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Xu S, Gu Z, Zhu W, Feng S. Association of COPD with adverse outcomes in heart failure patients with preserved ejection fraction. ESC Heart Fail 2024. [PMID: 38993173 DOI: 10.1002/ehf2.14958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 07/13/2024] Open
Abstract
We performed a systematic review and meta-analysis to detect the impact of chronic obstructive pulmonary disease (COPD) on the prognosis of heart failure patients with preserved ejection fraction (HFpEF). We systematically screened eligible literature from three electronic databases, PubMed, EMBASE and Cochrane Library, up to April 2023. Two researchers participated in data collection independently. Risk ratios (RRs) from included studies with 95% confidence intervals (CIs) were pooled in the Review Manager version 5.40 software using a random-effects model for analysis. A total of 11 studies (3 post hoc analyses of RCTs and 8 observational studies) with 18 602 participants were included in this meta-analysis. After pooling all the data from eligible studies, our results indicated that COPD was associated with an increased risk of hospitalization (RR = 1.66, 95% CI, 1.47-1.87, P < 0.00001), mortality (RR = 1.62, 95% CI, 1.34-1.95, P < 0.00001), and the composition of hospitalization or mortality (RR = 1.84, 95% CI, 1.35-2.51, P < 0.001) in patients with HFpEF. In a subgroup analysis, the risks of cardiovascular-related mortality (RR = 1.59, 95% CI, 1.30-1.93, P < 0.00001) and post-discharge mortality risk (RR = 2.57, 1.34-4.93, P < 0.01) were increased in HFpEF patients comorbid with COPD, and these associations were also detected in HF-caused hospitalization (RR = 1.64, 95% CI, 1.44-1.87, P < 0.00001). Evidence from existing studies supported that COPD was an independent prognostic risk factor for patients with HFpEF. Developing rapid clinical diagnostic indicators and early use of novel drugs such as SGLT-2 and ARNI may improve the prognosis of this population, deserving further study.
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Affiliation(s)
- Shuo Xu
- Department of Respiratory and Critical Care Medicine, Ganzhou People's Hospital, Ganzhou, China
| | - Zhenbang Gu
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wengen Zhu
- Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shenghui Feng
- Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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2
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Matsushita K, Harada K, Kohno T, Nakano H, Kitano D, Matsuda J, Takei M, Yoshino H, Yamamoto T, Nagao K, Takayama M. Prevalence and clinical characteristics of diabetic cardiomyopathy in patients with acute heart failure. Nutr Metab Cardiovasc Dis 2024; 34:1325-1333. [PMID: 38218713 DOI: 10.1016/j.numecd.2023.12.013] [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: 07/28/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND AND AIMS Diabetic cardiomyopathy refers to cases of diabetes mellitus (DM) complicated by cardiac dysfunction in the absence of cardiovascular disease and hypertension. Its epidemiology remains unclear due to the high rate of coexistence between DM and hypertension. Therefore, this study aimed to examine the prevalence and clinical characteristics of diabetic cardiomyopathy among patients with acute heart failure (HF). METHODS AND RESULTS This multicenter, retrospective study included 17,614 consecutive patients with acute HF. DM-related HF was defined as HF complicating DM without known manifestations of coronary artery disease, significant valvular heart disease, or congenital heart disease, while diabetic cardiomyopathy was defined as DM-related HF without hypertension. Univariable and multivariable logistic regression analyses were performed to identify factors associated with in-hospital mortality. Diabetic cardiomyopathy prevalence was 1.6 % in the entire cohort, 5.2 % in patients with acute HF complicating DM, and 10 % in patients with DM-related HF. Clinical characteristics, including the presence of comorbidities, laboratory data on admission, and factors associated with in-hospital mortality, significantly differed between the diabetic cardiomyopathy group and the DM-related HF with hypertension group. The in-hospital mortality rate was significantly higher in patients with diabetic cardiomyopathy than in patients with DM-related HF with hypertension (7.7 % vs. 2.8 %, respectively; P < 0.001). CONCLUSION The prevalence of diabetic cardiomyopathy was 1.6 % in patients with acute HF, and patients with diabetic cardiomyopathy were at high risk for in-hospital mortality. The clinical characteristics of patients with diabetic cardiomyopathy were significantly different than those of patients with DM-related HF with hypertension.
