0.028) were significant predictors of composite outcome. The ECV ability to improve this model added significant prognostic information. We then developed a risk score including diabetes, hemoglobin and ECV > 33% demonstrating significant prediction of risk and validated this score in a validation cohort of 53 patients. Kaplan-Meier curves showed a significant difference according to tertiles of the probability score (P < 0.001). CONCLUSION Among HFpEF patients, high ECV, likely reflecting abnormal diffuse myocardial fibrosis, was associated with a higher rate of all-cause death and first HF hospitalization in short term follow up. TRIAL REGISTRATION Characterization of Heart Failure With Preserved Ejection Fraction. TRIAL REGISTRATION NUMBER NCT03197350 . Date of registration: 20/06/2017. This trial was retrospectively registered.
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Affiliation(s)
- Clotilde Roy
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Alisson Slimani
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Christophe de Meester
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Mihaela Amzulescu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Agnes Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Beauloye
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Bernhard L. Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwé St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
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Savji N, Meijers WC, Bartz TM, Bhambhani V, Cushman M, Nayor M, Kizer JR, Sarma A, Blaha MJ, Gansevoort RT, Gardin JM, Hillege HL, Ji F, Kop WJ, Lau ES, Lee DS, Sadreyev R, van Gilst WH, Wang TJ, Zanni MV, Vasan RS, Allen NB, Psaty BM, van der Harst P, Levy D, Larson M, Shah SJ, de Boer RA, Gottdiener JS, Ho JE. The Association of Obesity and Cardiometabolic Traits With Incident HFpEF and HFrEF. JACC. HEART FAILURE 2018; 6:701-709. [PMID: 30007554 PMCID: PMC6076337 DOI: 10.1016/j.jchf.2018.05.018] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study evaluated the associations of obesity and cardiometabolic traits with incident heart failure with preserved versus reduced ejection fraction (HFpEF vs. HFrEF). Given known sex differences in HF subtype, we examined men and women separately. BACKGROUND Recent studies suggest that obesity confers greater risk of HFpEF versus HFrEF. Contributions of associated metabolic traits to HFpEF are less clear. METHODS We studied 22,681 participants from 4 community-based cohorts followed for incident HFpEF versus HFrEF (ejection fraction ≥50% vs. <50%). We evaluated the association of body mass index (BMI) and cardiometabolic traits with incident HF subtype using Cox models. RESULTS The mean age was 60 ± 13 years, and 53% were women. Over a median follow-up of 12 years, 628 developed incident HFpEF and 835 HFrEF. Greater BMI portended higher risk of HFpEF compared with HFrEF (hazard ratio [HR]: 1.34 per 1-SD increase in BMI; 95% confidence interval [CI]: 1.24 to 1.45 vs. HR: 1.18; 95% CI: 1.10 to 1.27). Similarly, insulin resistance (homeostatic model assessment of insulin resistance) was associated with HFpEF (HR: 1.20 per 1-SD; 95% CI: 1.05 to 1.37), but not HFrEF (HR: 0.99; 95% CI: 0.88 to 1.11; p < 0.05 for difference HFpEF vs. HFrEF). We found that the differential association of BMI with HFpEF versus HFrEF was more pronounced among women (p for difference HFpEF vs. HFrEF = 0.01) when compared with men (p = 0.34). CONCLUSIONS Obesity and related cardiometabolic traits including insulin resistance are more strongly associated with risk of future HFpEF versus HFrEF. The differential risk of HFpEF with obesity seems particularly pronounced among women and may underlie sex differences in HF subtypes.
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Affiliation(s)
- Nazir Savji
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Wouter C Meijers
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Vijeta Bhambhani
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary Cushman
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Matthew Nayor
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge R Kizer
- Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Amy Sarma
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland
| | - Ron T Gansevoort
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Hans L Hillege
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Fei Ji
- Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Willem J Kop
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Emily S Lau
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Ruslan Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Wiek H van Gilst
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Markella V Zanni
- Division of Neuroendocrinology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ramachandran S Vasan
- Framingham Heart Study, Framingham, Massachusetts; Cardiovascular Medicine Section, Department of Medicine and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Norrina B Allen
- Department of Epidemiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington; Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Pim van der Harst
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Daniel Levy
- Framingham Heart Study, Framingham, Massachusetts; Center for Population Studies of the National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Martin Larson
- Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rudolf A de Boer
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | | | - Jennifer E Ho
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts.
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24
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Kadri AN, Kaw R, Al-Khadra Y, Abuamsha H, Ravakhah K, Hernandez AV, Tang WHW. The role of B-type natriuretic peptide in diagnosing acute decompensated heart failure in chronic kidney disease patients. Arch Med Sci 2018; 14:1003-1009. [PMID: 30154881 PMCID: PMC6111357 DOI: 10.5114/aoms.2018.77263] [Citation(s) in RCA: 7] [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: 11/15/2017] [Accepted: 01/26/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) and congestive heart failure (CHF) patients have higher serum B-type natriuretic peptide (BNP), which alters the test interpretation. We aim to define BNP cutoff levels to diagnose acute decompensated heart failure (ADHF) in CKD according to CHF subtype: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). MATERIAL AND METHODS We reviewed 1,437 charts of consecutive patients who were admitted for dyspnea. We excluded patients with normal kidney function, without measured BNP, echocardiography, or history of CHF. BNP cutoff values to diagnose ADHF for CKD stages according to CHF subtype were obtained for the highest pair of sensitivity (Sn) and specificity (Sp). We calculated positive and negative likelihood ratios (LR+ and LR-, respectively), and diagnostic odds ratios (DOR), as well as the area under the receiver operating characteristic curves (AUC) for BNP. RESULTS We evaluated a cohort of 348 consecutive patients: 152 had ADHF, and 196 had stable CHF. In those with HFpEF with CKD stages 3-4, BNP < 155 pg/ml rules out ADHF (Sn90%, LR- = 0.26 and DOR = 5.75), and BNP > 670 pg/ml rules in ADHF (Sp90%, LR+ = 4 and DOR = 6), with an AUC = 0.79 (95% CI: 0.71-0.87). In contrast, in those with HFrEF with CKD stages 3-4, BNP < 412.5 pg/ml rules out ADHF (Sn90%, LR- = 0.19 and DOR = 9.37), and BNP > 1166.5 pg/ml rules in ADHF (Sp87%, LR+ = 3.9 and DOR = 6.97) with an AUC = 0.78 (95% CI: 0.69-0.86). All LRs and DOR were statistically significant. CONCLUSIONS BNP cutoff values for the diagnosis of ADHF in HFrEF were higher than those in HFpEF across CKD stages 3-4, with moderate discriminatory diagnostic ability.
