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Chiang WJ, Lee JT, Hung SY, Hsu PC, Chou CL. Prognostic Value of Body Surface Area-Adjusted Oxygen Uptake Efficiency Slope in Heart Failure Patients. ACTA CARDIOLOGICA SINICA 2024; 40:322-330. [PMID: 38779165 PMCID: PMC11106627 DOI: 10.6515/acs.202405_40(3).20240105a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 01/05/2024] [Indexed: 05/25/2024]
Abstract
Background COVID-19 has been associated with a higher risk of developing heart failure (HF). Among the parameters derived from cardiopulmonary exercise testing (CPET), oxygen uptake efficiency slope (OUES) has become one of the most important parameters for predicting the prognosis of HF patients. However, the clinical utilization of OUES is limited owing to its variation with patient height and weight. This study aimed to evaluate the prognostic value of body surface area-adjusted OUES (OUES/BSA) in adults with HF. Methods Thirty-six HF patients (mean age, 57 ± 12 years; 30 men) undergoing CPET between July 2019 and May 2020 who were followed up for 12 months were enrolled. The endpoints were major cardiovascular (CV) events, including hospitalization due to acute decompensated HF, left ventricular assist device implantation, heart transplantation, and cardiovascular-related death. We analyzed the correlations between clinical/CPET variables and major CV events. Results Among the analyzed CPET variables, OUES/BSA had better correlation with maximal oxygen uptake (VO2max) than other variables. In univariate Cox proportional analysis, OUES/BSA and peak VO2 were both significant independent prognostic factors. The cutoff value of OUES/BSA was 595 ml/min/m2 with an area under the curve of 0.929. The patients with OUES/BSA < 595 ml/min/m2 had a lower CV event-free survival rate at 12 months of follow-up compared with the other group (33.3% and 100%, respectively; log-rank test, p < 0.001). Conclusions BSA-adjusted OUES is an effective independent predictor for prognosis in HF patients and can be an alternative to peak VO2 for risk stratification in HF patients, regardless of exercise intensity. However, further large-scale studies are required to validate our findings.
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Affiliation(s)
- Wei-Jen Chiang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital
| | - Jen-Ting Lee
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital
| | - Su-Ying Hung
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital
| | - Po-Chen Hsu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital
- National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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Magrì D, Gallo G, Piepoli M, Salvioni E, Mapelli M, Vignati C, Fiori E, Muthukkattil ML, Corrà U, Metra M, Paolillo S, Maruotti A, Di Loro PA, Senni M, Lagioia R, Scrutinio D, Emdin M, Passino C, Parati G, Sinagra G, Correale M, Badagliacca R, Sciomer S, Di Lenarda A, Agostoni P, Filardi PP. What about chronotropic incompetence in heart failure with mildly reduced ejection fraction? Clinical and prognostic implications from the Metabolic Exercise combined with Cardiac and Kidney Indexes score dataset. Eur J Prev Cardiol 2024; 31:263-271. [PMID: 37890033 DOI: 10.1093/eurjpc/zwad338] [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: 07/29/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
AIMS Chronotropic incompetence (CI) is a strong predictor of outcome in heart failure with reduced ejection fraction, however no data on its clinical and prognostic impacts in heart failure with mildly reduced ejection fraction (HFmrEF) are available. Therefore, the study aims to investigate, in a large multicentre HFmrEF cohort, the prevalence of CI as well as its relationship with exercise capacity and its prognostic role over the cardiopulmonary exercise testing (CPET) parameters. METHODS AND RESULTS Within the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) database, we analysed data of 864 HFmrEF out of 1164 stable outpatients who performed a maximal CPET at the cycle ergometer and who had no significant rhythm disorders or comorbidities. The primary study endpoint was cardiovascular (CV) death. All-cause death was also explored. Chronotropic incompetence prevalence differed depending on the method (peak heart rate, pHR% vs. pHR reserve, pHRR%) and the cut-off adopted (pHR% from ≤75% to ≤60% and pHRR% ≤ 65% to ≤50%), ranging from 11% to 62%. A total of 84 (9.7%) CV deaths were collected, with 39 (4.5%) occurring within 5 years. At multivariate analysis, both pHR% [hazard ratio 0.97 (0.95-0.99), P < 0.05] and pHRR% [hazard ratio 0.977 (0.961-0.993), P < 0.01] were associated with the primary endpoint. A pHR% ≤ 75% and a pHRR% ≤ 50% represented the most accurate cut-off values in predicting the outcome. CONCLUSION The study suggests an association between blunted exercise-HR response, functional capacity, and CV death risk among patients with HFmrEF. Whether the CI presence might be adopted in daily HFmrEF management needs to be addressed in larger prospective studies.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Massimo Piepoli
- Department of Biomedical Science for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy, and Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy
| | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Melwyn Luis Muthukkattil
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Via Revislate 13, 28010 Veruno, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazza del Mercato 15, 25121 Brescia, Italy
| | - Stefania Paolillo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Via Leonardo Bianchi, 80131 Napoli, Italy
| | - Antonello Maruotti