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Affiliation(s)
| | | | - Takashi Kohno
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Hiroki Nakano
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Junya Matsuda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Makoto Takei
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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3
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Jimba T, Kohsaka S, Yamasaki M, Otsuka T, Harada K, Shiraishi Y, Koba S, Takei M, Kohno T, Matsushita K, Miyazaki T, Kodera S, Tsukamoto S, Iida K, Shindo A, Kitano D, Yamamoto T, Nagao K, Takayama M. Association of ambient temperature and acute heart failure with preserved and reduced ejection fraction. ESC Heart Fail 2022; 9:2899-2908. [PMID: 35719026 DOI: 10.1002/ehf2.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/07/2022] Open
Abstract
AIMS Evidence on the association between ambient temperature and the onset of acute heart failure (AHF) is scarce and mixed. We sought to investigate the incidence of AHF admissions based on ambient temperature change, with particular interest in detecting the difference between AHF with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF). METHODS AND RESULTS Individualized AHF admission data from January 2015 to December 2016 were obtained from a multicentre registry (Tokyo CCU Network Database). The primary event was the daily number of admissions. A linear regression model, using the lowest ambient temperature as the explanatory variable, was selected for the best-estimate model. We also applied the cubic spline model using five knots according to the percentiles of the distribution of the lowest ambient temperature. We divided the entire population into HFpEF + HFmrEF and HFrEF for comparison. In addition, the in-hospital treatment and mortality rates were obtained according to the interquartile ranges (IQRs) of the lowest ambient temperature (IQR1 <5.5°C; IQR25.5-13.3°C; IQR3 13.3-19.7°C; and IQR4 >19.7°C). The number of admissions for HFpEF, HFmrEF and HFrEF were 2736 (36%), 1539 (20%), and 3354 (44%), respectively. The lowest ambient temperature on the admission day was inversely correlated with the admission frequency for both HFpEF + HFmrEF and HFrEF patients, with a stronger correlation in patients with HFpEF + HFmrEF (R2 = 0.25 vs. 0.05, P < 0.001). In the sensitivity analysis, the decrease in the ambient temperature was associated with the greatest incremental increases in HFpEF, followed by HFmrEF and HFrEF patients (3.5% vs. 2.8% vs. 1.5% per -1°C, P < 0.001), with marked increase in admissions of hypertensive patients (systolic blood pressure >140 mmHg vs. 140-100 mmHg vs. <100 mmHg, 3.0% vs. 2.0% vs. 0.8% per -1°C, P for interaction <0.001). A mediator analysis indicated the presence of the mediator effect of systolic blood pressure. The in-hospital mortality rate (7.5%) did not significantly change according to ambient temperature (P = 0.62). CONCLUSIONS Lower ambient temperature was associated with higher frequency of AHF admissions, and the effect was more pronounced in HFpEF and HFmrEF patients than in those with HFrEF.
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Affiliation(s)
- Takahiro Jimba
- Tokyo CCU Network Scientific Committee/NTT Medical Center Tokyo, Tokyo, Japan
| | - Shun Kohsaka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Masao Yamasaki
- Tokyo CCU Network Scientific Committee/NTT Medical Center Tokyo, Tokyo, Japan
| | - Toshiaki Otsuka
- Tokyo CCU Network Scientific Committee/Nippon Medical School, Tokyo, Japan
| | | | | | - Shinji Koba
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Makoto Takei
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Takashi Kohno
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | | | - Kiyoshi Iida
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Akito Shindo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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4
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Higuchi S, Kohno T, Kohsaka S, Shiraishi Y, Takei M, Goda A, Shoji S, Nagatomo Y, Yoshikawa T. Different Impact of Beta-Blockers on Long-Term Mortality in Heart Failure Patients with and without Chronic Obstructive Pulmonary Disease. J Clin Med 2021; 10:jcm10194378. [PMID: 34640396 PMCID: PMC8509631 DOI: 10.3390/jcm10194378] [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] [Received: 08/28/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/04/2022] Open
Abstract
The administration of beta-blockers is challenging and their efficacy is unclear in heart failure (HF) patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the association of beta-blockers with mortality in such patients. This multicenter observational cohort study included hospitalized HF patients with a left ventricular ejection fraction <50% and evaluated them retrospectively. COPD was diagnosed based on medical records and/or the clinical judgment of each investigator. The study endpoints were two-year all-cause, cardiac, and non-cardiac mortality. This study included 83 patients with COPD and 1760 patients without. Two-year all-cause, cardiac, and non-cardiac mortality were observed in 315 (17%), 149 (8%), and 166 (9%) patients, respectively. Beta-blockers were associated with lower all-cause mortality regardless of COPD (COPD: hazard ratio [HR] 0.39, 95% CI 0.16–0.98, p = 0.044; non-COPD: HR 0.62, 95% CI 0.46–0.83, p = 0.001). This association in HF patients with COPD persisted after multivariate analysis and inverse probability weighting and was due to lower non-cardiac mortality (HR 0.40, 95% CI 0.14–1.18. p = 0.098), not cardiac mortality (HR 0.37, 95% CI 0.07–2.01, p = 0.248). Beta-blockers were associated with lower all-cause mortality in HF patients with COPD due to lower non-cardiac mortality. This may reflect selection biases in beta-blocker prescription.