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Affiliation(s)
| | - Roop Kaw
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Hasan Abuamsha
- St. Vincent Charity Medical Center – Case Western Reserve University, Cleveland, Ohio, USA
| | - Keyvan Ravakhah
- St. Vincent Charity Medical Center – Case Western Reserve University, Cleveland, Ohio, USA
| | - Adrian V. Hernandez
- University of Connecticut, Hartford Hospital Evidence-based Practice Center, Hartford, CT, USA
- School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
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25
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Kamimura D, Suzuki T, Furniss AL, Griswold ME, Kullo IJ, Lindsey ML, Winniford MD, Butler KR, Mosley TH, Hall ME. Elevated serum osteoprotegerin is associated with increased left ventricular mass index and myocardial stiffness. J Cardiovasc Med (Hagerstown) 2018; 18:954-961. [PMID: 28787318 DOI: 10.2459/jcm.0000000000000549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM Osteoprotegerin (OPG) is associated with a poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF). OPG has also been associated with fibrosis and collagen cross-linking, which increase arterial and left ventricle (LV) myocardial stiffness. Little is known about the relation of OPG and LV structure and function in African-Americans who are disproportionately affected by HFpEF. METHODS AND RESULTS Our analysis included 1172 participants with preserved LV ejection fraction (>50%) from the African-American cohort in the Genetic Epidemiology Network of Arteriopathy Study (mean age 63 years, 72% female). We used diastolic wall strain indicator measured by echocardiography to assess LV myocardial stiffness. Diastolic wall strain was calculated as (LV posterior thickness at end-systole - LV posterior thickness at end-diastole)/LV posterior thickness at end-systole. Associations between OPG levels and indices of arterial and LV structure and function were evaluated by using generalized linear mixed models and adjusted for possible confounders. OPG levels were correlated with age, female sex, presence of hypertension and diabetes, and lower estimated glomerular filtration rate (P < 0.05 for all). Multivariable analysis revealed that higher OPG levels were associated with greater LV mass index, increased LV myocardial stiffness, and higher N-terminal prohormone brain natriuretic peptide levels (P < 0.05 for all). CONCLUSION In African-Americans, higher OPG levels were associated with characteristics common in patients with HFpEF and were significantly associated with known precursors to HFpEF. These findings indicate a potential role for OPG in the pathophysiology of HFpEF in African-Americans.
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Affiliation(s)
- Daisuke Kamimura
- aDivision of CardiologybDepartment of Medicine, Center for Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MississippicDivision of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MinnesotadDepartment of Physiology and Biophysics, Mississippi Center for Heart Research, University of Mississippi Medical CentereResearch Service, G.V. (Sonny) Montgomery Veterans Affairs Medical CenterfDivision of Geriatric Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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26
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Kamimura D, Suzuki T, Wang W, deShazo M, Hall JE, Winniford MD, Kullo IJ, Mosley TH, Butler KR, Hall ME. Higher plasma leptin levels are associated with reduced left ventricular mass and left ventricular diastolic stiffness in black women: insights from the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Hypertens Res 2018; 41:629-638. [PMID: 29907861 DOI: 10.1038/s41440-018-0062-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 01/13/2018] [Accepted: 01/22/2018] [Indexed: 12/11/2022]
Abstract
Our previous experimental animal data suggest a beneficial effect of leptin on LV structure and function. We hypothesized that leptin levels are associated with lower LV mass and myocardial stiffness which are important risk factors for the development of heart failure with preserved ejection fraction (HFpEF). We evaluated 1172 blacks, in which the prevalence of HFpEF is quite high, with preserved LV ejection fraction (EF > 50%) from the Genetic Epidemiology Network of Arteriopathy Study (mean age 62.9 years, 72% women), a community-based study to identify genes influencing blood pressure and target organ damage due to hypertension. Associations between leptin levels and indices of LV structure and function were evaluated using generalized estimating equations accounting for clustering in siblings. LV myocardial stiffness was evaluated using diastolic wall strain (DWS) measured by echocardiography. Analyses were stratified by sex because leptin levels were three times higher in women than men (p < 0.001). After adjustment for confounders, higher leptin levels were associated with lower LV mass (coefficient for 1 s.d. increase of leptin level: -5.825 g, 95% CI: -9.755 to -1.895 g, P = 0.004) and higher DWS (lower LV stiffness) (coefficient for 1 s.d. increase of leptin level: 0.009, 95% CI: 0.002-0.015, P = 0.007) in women. There were no statistically significant associations in men. In women, there were interactions between leptin levels and body mass index quartiles on LV mass and stiffness (p < 0.05 for both). Higher leptin levels were associated with lower LV mass and stiffness in obese but not lean black women.
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Affiliation(s)
- Daisuke Kamimura
- Divsion of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Takeki Suzuki
- Divsion of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Wanmei Wang
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Matthew deShazo
- Divsion of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - John E Hall
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael D Winniford
- Divsion of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas H Mosley
- Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth R Butler
- Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael E Hall
- Divsion of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
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27
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Kamimura D, Suzuki T, Hall ME, Wang W, Winniford MD, Shah AM, Rodriguez CJ, Butler KR, Mosley TH. Diastolic wall strain is associated with incident heart failure in African Americans: Insights from the atherosclerosis risk in communities study. J Cardiol 2018; 71:477-483. [PMID: 29203080 PMCID: PMC6100746 DOI: 10.1016/j.jjcc.2017.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Increased left ventricular (LV) myocardial stiffness may be associated with impaired LV hemodynamics and incident heart failure (HF). However, an indicator that estimates LV myocardial stiffness easily and non-invasively is lacking. The purpose of this study was to determine whether diastolic wall strain (DWS), an echocardiographic estimator of LV myocardial stiffness, is associated with incident HF in a middle-aged community-based cohort of African Americans. METHODS AND RESULTS We investigated associations between DWS and incident HF among 1528 African Americans (mean age 58.5 years, 66% women) with preserved LV ejection fraction (EF ≥50%) and without a history of cardiovascular disease in the Atherosclerosis Risk in Communities Study. Participants with the smallest DWS quintile (more LV myocardial stiffness) had a higher LV mass index, higher relative wall thickness, and lower arterial compliance than those in the larger four DWS quintiles (p<0.01 for all). Over a mean follow-up of 15.6 years, there were 251 incident HF events (incidence rate: 10.9 per 1000 person-years). After adjustment for traditional risk factors and incident coronary artery disease, both continuous and categorical DWS were independently associated with incident HF (HR 1.21, 95%CI 1.04-1.41 for 0.1 decrease in continuous DWS, p=0.014, HR 1.40, 95%CI 1.05-1.87 for the smallest DWS quintile vs other combined quintiles, p=0.022). CONCLUSIONS DWS was independently associated with an increased risk of incident HF in a community-based cohort of African Americans. DWS could be used as a qualitative estimator of LV myocardial stiffness.
