1
|
Mueller C, McDonald K, de Boer RA, Maisel A, Cleland JG, Kozhuharov N, Coats AJ, Metra M, Mebazaa A, Ruschitzka F, Lainscak M, Filippatos G, Seferovic PM, Meijers WC, Bayes‐Genis A, Mueller T, Richards M, Januzzi JL. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail 2019; 21:715-731. [DOI: 10.1002/ejhf.1494] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Basel Switzerland
| | - Kenneth McDonald
- Department of CardiologySt. Vincent's University Hospital Dublin Ireland
| | - Rudolf A. de Boer
- University of Groningen, University Medical CenterGroningen, Department of Cardiology The Netherlands
| | | | - John G.F. Cleland
- Robertson Institute of Biostatistics and Clinical Trials UnitUniversity of Glasgow Glasgow UK
| | - Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Basel Switzerland
| | - Andrew J.S. Coats
- University of Warwick Coventry UK
- Monash University Melbourne Australia
- Pharmacology, Centre of Clinical and Experimental Medicine, San Raffaele Pisana Scientific Institute Rome Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
| | - Alexandre Mebazaa
- Université de Paris, APHP Département d'Anethésie‐Réanimation Hôpitaux Universitaires Saint Louis Lariboisière Paris France
| | - Frank Ruschitzka
- Department of Cardiology, University Heart CentreUniversity Hospital Zurich Zurich Switzerland
| | - Mitja Lainscak
- Department of Internal MedicineGeneral Hospital Murska Sobota Murska Sobota Slovenia
- Faculty of MedicineUniversity of Ljubljana Slovenia
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital AttikonUniversity of Athens Greece
- University of CyprusMedical School Nicosia Cyprus
| | | | - Wouter C. Meijers
- University of Groningen, University Medical CenterGroningen, Department of Cardiology The Netherlands
| | - Antoni Bayes‐Genis
- Heart InstituteHospital Universitari Germans Trias i Pujol, CIBERCV Barcelona Spain
- Department of MedicineAutonomous University of Barcelona Barcelona Spain
| | - Thomas Mueller
- Department of Clinical PathologyHospital of Bolzano Bolzano Italy
| | - Mark Richards
- Christchurch Heart InstituteUinversity of Otago New Zealand
- Cardiovascular Research InstituteNational University of Singapore Singapore
| | - James L. Januzzi
- Cardiology Division of the Department of MedicineMassachusetts General Hospital, Harvard Medical School Boston MA USA
| | | |
Collapse
|
2
|
Ho JE, Zern EK, Wooster L, Bailey CS, Cunningham T, Eisman AS, Hardin KM, Zampierollo GA, Jarolim P, Pappagianopoulos PP, Malhotra R, Nayor M, Lewis GD. Differential Clinical Profiles, Exercise Responses, and Outcomes Associated With Existing HFpEF Definitions. Circulation 2019; 140:353-365. [PMID: 31132875 DOI: 10.1161/circulationaha.118.039136] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is common, yet there is currently no consensus on how to define HFpEF according to various society and clinical trial criteria. How clinical and hemodynamic profiles of patients vary across definitions is unclear. We sought to determine clinical characteristics, as well as physiologic and prognostic implications of applying various criteria to define HFpEF. METHODS We examined consecutive patients with chronic exertional dyspnea (New York Heart Association class II to IV) and ejection fraction ≥50% referred for comprehensive cardiopulmonary exercise testing with invasive hemodynamic monitoring. We applied societal and clinical trial HFpEF definitions and compared clinical profiles, exercise responses, and cardiovascular outcomes. RESULTS Of 461 patients (age 58±15 years, 62% women), 416 met American College of Cardiology/American Heart Association (ACC/AHA), 205 met European Society of Cardiology (ESC), and 55 met Heart Failure Society of America (HFSA) criteria for HFpEF. Clinical profiles and exercise capacity varied across definitions, with peak oxygen uptake of 16.2±5.2 (ACC/AHA), 14.1±4.2 (ESC), and 12.7±3.1 mL·kg-1·min-1 (HFSA). A total of 243 patients had hemodynamic evidence of HFpEF (abnormal rest or exercise filling pressures), of whom 222 met ACC/AHA, 161 met ESC, and 41 met HFSA criteria. Over a mean follow-up of 3.8 years, the incidence of cardiovascular outcomes ranged from 75 (ACC/AHA) to 298 events per 1000 person-years (HFSA). Application of clinical trial definitions of HFpEF similarly resulted in distinct patient classification and prognostication. CONCLUSIONS Use of different HFpEF classifications variably enriches for future cardiovascular events, but at the expense of not including up to 85% of individuals with physiologic evidence of HFpEF. Comprehensive phenotyping of patients with suspected heart failure highlights the limitations and heterogeneity of current HFpEF definitions and may help to refine HFpEF subgrouping to test therapeutic interventions.
