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Fu K, Yang Z, Wang N, Dong Y, Wang Z, Chen W, Lu H. Recurrence of left ventricular systolic dysfunction and its risk factors in heart failure with improved ejection fraction patients receiving guideline-directed medical therapy: A trajectory analysis based on echocardiography. Int J Cardiol 2024; 415:132370. [PMID: 39029560 DOI: 10.1016/j.ijcard.2024.132370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/10/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Despite the better prognosis of heart failure (HF) with improved ejection fraction (HFimpEF), remnant cardiovascular risks, including cardiovascular death, rehospitalization, and future deterioration of left ventricular (LV) systolic function, remain in HFimpEF. However, for HFimpEF patients, especially for those receiving guideline-directed medical therapy (GDMT), the recurrent LV systolic dysfunction and its risk factors is still unclear. METHODS A total of 1098 HF patients under HF follow-up management system were initially screened. Echocardiography was re-evaluated at 3-, 6-, and 12-month follow-up. After exclusion, a total of 203 HFimpEF patients on GDMT were enrolled in our final analysis. Cox regression analysis was conducted to select risk factors. RESULTS During the 1-year follow-up, a total of 28 (13.8%) patients had recurrent LV systolic dysfunction. The trajectory analysis of echocardiographic parameters illustrated that persistent decline of left ventricular ejection fraction (LVEF) and worsening LV remodeling was observed in patients with recurrent LV systolic dysfunction. Multivariable Cox regression analysis identified that ischemic cardiomyopathy, atrial fibrillation, higher left ventricular end-diastolic diameter index (LVEDDI), elevated serum potassium, and a lack of sodium-glucose co-transporter-2 inhibitors (SGLT2i) treatment were confirmed as independent risk factors for recurrent LV systolic dysfunction. Recurrent LV systolic dysfunction was associated with higher rehospitalization rate. CONCLUSION In our longitudinal cohort study, almost 14% HFimpEF receiving GDMT suffered recurrent LV systolic dysfunction. Ischemic cardiomyopathy, atrial fibrillation, higher LVEDDI, higher serum potassium, and a lack of SGLT2i therapy were tightly associated with recurrence of LV systolic dysfunction. Relapse of LV systolic dysfunction correlated with poor prognosis.
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Affiliation(s)
- Kang Fu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhuohao Yang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Ning Wang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Youran Dong
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiyuan Wang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenqiang Chen
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
| | - Huixia Lu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
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Xu Y, Li Y, Wang S, Wan K, Tan Y, Li W, Wang J, Guo J, Ghaithan S, Cheng W, Sun J, Zhang Q, Han Y, Chen Y. Prognostic value of mid-term cardiovascular magnetic resonance follow-up in patients with non-ischemic dilated cardiomyopathy: a prospective cohort study. J Cardiovasc Magn Reson 2024; 26:101002. [PMID: 38237899 PMCID: PMC10926272 DOI: 10.1016/j.jocmr.2024.101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The prognostic value of follow-up cardiovascular magnetic resonance (CMR) in dilated cardiomyopathy (DCM) patients is unclear. We aimed to investigate the prognostic value of cardiac function, structure, and tissue characteristics at mid-term CMR follow-up. METHODS The study population was a prospectively enrolled cohort of DCM patients who underwent guideline-directed medical therapy with baseline and follow-up CMR, which included measurement of biventricular volume and ejection fraction, late gadolinium enhancement, native T1, native T2, and extracellular volume. During follow-up, major adverse cardiac events (MACE) were defined as a composite endpoint of cardiovascular death, heart transplantation, and heart-failure readmission. RESULTS Among 235 DCM patients (median CMR interval: 15.3 months; interquartile range: 12.5-19.2 months), 54 (23.0%) experienced MACE during follow-up (median: 31.2 months; interquartile range: 20.8-50.0 months). In multivariable Cox regression, follow-up CMR models showed significantly superior predictive value than baseline CMR models. Stepwise multivariate Cox regression showed that follow-up left ventricular ejection fraction (LVEF; hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.91-0.96; p < 0.001) and native T1 (HR, 1.01; 95% CI, 1.00-1.01; p = 0.030) were independent predictors of MACE. Follow-up LVEF ≥ 40% or stable LVEF < 40% with T1 ≤ 1273 ms indicated low risk (annual event rate < 4%), while stable LVEF < 40% and T1 > 1273 ms or LVEF < 40% with deterioration indicated high risk (annual event rate > 15%). CONCLUSIONS Follow-up CMR provided better risk stratification than baseline CMR. Improvements in the LVEF and T1 mapping are associated with a lower risk of MACE.