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Affiliation(s)
- Daisuke Kamimura
- Department of Medicine-Cardiology, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Takeki Suzuki
- Department of Medicine-Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael E Hall
- Department of Medicine-Cardiology, University of Mississippi Medical Center, Jackson, MS, USA; Mississippi Center for Heart Research, Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Wanmei Wang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael D Winniford
- Department of Medicine-Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Carlos J Rodriguez
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Internal Medicine - Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kenneth R Butler
- Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Thomas H Mosley
- Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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28
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Hohendanner F, Messroghli D, Bode D, Blaschke F, Parwani A, Boldt L, Heinzel FR. Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction. ESC Heart Fail 2018; 5:211-221. [PMID: 29457877 PMCID: PMC5880666 DOI: 10.1002/ehf2.12260] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Felix Hohendanner
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Daniel Messroghli
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
- Department of Internal Medicine—CardiologyDeutsches Herzzentrum BerlinBerlinGermany
| | - David Bode
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Florian Blaschke
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Abdul Parwani
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Leif‐Hendrik Boldt
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
| | - Frank R. Heinzel
- Department of CardiologyCharité University MedicineCampus Virchow‐Klinikum, Augustenburger Platz 113353BerlinGermany
- German Center for Cardiovascular Research (DZHK), Partner SiteBerlinGermany
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29
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Lewis EF, Claggett B, Shah AM, Liu J, Shah SJ, Anand I, O’Meara E, Sweitzer NK, Rouleau JL, Fang JC, Desai AS, Retta TM, Solomon SD, Heitner JF, Stamos TD, Boineau R, Pitt B, Pfeffer MA. Racial Differences in Characteristics and Outcomes of Patients With Heart Failure and Preserved Ejection Fraction in the Treatment of Preserved Cardiac Function Heart Failure Trial. Circ Heart Fail 2018; 11:e004457. [DOI: 10.1161/circheartfailure.117.004457] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/21/2018] [Indexed: 12/23/2022]
Abstract
Background:
Black patients have been shown to have different baseline characteristics and outcomes compared with nonblack patients in cohort studies. However, few studies have focused on heart failure (HF) with preserved ejection fraction (HFpEF) patients. We aimed to determine the difference in cardiovascular outcomes in black and nonblack patients with HFpEF and to determine the relative efficacy and safety of spironolactone in black and nonblack patients.
Methods and Results:
Patients with HFpEF, randomized to spironolactone versus placebo in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) in North and South America, were grouped according to self-described black and nonblack race. Black HFpEF patients (n=302) were younger and were more likely to have diabetes mellitus and hypertension than nonblack patients but had similar HFpEF severity. Black patients had higher risk for the primary outcome (hazard ratio [HR], 1.34; 95% confidence interval, 1.06–1.71;
P
=0.02) and first HF hospitalization (HR, 1.51; 95% confidence interval, 1.167–1.97;
P
=0.002)], but no significant difference in cardiovascular mortality risk (HR, 0.78; 95% confidence interval, 0.51–1.20;
P
=0.326). In black and nonblack patients, randomization to spironolactone conferred similar efficacy in the primary outcome (HR, 0.83 versus 0.79;
P
for interaction=0.49), HF hospitalization (HR, 0.67 versus 0.82;
P
for interaction=0.76), and cardiovascular mortality (
P
for interaction=0.19). The risk of hyperkalemia and worsening renal function with spironolactone and study drug adherence were also similar.
Conclusions:
Black patients with HFpEF have a higher HF hospitalization risk than nonblack patients, but spironolactone is similarly effective and safe in both groups.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00094302.
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Affiliation(s)
- Eldrin F. Lewis
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Brian Claggett
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Amil M. Shah
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Jiankang Liu
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Sanjiv J. Shah
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Inder Anand
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Eileen O’Meara
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Nancy K. Sweitzer
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Jean L. Rouleau
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - James C. Fang
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Akshay S. Desai
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Tamrat M. Retta
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Scott D. Solomon
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - John F. Heitner
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Thomas D. Stamos
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Robin Boineau
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Bertram Pitt
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
| | - Marc A. Pfeffer
- From the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (E.F.L., B.C., A.M.S., J.L., A.S.D., S.D.S., M.A.P.); Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Veterans Affairs Medical Center Minneapolis, Minnesota (I.A.); University of Minnesota Medical School, Minneapolis (I.A.); Veterans Affairs Medical Center at San Diego, CA (I.A.); Montreal Heart Institute, Quebec, Canada (J.L.R., E.O.); Department of
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Nadruz W, West E, Sengeløv M, Santos M, Groarke JD, Forman DE, Claggett B, Skali H, Shah AM. Prognostic Value of Cardiopulmonary Exercise Testing in Heart Failure With Reduced, Midrange, and Preserved Ejection Fraction. J Am Heart Assoc 2017; 6:JAHA.117.006000. [PMID: 29089342 PMCID: PMC5721737 DOI: 10.1161/jaha.117.006000] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background This study aimed to compare the independent and incremental prognostic value of peak oxygen consumption (VO2) and minute ventilation/carbon dioxide production (VE/VCO2) in heart failure (HF) with preserved (HFpEF), midrange (HFmEF), and reduced (HFrEF) ejection fraction (LVEF). Methods and Results In 195 HFpEF (LVEF ≥50%), 144 HFmEF (LVEF 40–49%), and 630 HFrEF (LVEF <40%) patients, we assessed the association of cardiopulmonary exercise testing variables with the composite outcome of death, left ventricular assist device implantation, or heart transplantation (256 events; median follow‐up of 4.2 years), and 2‐year incident HF hospitalization (244 events). In multivariable Cox regression analysis, greater association with outcomes in HFpEF than HFrEF were noted with peak VO2 (HR [95% confidence interval]: 0.76 [0.67–0.87] versus 0.87 [0.83–0.90] for the composite outcome, Pinteraction=0.052; 0.77 [0.69–0.86] versus 0.92 [0.88–0.95], respectively for HF hospitalization, Pinteraction=0.003) and VE/VCO2 slope (1.11 [1.06–1.17] versus 1.04 [1.03–1.06], respectively for the composite outcome, Pinteraction=0.012; 1.10 [1.05–1.15] versus 1.04 [1.03–1.06], respectively for HF hospitalization, Pinteraction=0.019). In HFmEF, peak VO2 and VE/VCO2 slope were associated with the composite outcome (0.79 [0.70–0.90] and 1.12 [1.05–1.19], respectively), while only peak VO2 was related to HF hospitalization (0.81 [0.72–0.92]). In HFpEF and HFrEF, peak VO2 and VE/VCO2 slope provided incremental prognostic value beyond clinical variables based on the C‐statistic, net reclassification improvement, and integrated diagnostic improvement, with models containing both measures demonstrating the greatest incremental value. Conclusions Both peak VO2 and VE/VCO2 slope provided incremental value beyond clinical characteristics and LVEF for predicting outcomes in HFpEF. Cardiopulmonary exercise testing variables provided greater risk discrimination in HFpEF than HFrEF.