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Affiliation(s)
- Satoshi Higuchi
- Department of Emergency and General Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
- Correspondence: (S.H.); (T.K.)
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan;
- Correspondence: (S.H.); (T.K.)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.K.); (Y.S.); (S.S.)
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.K.); (Y.S.); (S.S.)
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo 108-0073, Japan;
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan;
| | - Satoshi Shoji
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.K.); (Y.S.); (S.S.)
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan;
| | - Tsutomu Yoshikawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan;
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5
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Mooney L, Goodyear CS, Chandra T, Kirschner K, Copland M, Petrie MC, Lang NN. Clonal haematopoiesis of indeterminate potential: intersections between inflammation, vascular disease and heart failure. Clin Sci (Lond) 2021; 135:991-1007. [PMID: 33861346 PMCID: PMC8055963 DOI: 10.1042/cs20200306] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/12/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022]
Abstract
Ageing is a major risk factor for the development of cardiovascular disease (CVD) and cancer. Whilst the cumulative effect of exposure to conventional cardiovascular risk factors is important, recent evidence highlights clonal haematopoiesis of indeterminant potential (CHIP) as a further key risk factor. CHIP reflects the accumulation of somatic, potentially pro-leukaemic gene mutations within haematopoietic stem cells over time. The most common mutations associated with CHIP and CVD occur in genes that also play central roles in the regulation of inflammation. While CHIP carriers have a low risk of haematological malignant transformation (<1% per year), their relative risk of mortality is increased by 40% and this reflects an excess of cardiovascular events. Evidence linking CHIP, inflammation and atherosclerotic disease has recently become better defined. However, there is a paucity of information about the role of CHIP in the development and progression of heart failure, particularly heart failure with preserved ejection fraction (HFpEF). While systemic inflammation plays a role in the pathophysiology of both heart failure with reduced and preserved ejection fraction (EF), it may be of greater relevance in the pathophysiology of HFpEF, which is also strongly associated with ageing. This review describes CHIP and its pathogenetic links with ageing, inflammation and CVD, while providing insight into its putative role in HFpEF.
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Affiliation(s)
- Leanne Mooney
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, U.K
| | - Carl S. Goodyear
- Institute of Immunity, Infection and Inflammation, University of Glasgow, Glasgow, U.K
| | - Tamir Chandra
- The Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, U.K
| | - Kristina Kirschner
- Paul O’Gorman Leukaemia Research Centre, Institute for Cancer Science, University of Glasgow, Glasgow, U.K
| | - Mhairi Copland
- Paul O’Gorman Leukaemia Research Centre, Institute for Cancer Science, University of Glasgow, Glasgow, U.K
| | - Mark C. Petrie
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, U.K
| | - Ninian N. Lang
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, U.K
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6
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Saitoh M, Takahashi Y, Okamura D, Akiho M, Suzuki H, Noguchi N, Yamaguchi Y, Hori K, Adachi Y, Takahashi T. Prognostic impact of hospital-acquired disability in elderly patients with heart failure. ESC Heart Fail 2021; 8:1767-1774. [PMID: 33838022 PMCID: PMC8120367 DOI: 10.1002/ehf2.13356] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/28/2021] [Accepted: 03/29/2021] [Indexed: 01/01/2023] Open
Abstract
Aims Functional decline is associated with worse outcomes in patients with elderly heart failure (HF), but little is known about the prognostic impact of hospital‐acquired disability (HAD) during hospital stay after acute HF. The present study examines the prognostic significance of HAD in the prediction of all‐cause mortality in elderly patients who admitted for acute HF. Methods and results This retrospective study was performed in 1941 elderly patients aged ≥65 years or older from the cardiovascular physiotherapy for acute HF patients in the Tokyo metropolitan area registry and excluded those who died in hospital. HAD was defined as any decline in the Barthel index (BI) before discharge compared with the BI within 1 month before hospital admission. The primary outcome of this study was all‐cause death and HF readmission. A total of 565 (29%) deaths and 789 (41%) HF readmission occurred over a median follow‐up period of 1.7 years. A total of 476 patients (25%) had HAD during hospital stay after acute HF. In multivariable analysis, HAD predicted all‐cause death [hazard ratio (HR): 1.772; 95% confidence interval (CI): 1.450–2.167; P < 60; 0.001] and with risk of HF readmission (HR: 1.193; 95% CI: 1.005–1.416; P = 0.043) after adjusting for the Meta‐analysis Global Group in Chronic Heart Failure risk score. Conclusions Hospital‐acquired disability is associated with an increased risk of all‐cause death and readmission for HF in elderly patients with acute HF.