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Affiliation(s)
- Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yangjie Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shiqian Wang
- West China Clinical Medical College of Sichuan University, Chengdu, Sichuan Province, China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yinxi Tan
- West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiajun Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Saeed Ghaithan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuchi Han
- Cardiac Imaging Cardiovascular Medicine, Wexner Medical Center, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Kasiakogias A, Ragavan A, Halliday BP. Your Heart Function Has Normalized-What Next After TRED-HF? Curr Heart Fail Rep 2023; 20:542-554. [PMID: 37999902 PMCID: PMC10746577 DOI: 10.1007/s11897-023-00636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW With the widespread implementation of contemporary disease-modifying heart failure therapy, the rates of normalization of ejection fraction are continuously increasing. The TRED-HF trial confirmed that heart failure remission rather than complete recovery is typical in patients with dilated cardiomyopathy who respond to therapy. The present review outlines key points related to the management and knowledge gaps of this growing patient group, focusing on patients with non-ischaemic dilated cardiomyopathy. RECENT FINDINGS There is substantial heterogeneity among patients with normalized ejection fraction. The specific etiology is likely to affect the outcome, although a multiple-hit phenotype is frequent and may not be identified without comprehensive characterization. A monogenic or polygenic genetic susceptibility is common. Ongoing pathophysiological processes may be unraveled with advanced cardiac imaging, biomarkers, multi-omics, and machine learning technologies. There are limited studies that have investigated the withdrawal of specific heart failure therapies in these patients. Diuretics may be safely withdrawn if there is no evidence of congestion, while continued therapy with at least some disease-modifying therapy is likely to be required to reduce myocardial workload and sustain remission for the vast majority. Understanding the underlying disease mechanisms of patients with normalized ejection fraction is crucial in identifying markers of myocardial relapse and guiding individualized therapy in the future. Ongoing clinical trials should inform personalized approaches to therapy.
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Affiliation(s)
- Alexandros Kasiakogias
- Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aaraby Ragavan
- Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Brian P Halliday
- Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK.
- National Heart and Lung Institute, Imperial College London, London, UK.
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Hammersley DJ, Jones RE, Owen R, Mach L, Lota AS, Khalique Z, De Marvao A, Androulakis E, Hatipoglu S, Gulati A, Reddy RK, Yoon WY, Talukder S, Shah R, Baruah R, Guha K, Pantazis A, Baksi AJ, Gregson J, Cleland JG, Tayal U, Pennell DJ, Ware JS, Halliday BP, Prasad SK. Phenotype, outcomes and natural history of early-stage non-ischaemic cardiomyopathy. Eur J Heart Fail 2023; 25:2050-2059. [PMID: 37728026 PMCID: PMC10946699 DOI: 10.1002/ejhf.3037] [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: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS To characterize the phenotype, clinical outcomes and rate of disease progression in patients with early-stage non-ischaemic cardiomyopathy (early-NICM). METHODS AND RESULTS We conducted a prospective observational cohort study of patients with early-NICM assessed by late gadolinium enhancement cardiovascular magnetic resonance (CMR). Cases were classified into the following subgroups: isolated left ventricular dilatation (early-NICM H-/D+), non-dilated left ventricular cardiomyopathy (early-NICM H+/D-), or early dilated cardiomyopathy (early-NICM H+/D+). Clinical follow-up for major adverse cardiovascular events (MACE) included non-fatal life-threatening arrhythmia, unplanned cardiovascular hospitalization or cardiovascular death. A subset of patients (n = 119) underwent a second CMR to assess changes in cardiac structure and function. Of 254 patients with early-NICM (median age 46 years [interquartile range 36-58], 94 [37%] women, median left ventricular ejection fraction [LVEF] 55% [52-59]), myocardial fibrosis was present in 65 (26%). There was no difference in the prevalence of fibrosis between subgroups (p = 0.90), however fibrosis mass was lowest in early-NICM H-/D+, higher in early-NICM H+/D- and highest in early-NICM H+/D+ (p = 0.03). Over a median follow-up of 7.9 (5.5-10.0) years, 28 patients (11%) experienced MACE. Non-sustained ventricular tachycardia (hazard ratio [HR] 5.1, 95% confidence interval [CI] 2.36-11.00, p < 0.001), myocardial fibrosis (HR 3.77, 95% CI 1.73-8.20, p < 0.001) and diabetes mellitus (HR 5.12, 95% CI 1.73-15.18, p = 0.003) were associated with MACE in a multivariable model. Only 8% of patients progressed from early-NICM to dilated cardiomyopathy with LVEF <50% over a median of 16 (11-34) months. CONCLUSION Early-NICM is not benign. Fibrosis develops early in the phenotypic course. In-depth characterization enhances risk stratification and might aid clinical management.