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Affiliation(s)
- Wilson Nadruz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.,Department of Internal Medicine, University of Campinas, Brazil
| | - Erin West
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Morten Sengeløv
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Mário Santos
- Faculty of Medicine of University of Porto, Portugal
| | - John D Groarke
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Daniel E Forman
- Department of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA.,VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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31
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Koo P, Gjelsvik A, Choudhary G, Wu WC, Wang W, McCool FD, Eaton CB. Prospective Association of Physical Activity and Heart Failure Hospitalizations Among Black Adults With Normal Ejection Fraction: The Jackson Heart Study. J Am Heart Assoc 2017; 6:JAHA.117.006107. [PMID: 28882818 PMCID: PMC5634276 DOI: 10.1161/jaha.117.006107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Given high rates of obesity, hypertension, and diabetes mellitus, black persons are at risk to develop heart failure. The association of moderate to vigorous physical activity (MVPA) and heart failure in black adults is underresearched. The purpose of this study was to explore whether greater MVPA was associated with lower risk of heart failure hospitalizations (HFHs) among black adults with normal ejection fractions. METHODS AND RESULTS We performed a prospective analysis of 4066 black adults who participated in the Jackson Heart Study and who had physical activity measured, had normal ejection fraction on 2-dimensional echocardiograms, and were followed for 7 years for incident HFH. We used Cox proportional regression analyses adjusted for age, sex, body mass index, smoking status, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, coronary heart disease, atrial fibrillation, and chronic kidney disease and examined effect modification by sex and body mass index. Of the eligible population, 1925 participants, according to the duration of MVPA, had poor health (0 minutes/week), 1332 had intermediate health (1-149 minutes/week), and 809 had ideal health (≥150 minutes/week). There were 168 incident HFHs. MVPA for intermediate and ideal health was associated with decreasing risk of incident HFH (hazard ratio: 0.70 [95% confidence interval, 49-1.00] and 0.35 [95% confidence interval, 0.19-0.64], respectively; Ptrend=0.003). The full model revealed hazard ratios of 0.74 [95% confidence interval, 0.52-1.07] and 0.41 [95% confidence interval, 0.22-0.74], respectively. There was no effect modification between MVPA and body mass index or sex on incident HFH. CONCLUSIONS A dose-response relationship between increasing levels of MVPA and protection from incident HFH was found in black men and women with normal ejection fractions.
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Affiliation(s)
- Patrick Koo
- Department of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, Rhode Island .,Department of Respiratory, Critical Care, and Sleep Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
| | - Annie Gjelsvik
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Gaurav Choudhary
- Department of Cardiology, VA Medical Center, Providence, Rhode Island
| | - Wen-Chih Wu
- Department of Cardiology, VA Medical Center, Providence, Rhode Island
| | - Wei Wang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi
| | - F Dennis McCool
- Department of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Charles B Eaton
- Department of Family Medicine and Epidemiology, Alpert Medical School of Brown University Brown University School of Public Health, Providence, Rhode Island
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32
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Ziaeian B, Heidenreich PA, Xu H, DeVore AD, Matsouaka RA, Hernandez AF, Bhatt DL, Yancy CW, Fonarow GC. Race/Ethnic Differences in Outcomes Among Hospitalized Medicare Patients With Heart Failure and Preserved Ejection Fraction. JACC-HEART FAILURE 2017; 5:483-493. [PMID: 28501527 DOI: 10.1016/j.jchf.2017.02.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/10/2017] [Accepted: 02/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study analyzed HFpEF patient characteristics and clinical outcomes according to race/ethnicity and adjusted for patient and hospital characteristics along with socioeconomic status (SES). BACKGROUND The proportion of hospitalizations for heart failure with preserved ejection fraction (HFpEF) has increased over the last decade. Whether the short- and long-term outcomes differ between racial/ethnic groups is not well described. METHODS The Get With The Guidelines-Heart Failure registry was linked to Medicare administrative data to identify hospitalized patients with HFpEF ≥65 years of age with left ventricular ejection fraction ≥50% between 2006 and 2014. Cox proportional hazards models were used to report hazard ratios (HRs) for 30-day and 1-year readmission and mortality rates with sequential adjustments for patient characteristics, hospital characteristics, and SES. RESULTS The final cohort included 53,065 patients with HFpEF. Overall 30-day mortality was 5.87%; at 1 year, it was 33.1%. The 30-day all-cause readmission rate was 22.2%, and it was 67.0% at 1 year. After adjusting for patient characteristics, hospital characteristics, and SES, 30-day mortality was lower for black patients (HR: 0.84; 95% confidence interval [CI]: 0.71 to 0.98; p = 0.031) and Hispanic patients (HR: 0.78; 95% CI: 0.64 to 0.96; p = 0.017) compared with white patients. One-year mortality was lower for black patients (HR: 0.93; 95% CI: 0.87 to 0.99; p = 0.031), Hispanic patients (HR: 0.83; 95% CI: 0.75 to 0.91; p < 0.001), and Asian patients (HR: 0.76; 95% CI: 0.66 to 0.88; p < 0.001) compared with white patients. Black patients had a higher risk of readmission at 30 days (HR: 1.09; 95% CI: 1.02 to 1.16; p = 0.012) and 1 year (HR: 1.14; 95% CI: 1.09 to 1.20; p < 0.001) compared with white patients. CONCLUSIONS Black, Hispanic, and Asian patients had a lower mortality risk after a hospitalization for HFpEF compared with white patients; black patients had higher readmission rates. These differences in mortality and readmission risk according to race/ethnicity persisted after adjusting for patient characteristics, SES, and hospital factors.
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Affiliation(s)
- Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California; Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Paul A Heidenreich
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Haolin Xu
- Duke Clinical Research Institute, Durham, North Carolina
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California.