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Affiliation(s)
- Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University Tokyo, 3-2-12, Hongo, Bunkyo-ku, Ochanomizu Centre Building 503, Tokyo, 113-0033, Japan.,Department of Rehabilitation, Sakakibara Heart Institute, Tokyo, Japan
| | - Yuta Takahashi
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Rehabilitation, St. Luke's International Hospital, Tokyo, Japan
| | - Daisuke Okamura
- Department of Rehabilitation, St. Luke's International Hospital, Tokyo, Japan
| | - Mitsutoshi Akiho
- Department of Rehabilitation, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hidetoshi Suzuki
- Department of Rehabilitation, Mitsui Memorial Hospital, Tokyo, Japan
| | - Naoki Noguchi
- Department of Rehabilitation, Ayase Heart Hospital, Tokyo, Japan
| | - Yukito Yamaguchi
- Department of Rehabilitation, Ayase Heart Hospital, Tokyo, Japan
| | - Kentaro Hori
- Department of Rehabilitation, Sakakibara Heart Institute, Tokyo, Japan
| | - Yuichi Adachi
- Department of Rehabilitation, Sakakibara Heart Institute, Tokyo, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University Tokyo, 3-2-12, Hongo, Bunkyo-ku, Ochanomizu Centre Building 503, Tokyo, 113-0033, Japan
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7
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Matsushita K. Heart Failure and Adipose Mesenchymal Stem Cells. Trends Mol Med 2020; 26:369-379. [PMID: 32277931 DOI: 10.1016/j.molmed.2020.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/03/2019] [Accepted: 01/21/2020] [Indexed: 02/08/2023]
Abstract
Mesenchymal stem cells (MSCs) are considered a promising cell type for the treatment of heart failure (HF). In particular, MSCs in adipose tissue are being evaluated as an effective therapeutic tool. However, adipose MSCs are a major source of adipocyte generation and linked to obesity, which is an independent risk factor for HF. MSCs express all of the components of the renin-angiotensin system (RAS), which plays a pivotal role in the pathophysiology of HF. The local RAS also regulates MSC adipogenesis, indicating a connection between MSC-adipogenesis-obesity and HF. This review examines evidence of the complex relationship between HF and adipose MSCs and discusses how to explore this association for favorable therapeutic outcomes for HF.
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Affiliation(s)
- Kenichi Matsushita
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
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8
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Matsushita K, Harada K, Miyazaki T, Miyamoto T, Kohsaka S, Iida K, Yamamoto Y, Nagatomo Y, Yoshino H, Yamamoto T, Nagao K, Takayama M. Reply to: Heart Failure With Preserved Ejection Fraction in Older Adults. J Am Geriatr Soc 2019; 68:665-666. [PMID: 31859370 DOI: 10.1111/jgs.16301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Kenichi Matsushita
- Tokyo CCU Network Scientific Committee, Tokyo, Japan.,Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | | | | | | | - Shun Kohsaka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Kiyoshi Iida
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Yuji Nagatomo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Hideaki Yoshino
- Tokyo CCU Network Scientific Committee, Tokyo, Japan.,Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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9
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Shil AB, Oo TN, Ragaza NC. Heart Failure with Preserved Ejection Fraction in Older Adults. J Am Geriatr Soc 2019; 68:664-665. [PMID: 31859364 DOI: 10.1111/jgs.16304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Asit Baran Shil
- Geriatric Medicine, Kaiser Permanente, Fontana Medical Center, Fontana, California
| | - Thet N Oo
- Geriatric Medicine, Kaiser Permanente, Fontana Medical Center, Fontana, California
| | - Norman C Ragaza
- Geriatric Medicine, Kaiser Permanente, Fontana Medical Center, Fontana, California
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