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Affiliation(s)
- Daniel J. Hammersley
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Richard E. Jones
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Anglia Ruskin Medical School, UKCambridgeUK
- Essex Cardiothoracic CentreBasildonUK
| | - Ruth Owen
- London School of Hygiene and Tropical MedicineLondonUK
| | - Lukas Mach
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Amrit S. Lota
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Zohya Khalique
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Antonio De Marvao
- Department of Women and Children's HealthKing's College LondonLondonUK
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and SciencesKing's College LondonLondonUK
| | - Emmanuel Androulakis
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Suzan Hatipoglu
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - Rohin K. Reddy
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Won Young Yoon
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Suprateeka Talukder
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Riya Shah
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Resham Baruah
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - Antonis Pantazis
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - A. John Baksi
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - John Gregson
- London School of Hygiene and Tropical MedicineLondonUK
| | - John G.F. Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Upasana Tayal
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Dudley J. Pennell
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - James S. Ware
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- MRC London Institute of Medical SciencesImperial College LondonLondonUK
| | - Brian P. Halliday
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Sanjay K. Prasad
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
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Halliday BP, Owen R, Gregson J, Vazir A, Wassall R, Khalique Z, Lota AS, Tayal U, Hammersley DJ, Jones RE, Pennell DJ, Cowie MR, Cleland JG, Prasad SK. Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy. ESC Heart Fail 2022; 9:1616-1624. [PMID: 35257498 PMCID: PMC9065828 DOI: 10.1002/ehf2.13872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS This study aimed to profile the changes in non-invasive clinical, biochemical, and imaging markers during withdrawal of therapy in patients with recovered dilated cardiomyopathy, providing insights into the pathophysiology of relapse. METHODS AND RESULTS Clinical, biochemical, and imaging data from patients during phased withdrawal of therapy in the randomized or single-arm cross-over phases of TRED-HF were profiled. Clinical variables were measured at each study visit and imaging variables were measured at baseline, 16 weeks, and 6 months. Amongst the 49 patients [35% women, mean age 53.6 years (standard deviation 11.6)] who withdrew therapy, 20 relapsed. Increases in mean heart rate [7.6 beats per minute (95% confidence interval, CI, 4.5, 10.7)], systolic blood pressure [6.6 mmHg (95% CI 2.7, 10.5)], and diastolic blood pressure [5.8 mmHg (95% CI 3.1, 8.5)] were observed within 4-8 weeks of starting to withdraw therapy. A rise in mean left ventricular (LV) mass [5.1 g/m2 (95% CI 2.8, 7.3)] and LV end-diastolic volume [3.9 mL/m2 (95% CI 1.1, 6.7)] and a reduction in mean LV ejection fraction [-4.2 (95% CI -6.6, -1.8)] were seen by 16 weeks, the earliest imaging follow-up. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) fell immediately after withdrawing beta-blockers and only tended to increase 6 months after beginning therapy withdrawal [mean change in log NT-proBNP at 6 months: 0.2 (95% CI -0.1, 0.4)]. CONCLUSIONS Changes in plasma NT-proBNP are a late feature of relapse, often months after a reduction in LV function. A rise in heart rate and blood pressure is observed soon after withdrawing therapy in recovered dilated cardiomyopathy, typically accompanied or closely followed by early changes in LV structure and function.
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Affiliation(s)
- Brian P. Halliday
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Ruth Owen
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - John Gregson
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Ali Vazir
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Rebecca Wassall
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Zohya Khalique
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Amrit S. Lota
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Upasana Tayal
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Daniel J. Hammersley
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Richard E. Jones
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Dudley J. Pennell
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
| | - Martin R. Cowie
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
- Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - John G.F. Cleland
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Sanjay K. Prasad
- Cardiovascular Research Centre, Royal Brompton Hospital, Guy's and St Thomas' NHS Trust and National Heart Lung InstituteImperial CollegeLondonSW3 6NPUK
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Takada T, Matsuura K, Minami Y, Abe T, Yoshida A, Kishihara M, Watanabe S, Shirotani S, Jujo K, Hagiwara N. Prognosis and diastolic dysfunction predictors in patients with heart failure and recovered ejection fraction. Sci Rep 2022; 12:8768. [PMID: 35610337 PMCID: PMC9130289 DOI: 10.1038/s41598-022-12823-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/16/2022] [Indexed: 12/28/2022] Open
Abstract
There is limited data on whether diastolic dysfunction in patients with heart failure (HF) and recovered ejection fraction (HFrecEF) is associated with worse prognosis. We retrospectively assessed 96 patients diagnosed with HFrecEF and created ROC curve of their diastolic function at the 1-year follow-up for the composite endpoint of cardiovascular death and HF readmission after the follow-up. Eligible patients were divided into two groups according to the cutoff value of E/e′ ratio (12.1) with the highest AUC (0.70). Kaplan–Meier analysis showed that HFrecEF with high E/e′ group had a significantly poorer prognosis than the low E/e′ group (log-rank, p = 0.01). Multivariate Cox regression analysis revealed that the high E/e′ group was significantly related to the composite endpoint (hazard ratio 5.45, 95% confidence interval [CI] 1.23–24.1). The independent predictors at discharge for high E/e′ ratio at the 1-year follow-up were older age and female sex after adjustment for covariates (odds ratio [OR] 1.07, 95% CI 1.01–1.13 and OR 4.70, 95% CI 1.08–20.5). In conclusion, HFrecEF with high E/e′ ratio might be associated with a poor prognosis. Older age and female sex were independent predictors for a sustained high E/e′ ratio in patients with HFrecEF.
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Affiliation(s)
- Takuma Takada
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsuhisa Matsuura
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takuro Abe
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ayano Yoshida
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Makoto Kishihara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shonosuke Watanabe
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shota Shirotani
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
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