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33
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Goyal P, Paul T, Almarzooq ZI, Peterson JC, Krishnan U, Swaminathan RV, Feldman DN, Wells MT, Karas MG, Sobol I, Maurer MS, Horn EM, Kim LK. Sex- and Race-Related Differences in Characteristics and Outcomes of Hospitalizations for Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2017; 6:JAHA.116.003330. [PMID: 28356281 PMCID: PMC5532983 DOI: 10.1161/jaha.116.003330] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Sex and race have emerged as important contributors to the phenotypic heterogeneity of heart failure with preserved ejection fraction (HFpEF). However, there remains a need to identify important sex‐ and race‐related differences in characteristics and outcomes using a nationally representative cohort. Methods and Results Data were obtained from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project—Nationwide Inpatient Sample files between 2008 and 2012. Hospitalizations with a diagnosis of HFpEF were included for analysis. Demographics, hospital characteristics, and age‐adjusted comorbidity prevalence rates were compared between men and women and whites and blacks. In‐hospital mortality was determined and compared for each subgroup. Multivariable regression analyses were used to identify and compare correlates of in‐hospital mortality for each subgroup. A sample of 1 889 608 hospitalizations was analyzed. Men with HFpEF were slightly younger than women with HFpEF and had a higher Elixhauser comorbidity score. Men experienced higher in‐hospital mortality compared with women, a finding that was attenuated after adjusting for comorbidity. Blacks with HFpEF were younger than whites with HFpEF, with lower rates of most comorbidities. Hypertension, diabetes, anemia, and chronic renal failure were more common among blacks. Blacks experienced lower in‐hospital mortality compared with whites, even after adjusting for age and comorbidity. Important correlates of mortality among all 4 subgroups included pulmonary circulation disorders, liver disease, and chronic renal failure. Atrial fibrillation was an important correlate of mortality only among women and blacks. Conclusions Differences in patient characteristics and outcomes reinforce the notion that sex and race contribute to the phenotypic heterogeneity of HFpEF.
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Affiliation(s)
- Parag Goyal
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY .,Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, New York, NY
| | - Tracy Paul
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Zaid I Almarzooq
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Janey C Peterson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, New York, NY
| | - Udhay Krishnan
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Dmitriy N Feldman
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Martin T Wells
- Departments of Statistical Science and Social Statistics, Cornell University, Ithaca, NY
| | - Maria G Karas
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Irina Sobol
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Mathew S Maurer
- Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY
| | - Evelyn M Horn
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Luke K Kim
- Division of Cardiology/Department of Medicine, Weill Cornell Medical College, New York, NY
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34
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Bonsu KO, Owusu IK, Buabeng KO, Reidpath DD, Kadirvelu A. Clinical characteristics and prognosis of patients admitted for heart failure: A 5-year retrospective study of African patients. Int J Cardiol 2017; 238:128-135. [PMID: 28318656 DOI: 10.1016/j.ijcard.2017.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/28/2017] [Accepted: 03/04/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mortality associated with heart failure (HF) remains high. There are limited clinical data on mortality among HF patients from African populations. We examined the clinical characteristics, long-term outcomes, and prognostic factors of African HF patients with preserved, mid-range or reduced left ventricular ejection fraction (LVEF). METHODS AND RESULTS We conducted a retrospective longitudinal cohort study of individuals aged ≥18years discharged from first HF admission between January 1, 2009 and December 31, 2013 from the Cardiac Clinic, Directorate of Medicine of the Komfo Anokye Teaching Hospital, Ghana. A total of 1488 patients diagnosed of HF were included in the analysis. Of these, 345 patients (23.2%) had reduced LVEF (LVEF<40%) [HFrEF], 265(17.8%) with mid-range LVEF (40%≥LVEF<50%) [HFmEF] and 878 (59.0%) had preserved LVEF (LVEF≥50%) [HFpEF]. Kaplan-Meier curves and log-rank test demonstrated better prognosis for HFpEF compared to HFrEF and HFmEF patients. An adjusted Cox analysis showed a significantly lower risk of mortality for HFpEF (hazard ratio (HR); 0.74; 95% confidence interval (CI) 0.57-0.94) p=0.015). Multivariate analyses showed that age, higher New York Heart Association (NYHA) functional class, lower LVEF, chronic kidney disease, atrial fibrillation, anemia, diabetes mellitus and absence of statin and aldosterone antagonist treatment were independent predictors of mortality in HF. Although, prognostic factors varied across the three groups, age was a common predictor of mortality in HFpEF and HFmEF. CONCLUSIONS This study identified the clinical characteristics, long-term mortality and prognostic factors of African HF patients with reduced, mid-range and preserved ejection fractions in a clinical setting.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor DE, Malaysia; Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana.
| | - Isaac Kofi Owusu
- Directorate of Medicine, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana; Department of Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology.
| | - Daniel D Reidpath
- School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor DE, Malaysia.
| | - Amudha Kadirvelu
- School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor DE, Malaysia.
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35
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Eaton CB, Pettinger M, Rossouw J, Martin LW, Foraker R, Quddus A, Liu S, Wampler NS, Hank Wu WC, Manson JE, Margolis K, Johnson KC, Allison M, Corbie-Smith G, Rosamond W, Breathett K, Klein L. Risk Factors for Incident Hospitalized Heart Failure With Preserved Versus Reduced Ejection Fraction in a Multiracial Cohort of Postmenopausal Women. Circ Heart Fail 2016; 9:e002883. [PMID: 27682440 PMCID: PMC5111360 DOI: 10.1161/circheartfailure.115.002883] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure is an important and growing public health problem in women. Risk factors for incident hospitalized heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF) in women and differences by race/ethnicity are not well characterized. METHODS AND RESULTS We prospectively evaluated the risk factors for incident hospitalized HFpEF and HFrEF in a multiracial cohort of 42 170 postmenopausal women followed up for a mean of 13.2 years. Cox regression models with time-dependent covariate adjustment were used to define risk factors for HFpEF and HFrEF. Differences by race/ethnicity about incidence rates, baseline risk factors, and their population-attributable risk percentage were analyzed. Risk factors for both HFpEF and HFrEF were as follows: older age, white race, diabetes mellitus, cigarette smoking, and hypertension. Obesity, history of coronary heart disease (other than myocardial infarction), anemia, atrial fibrillation, and more than one comorbidity were associated with HFpEF but not with HFrEF. History of myocardial infarction was associated with HFrEF but not with HFpEF. Obesity was found to be a more potent risk factor for African American women compared with white women for HFpEF (P for interaction=0.007). For HFpEF, the population-attributable risk percentage was greatest for hypertension (40.9%) followed by obesity (25.8%), with the highest population-attributable risk percentage found in African Americans for these risk factors. CONCLUSIONS In this multiracial cohort of postmenopausal women, obesity stands out as a significant risk factor for HFpEF, with the strongest association in African American women. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
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Affiliation(s)
- Charles B Eaton
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.).