Collapse
Affiliation(s)
- Jennifer E Ho
- Cardiovascular Research Center (J.E.H., R.M.), Massachusetts General Hospital, Boston.,Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| | - Emily K Zern
- Cedars-Sinai Medical Center, Los Angeles, CA (E.Z.K.)
| | - Luke Wooster
- Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| | - Cole S Bailey
- Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| | - Thomas Cunningham
- Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| | - Aaron S Eisman
- Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| | - Kathryn M Hardin
- Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| | | | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Boston, MA (P.J.)
| | - Paul P Pappagianopoulos
- Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| | - Rajeev Malhotra
- Cardiovascular Research Center (J.E.H., R.M.), Massachusetts General Hospital, Boston.,Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| | - Matthew Nayor
- Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| | - Gregory D Lewis
- Cardiology Division, Department of Medicine (J.E.H., L.W., C.S.B., T.C., A.S.E., K.M.H., P.P.P., R.M., M.N., G.D.L.), Massachusetts General Hospital, Boston
| |
Collapse
|
3
|
Slee A, Saad M, Saksena S. Heart failure progression and mortality in atrial fibrillation patients with preserved or reduced left ventricular ejection fraction. J Interv Card Electrophysiol 2019; 55:325-331. [PMID: 30887281 DOI: 10.1007/s10840-019-00534-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) worsens cardiovascular (CV) outcomes of heart failure (HF) and vice versa. The impact of rate or rhythm control strategies on HF progression and survival remains unclear. METHODS We examined the risk of HF progression in AF patients (pts) with a prior HF event and minimal or no HF burden (NYHA class 0 or 1). They were stratified into HF with a preserved left ventricular ejection fraction (≥ 40%, pEF) or reduced EF (< 40%, rEF). HF subgroups from the Rate and Rhythm arm were compared for the primary outcome of worsening HF or death (WHFD), total mortality, cardiovascular mortality, and cardiovascular hospitalizations. RESULTS Four hundred ninety-two AF pts (HFpEF = 349, HFrEF = 143) were analyzed. Baseline characteristics were generally comparable in the Rate and Rhythm arms of the two subgroups. Over a median follow-up of 4 years, HF recurred and worsened in 66.6% and 41.2% of pts by ≥ 1 and ≥ 2 NYHA classes, respectively. HF progression by even 1 NYHA class increased the mortality risk in HFpEF (hazard ratio (HR) 2.06; 95% confidence intervals (CI) 1.25-3.4; p = 0.004) and HFrEF (HR 1.9; 95% CI 0.99-3.66; p = 0.054). Cardiovascular hospitalization (CVH) increased in HFpEF (HR 3.67; 95% CI 2.56, 5.25; p < 0.0001) and HFrEF (HR 2.8; 95% CI 1.53-5.14; p = 0.0009). HF progression by 2 or more NYHA classes or death was significantly worse in pts with HFrEF with the Rate control strategy compared with the Rhythm control (HR 1.62; 95% CI 1.03-2.53; p = 0.036) but similar in pts with HFpEF (HR 0.88; 95% CI 0.64-1.21; p = 0.440).The time to first AF recurrence was longer in the Rhythm arms of both HF subgroups as compared with Rate (Figure, p < 0.05). CONCLUSIONS (1) HF progression in AF pts with a prior HF event confers significant mortality and CVH risk in both HFrEF and HFpEF populations. (2) HF progression is more pronounced with a Rate control strategy in AF pts with HFrEF, but is comparable to Rhythm control in AF pts with HFpEF. (3) A Rhythm control strategy may be desirable to reduce HF progression in pts with HFrEF and AF. Prospective clinical trials appear warranted to examine HF progression by treatment strategy in HFpEF and HFrEF populations with AF.
Collapse
Affiliation(s)
- April Slee
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA
| | - Marwan Saad
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA
| | - Sanjeev Saksena
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA. .,Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA.
| |
Collapse
|