| | - Mary Pettinger
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Jacques Rossouw
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Lisa Warsinger Martin
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Randi Foraker
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Abdullah Quddus
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Simin Liu
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Nina S Wampler
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Wen-Chih Hank Wu
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - JoAnn E Manson
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Karen Margolis
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Karen C Johnson
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Matthew Allison
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Giselle Corbie-Smith
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Wayne Rosamond
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Khadijah Breathett
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Liviu Klein
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
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Mehta H, Armstrong A, Swett K, Shah SJ, Allison MA, Hurwitz B, Bangdiwala S, Dadhania R, Kitzman DW, Arguelles W, Lima J, Youngblood M, Schneiderman N, Daviglus ML, Spevack D, Talavera GA, Raisinghani A, Kaplan R, Rodriguez CJ. Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States: Insights From the Echocardiographic Study of Latinos. Circ Heart Fail 2016; 9:e002733. [PMID: 27048764 PMCID: PMC4826756 DOI: 10.1161/circheartfailure.115.002733] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Population-based estimates of cardiac dysfunction and clinical heart failure (HF) remain undefined among Hispanics/Latino adults. METHODS AND RESULTS Participants of Hispanic/Latino origin across the United States aged 45 to 74 years were enrolled into the Echocardiographic Study of Latinos (ECHO-SOL) and underwent a comprehensive echocardiography examination to define left ventricular systolic dysfunction (LVSD) and left ventricular diastolic dysfunction (LVDD). Clinical HF was defined according to self-report, and those with cardiac dysfunction but without clinical HF were characterized as having subclinical or unrecognized cardiac dysfunction. Of 1818 ECHO-SOL participants (mean age 56.4 years; 42.6% male), 49.7% had LVSD or LVDD or both. LVSD prevalence was 3.6%, whereas LVDD was detected in 50.3%. Participants with LVSD were more likely to be males and current smokers (all P<0.05). Female sex, hypertension, diabetes mellitus, higher body mass index, and renal dysfunction were more common among those with LVDD (all P<0.05). In age-sex adjusted models, individuals of Central American and Cuban backgrounds were almost 2-fold more likely to have LVDD compared with those of Mexican backgrounds. Prevalence of clinical HF with LVSD (HF with reduced EF) was 7.3%; prevalence of clinical HF with LVDD (HF with preserved EF) was 3.6%. 96.1% of the cardiac dysfunction seen was subclinical or unrecognized. Compared with those with clinical cardiac dysfunction, prevalent coronary heart disease was the only factor independently associated with subclinical or unrecognized cardiac dysfunction (odds ratio: 0.1; 95% confidence interval: 0.1-0.4). CONCLUSIONS Among Hispanics/Latinos, most cardiac dysfunction is subclinical or unrecognized, with a high prevalence of diastolic dysfunction. This identifies a high-risk population for the development of clinical HF.
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Affiliation(s)
- Hardik Mehta
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Anderson Armstrong
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Katrina Swett
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Sanjiv J Shah
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Matthew A Allison
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Barry Hurwitz
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Shrikant Bangdiwala
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Rupal Dadhania
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Dalane W Kitzman
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - William Arguelles
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Joao Lima
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Marston Youngblood
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Neil Schneiderman
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Martha L Daviglus
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Daniel Spevack
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Greg A Talavera
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Ajit Raisinghani
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Robert Kaplan
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.)
| | - Carlos J Rodriguez
- From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
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The Obesity and Heart Failure Epidemics Among African Americans: Insights From the Jackson Heart Study. J Card Fail 2016; 22:589-97. [PMID: 26975941 DOI: 10.1016/j.cardfail.2016.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Higher rates of obesity and heart failure have been observed in African Americans, but associations with mortality are not well-described. We examined intermediate and long-term clinical implications of obesity in African Americans and associations between obesity and all-cause mortality, heart failure, and heart failure hospitalization. METHODS AND RESULTS We conducted a retrospective analysis of a community sample of 5292 African Americans participating in the Jackson Heart Study between September 2000 and January 2013. The main outcomes were associations between body mass index (BMI) and all-cause mortality at 9 years and heart failure hospitalization at 7 years using Cox proportional hazards models and interval development of heart failure (median 8 years' follow-up) using a modified Poisson model. At baseline, 1406 (27%) participants were obese and 1416 (27%) were morbidly obese. With increasing BMI, the cumulative incidence of mortality decreased (P= .007), whereas heart failure increased (P < .001). Heart failure hospitalization was more common among morbidly obese participants (9.0%; 95% confidence interval [CI] 7.6-11.7) than among normal-weight patients (6.3%; 95% CI 4.7-8.4). After risk adjustment, BMI was not associated with mortality. Each 1-point increase in BMI was associated with a 5% increase in the risk of heart failure (hazard ratio 1.05; 95% CI 1.03-1.06; P < .001) and the risk of heart failure hospitalization for BMI greater than 32 kg/m(2) (hazard ratio 1.05; 95% CI 1.03-1.07; P < .001). CONCLUSIONS Obesity and morbid obesity were common in a community sample of African Americans, and both were associated with increased heart failure and heart failure hospitalization.
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Samson R, Jaiswal A, Ennezat PV, Cassidy M, Le Jemtel TH. Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2016; 5:e002477. [PMID: 26811159 PMCID: PMC4859363 DOI: 10.1161/jaha.115.002477] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Rohan Samson
- Tulane University Heart and Vascular InstituteTulane University School of MedicineNew OrleansLA
| | - Abhishek Jaiswal
- Tulane University Heart and Vascular InstituteTulane University School of MedicineNew OrleansLA
| | - Pierre V. Ennezat
- Department of CardiologyCentre Hospitalier Universitaire de GrenobleGrenoble Cedex 09France
| | - Mark Cassidy
- Tulane University Heart and Vascular InstituteTulane University School of MedicineNew OrleansLA
| | - Thierry H. Le Jemtel
- Tulane University Heart and Vascular InstituteTulane University School of MedicineNew OrleansLA
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Vaduganathan M, Michel A, Hall K, Mulligan C, Nodari S, Shah SJ, Senni M, Triggiani M, Butler J, Gheorghiade M. Spectrum of epidemiological and clinical findings in patients with heart failure with preserved ejection fraction stratified by study design: a systematic review. Eur J Heart Fail 2015; 18:54-65. [PMID: 26634799 DOI: 10.1002/ejhf.442] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/03/2015] [Accepted: 10/09/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) represents a major global and economic burden, but its epidemiological, clinical, and outcome data have varied according to study design. METHODS AND RESULTS We conducted a systematic review of published HFpEF clinical trials and observational studies (community-based studies and registries) from August 1998 to July 2013 using PubMed and EMBASE databases. Two independent investigators manually screened and extracted relevant data. We included 62 articles (19 describing clinical trials, 12 describing community-based observational studies, and 31 describing registries). The ejection fraction (EF) cut-off values ranged widely for HFpEF from >40% to >55%. However, differences in EF cut-offs were not clearly associated with incidence and prevalence data across studies. Of all patients with heart failure in community studies, 33-84% had HFpEF, which tended to be higher than reported in registries. The HFpEF patients in included studies were primarily older, white (>70%) patients with hypertension (∼50-90%) and coronary artery disease (up to 60%). All-cause mortality and all-cause hospitalizations ranged from 13% to 23% (26-50 months follow-up) and 55% to 67% (37-50 months follow-up), respectively, in clinical trials; cardiovascular causes accounted for 70% of both outcomes. All-cause mortality tended to be higher in registries than in clinical trials and community-based observational studies up to 5 years into follow-up. CONCLUSIONS Important differences in EF thresholds, epidemiological indices, clinical profiles, treatment patterns, and outcomes exist across contemporary HFpEF clinical trials, observational studies, and registries. Precision in definition and inclusion of more uniform populations may facilitate improved profiling of HFpEF patients.
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Affiliation(s)
- Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | | | - Kathryn Hall
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK
| | | | - Savina Nodari
- Department of Experimental and Applied Medicine - Section of Cardiovascular Diseases, University of Brescia, Brescia, Italy
| | - Sanjiv J Shah
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, 201 East Huron, Galter 3-150, Chicago, IL, USA
| | - Michele Senni
- Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovannni XXIII, Bergamo, Italy
| | - Marco Triggiani
- Department of Experimental and Applied Medicine - Section of Cardiovascular Diseases, University of Brescia, Brescia, Italy
| | - Javed Butler
- Division of Cardiology, Stony Brook University, Stony Brook, NY, USA
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, 201 East Huron, Galter 3-150, Chicago, IL, USA
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Colvin M, Sweitzer NK, Albert NM, Krishnamani R, Rich MW, Stough WG, Walsh MN, Westlake Canary CA, Allen LA, Bonnell MR, Carson PE, Chan MC, Dickinson MG, Dries DL, Ewald GA, Fang JC, Hernandez AF, Hershberger RE, Katz SD, Moore S, Rodgers JE, Rogers JG, Vest AR, Whellan DJ, Givertz MM. Heart Failure in Non-Caucasians, Women, and Older Adults: A White Paper on Special Populations From the Heart Failure Society of America Guideline Committee. J Card Fail 2015; 21:674-93. [DOI: 10.1016/j.cardfail.2015.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 01/11/2023]
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The complex relationship of race to outcomes in heart failure with preserved ejection fraction. Am J Med 2015; 128:591-600. [PMID: 25554372 PMCID: PMC4442751 DOI: 10.1016/j.amjmed.2014.11.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 11/22/2014] [Accepted: 11/24/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND An improved understanding of racial differences in the natural history, clinical characteristics, and outcomes of heart failure will have important clinical and public health implications. We assessed how clinical characteristics and outcomes vary across racial groups (whites, blacks, and Asians) in adults with heart failure with preserved ejection fraction. METHODS We identified all adults with heart failure with preserved ejection fraction between 2005 and 2008 from 4 health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses. RESULTS Among 13,437 adults with confirmed heart failure with preserved ejection fraction, 85.9% were white, 7.6% were black, and 6.5% were Asian. After adjustment for potential confounders and use of cardiovascular therapies, compared with whites, blacks (adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.62-0.85) and Asians (HR, 0.75; 95% CI, 0.64-0.87) had a lower risk of death from any cause. Compared with whites, blacks had a higher risk of hospitalization for heart failure (HR, 1.48; 95% CI, 1.29-1.68); no difference was observed for Asians compared with whites (HR, 1.01; 95% CI, 0.86-1.18). Compared with whites, no significant differences were detected in risk of hospitalization for any cause for blacks (HR, 1.03; 95% CI, 0.95-1.12) and Asians (HR, 0.93; 95% CI, 0.85-1.02). CONCLUSIONS In a diverse population with heart failure with preserved ejection fraction, we observed complex relationships between race and important clinical outcomes. More detailed studies of large populations are needed to fully characterize the epidemiologic picture and to elucidate potential pathophysiologic and treatment-response differences that may relate to race.
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Abstract
Heart failure with preserved ejection fraction (HFPEF) is a common condition, and the prevalence is projected to increase further. Studies differ in the reported incidence and mortality associated with this condition, although there is agreement that between a third and one-half of all patients with heart failure have HFPEF. Although several consensus statements and guidelines have been published, some recent randomized clinical trials have reported low mortality, raising doubts about whether all patients diagnosed with HFPEF have HFPEF or whether the condition is heterogeneous in its cause and prognosis. The overall reported prognosis of patients with HFPEF remains poor.
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Affiliation(s)
- Charlotte Andersson
- Framingham Heart Study, Mt Wayte Avenue 73, Suite 2, Framingham, MA 01702-5827, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA; Department of Cardiology, Gentofte Hospital, Niels Andersens vej 65, Hellerup 2900, Denmark.
| | - Ramachandran S Vasan
- Framingham Heart Study, Mt Wayte Avenue 73, Suite 2, Framingham, MA 01702-5827, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA; Section of Cardiology, Boston University School of Medicine, 801 Massachussetts Avenue, Suite 470, Boston, MA 02118, USA
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Rossi A, Gheorghiade M, Triposkiadis F, Solomon SD, Pieske B, Butler J. Left Atrium in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2014; 7:1042-9. [DOI: 10.1161/circheartfailure.114.001276] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Andrea Rossi
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Mihai Gheorghiade
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Filippos Triposkiadis
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Scott D. Solomon
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Burkert Pieske
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Javed Butler
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
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Gupta DK, Skali H, Claggett B, Kasabov R, Cheng S, Shah AM, Loehr LR, Heiss G, Nambi V, Aguilar D, Wruck LM, Matsushita K, Folsom AR, Rosamond WD, Solomon SD. Heart failure risk across the spectrum of ankle-brachial index: the ARIC study (Atherosclerosis Risk In Communities). JACC. HEART FAILURE 2014; 2:447-54. [PMID: 25194293 PMCID: PMC4194157 DOI: 10.1016/j.jchf.2014.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 05/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to describe the relationship between ankle brachial index (ABI) and the risk for heart failure (HF). BACKGROUND The ABI is a simple, noninvasive measure associated with atherosclerotic cardiovascular disease and death; however, the relationship between ABI and risk for HF is less well characterized. METHODS Between 1987 and 1989 in the ARIC (Atherosclerosis Risk In Communities) study, an oscillometric device was used to measure blood pressure in a single upper and randomly chosen lower extremity to determine the ABI. Incident HF events were defined by the first hospitalization with an International Classification of Diseases, Ninth Revision, code of 428.x through 2008. The risk for HF was assessed across the ABI range using restricted cubic splines and Cox proportional hazards models. RESULTS ABI was available in 13,150 participants free from prevalent HF. Over a mean 17.7 years of follow-up, 1,809 incident HF events occurred. After adjustment for traditional HF risk factors, prevalent coronary heart disease, subclinical carotid atherosclerosis, and interim myocardial infarction, compared with an ABI of 1.01 to 1.40, participants with ABIs ≤0.90 were at increased risk for HF (hazard ratio: 1.40; 95% confidence interval: 1.12 to 1.74), as were participants with ABIs of 0.91 to 1.00 (hazard ratio: 1.36; 95% confidence interval: 1.17 to 1.59). CONCLUSIONS In a middle-age community cohort, an ABI ≤1.00 was significantly associated with an increased risk for HF, independent of traditional HF risk factors, prevalent coronary heart disease, carotid atherosclerosis, and interim myocardial infarction. Low ABI may reflect not only overt atherosclerosis but also pathologic processes in the development of HF beyond epicardial atherosclerotic disease and myocardial infarction alone. A low ABI, as a simple, noninvasive measure, may be a risk marker for HF.
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Affiliation(s)
- Deepak K Gupta
- Vanderbilt Heart and Vascular Institute, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Hicham Skali
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Claggett
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rumen Kasabov
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amil M Shah
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura R Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Vijay Nambi
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - David Aguilar
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Lisa Miller Wruck
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Shah AM, Claggett B, Sweitzer NK, Shah SJ, Anand IS, O'Meara E, Desai AS, Heitner JF, Li G, Fang J, Rouleau J, Zile MR, Markov V, Ryabov V, Reis G, Assmann SF, McKinlay SM, Pitt B, Pfeffer MA, Solomon SD. Cardiac structure and function and prognosis in heart failure with preserved ejection fraction: findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial. Circ Heart Fail 2014; 7:740-51. [PMID: 25122186 PMCID: PMC4916914 DOI: 10.1161/circheartfailure.114.001583] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/31/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Abnormalities in cardiac structure and function in heart failure with preserved ejection fraction may help identify patients at particularly high risk for cardiovascular morbidity and mortality. METHODS AND RESULTS Cardiac structure and function were assessed by echocardiography in a blinded core laboratory at baseline in 935 patients with heart failure with preserved ejection fraction (left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial and related to the primary composite outcome of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest, and its components. At a median follow-up of 2.9 years, 244 patients experienced the primary outcome. Left ventricular hypertrophy (adjusted hazard ratio, 1.52; 95% confidence interval, 1.16-2.00), elevated left ventricular filling pressure (E/E'; adjusted hazard ratio 1.05 per 1 integer increase; 95% confidence interval, 1.02-1.07), and higher pulmonary artery pressure assessed by the tricuspid regurgitation velocity (hazard ratio, 1.23 per 0.5 m/s increase; 95% confidence interval, 1.02-1.49) were associated with the composite outcome and heart failure hospitalization alone after adjusting for clinical and laboratory variables. The risk of adverse outcome associated with left ventricular hypertrophy was additive to the risk associated with elevated E/E'. CONCLUSIONS Among heart failure with preserved ejection fraction patients enrolled in TOPCAT, left ventricular hypertrophy, higher left ventricular filling pressure, and higher pulmonary artery pressure were predictive of heart failure hospitalization, cardiovascular death, or aborted cardiac arrest independent of clinical and laboratory predictors. These features, both alone and in combination, identify heart failure with preserved ejection fraction patients at particularly high risk for cardiovascular morbidity and mortality. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Amil M Shah
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
| | - Brian Claggett
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Nancy K Sweitzer
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Sanjiv J Shah
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Inder S Anand
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Eileen O'Meara
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Akshay S Desai
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - John F Heitner
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Guichu Li
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - James Fang
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Jean Rouleau
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Michael R Zile
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Valetin Markov
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Vyacheslav Ryabov
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Gilmar Reis
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Susan F Assmann
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Sonja M McKinlay
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Bertram Pitt
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Marc A Pfeffer
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Scott D Solomon
- From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.)
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Shah AM, Shah SJ, Anand IS, Sweitzer NK, O'Meara E, Heitner JF, Sopko G, Li G, Assmann SF, McKinlay SM, Pitt B, Pfeffer MA, Solomon SD. Cardiac structure and function in heart failure with preserved ejection fraction: baseline findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. Circ Heart Fail 2014; 7:104-15. [PMID: 24249049 PMCID: PMC4467731 DOI: 10.1161/circheartfailure.113.000887] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 10/21/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population. METHODS AND RESULTS Echocardiograms were obtained from 935 patients with HFpEF (left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric left ventricular remodeling (34%) and hypertrophy (43%), and left atrial enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater left ventricular hypertrophy and a higher prevalence of left atrial enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. CONCLUSIONS Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including left ventricular hypertrophy and left atrial enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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Abstract
Heart failure with preserved ejection fraction (HFpEF) is common, increasing in prevalence, and causes substantial morbidity and mortality. HFpEF has commonly been viewed as an expression of advanced hypertensive heart disease, with a cardiac phenotype characterized by an increase in wall thickness-to-chamber radius ratio (concentric hypertrophy). However, marked clinical heterogeneity within this syndrome is now well appreciated, and is mirrored in the variability in left ventricular (LV) structure. A review of larger imaging studies from epidemiology and clinical trial cohorts demonstrate that while concentric LV remodeling is common, it is by no means universal and many patients demonstrate normal LV geometry or even an eccentric pattern. More detailed assessment of cardiac structure and function in broader HFpEF populations will be necessary to better define the prevalence, determinants, and prognostic relevance of these measures, which may in turn serve as a foundation to identify pathophysiologically relevant sub-phenotypes within this diverse syndrome.
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Affiliation(s)
- Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA,
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Abstract
Atrial fibrillation (AF) is the most commonly encountered clinical arrhythmia and is associated with adverse outcomes and increased healthcare costs. Racial variations in AF are recognized yet poorly understood. In this review we summarize racial differences in AF epidemiology, risk factors, genetics, and outcomes. We identify novel risk factors, inflammatory mediators and biomarkers associated with AF, which have had limited study in racial and ethnic minorities. We describe the mismatch between risk factor burden and AF. We highlight the limited participation of minorities in trials for AF management and stroke prevention that contrasts with observed racial variability in anticoagulation efficacy and practice. Throughout we provide specific strategies for future directions to address gaps in the epidemiology of racial differences and to meet identified racial disparities. We specifically identify areas for further research. We conclude that addressing disparities in prevention and healthcare resource allocation will likely improve AF-related outcomes in minorities.
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