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne, Libera Università Maria Ss Assunta, Via della Traspontina 21, 00193 Roma, Italy
| | - Pierfrancesco Alaimo Di Loro
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne, Libera Università Maria Ss Assunta, Via della Traspontina 21, 00193 Roma, Italy
| | - Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Rocco Lagioia
- Division of Cardiology, 'S. Maugeri' Foundation, IRCCS, Institute of Cassano Murge, Via Generale Bellomo 73-75, 70124 Bari, Italy
| | - Domenico Scrutinio
- Division of Cardiology, 'S. Maugeri' Foundation, IRCCS, Institute of Cassano Murge, Via Generale Bellomo 73-75, 70124 Bari, Italy
| | - Michele Emdin
- Life Science Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Claudio Passino
- Life Science Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Via della Pietà 19, 34129 Trieste, Italy
| | - Michele Correale
- Department of Cardiology, University of Foggia, Via Antonio Gramsci 89, 71122 Foggia, Italy
| | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Via del Policlinico 155, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Via del Policlinico 155, 00161 Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n°1 and University of Trieste, Via Slataper 9, 34134 Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Pasquale Perrone Filardi
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Via Leonardo Bianchi, 80131 Napoli, Italy
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Seferović P, Polovina M, Milinković I, Krljanac G, Ašanin M. Risk stratification models for predicting mortality in heart failure: a favourite or an outsider? Eur J Prev Cardiol 2024; 31:272-273. [PMID: 35950368 DOI: 10.1093/eurjpc/zwac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Petar Seferović
- Faculty of Medicine, Belgrade University, 8 Dr Subotića, 11000 Belgrade, Serbia
- Serbian Academy of Sciences and Arts, 35 Kneza Mihaila, 11000 Belgrade, Serbia
| | - Marija Polovina
- Faculty of Medicine, Belgrade University, 8 Dr Subotića, 11000 Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, 8 Koste Todorovića, Belgrade, Serbia
| | - Ivan Milinković
- Faculty of Medicine, Belgrade University, 8 Dr Subotića, 11000 Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, 8 Koste Todorovića, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, Belgrade University, 8 Dr Subotića, 11000 Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, 8 Koste Todorovića, Belgrade, Serbia
| | - Milika Ašanin
- Faculty of Medicine, Belgrade University, 8 Dr Subotića, 11000 Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, 8 Koste Todorovića, Belgrade, Serbia
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Heart failure classification based on resting ejection fraction does not display a unique exercise response pattern. Int J Cardiol 2023; 376:157-164. [PMID: 36716970 DOI: 10.1016/j.ijcard.2023.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Heart failure with preserved (HFpEF), mildly reduced (HFmrEF) and reduced (HFrEF) ejection fraction (EF) remains a controversial categorization. Whether these three categories reflect a distinct pattern of exercise limitation in cardiopulmonary exercise testing (CPET) needs to be investigated. We aimed to analyze whether CPET variables differ between all heart failure categories (HF). METHODS We analyzed CPET variables of stable HFpEF (n = 123), HFmrEF (n = 31), and HFrEF (n = 153; 74 patients with and 79 patients without left ventricular assist device, LVAD) patients. The association between HF and peak oxygen consumption (VO2peak) was used as a primary outcome, while the association between HF, oxygen uptake efficiency slope (OUES), and increase of O2 pulse (ΔO2 pulse) were analyzed as secondary outcomes. RESULTS VO2peak displayed a consistent decline across all HF categories (19.8 ml ± 6.2/kg/min vs. 17.5 ± 7.9 ml/kg/min vs. 13.7 ± 4.0 ml/kg/min, p < 0.001). OUES only showed differences between HFpEF and HFrEF (1.8 ± 0.6 vs. 1.4 ± 0.5, p < 0.001) as well as HFmrEF and HFrEF (1.9 ± 0.9 vs. 1.4 ± 0.5, p = 0.004). ΔO2 pulse differed between HFpEF and HFrEF (7.7 ± 3.5 ml/beat/kg*100 vs. 5.5 ± 3.0 ml/beat/kg*100, p < 0.001) as well as HFpEF and HFmrEF (7.7 ± 3.5 ml/beat/kg*100 vs. 6.3 ± 4.1 ml/beat/kg*100, p = 0.049). Outcome variables did not differ between HFrEF with and without LVAD support (VO2peak: p = 0.364, OUES: p = 0.129, ΔO2 pulse: p = 0.564). CONCLUSIONS HF did not display a distinct CPET profile. Thus, EF-based categorization does not entirely reflect exercise limitations. CPET variables could contribute to better characterize HF phenotypes.
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Dong X, Xie Y, Xu J, Qin Y, Zheng Q, Hu R, Zhang X, Wang W, Tian J, Yi K. Global historical retrospect and future prospects on biomarkers of heart failure: A bibliometric analysis and science mapping. Heliyon 2023; 9:e13509. [PMID: 36825183 PMCID: PMC9942007 DOI: 10.1016/j.heliyon.2023.e13509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Heart failure is a rapidly growing public health problem and has become a major cause of hospitalization in middle-aged and older adults. Biomarkers are clinically important in managing heart failure and have attracted more attention from researchers in recent years. This study aimed to evaluate the global research of heart failure biomarkers by bibliometrics and to identify the hot spots and perspectives for further advancement. Methods Selection of relevant documents was from the Web of Science Core Collection. Microsoft Excel, VOSviewer, SciMA, and CiteSpace software were used for bibliometric analysis. Results As of October 29, 2021, 5,978 documents for heart failure biomarkers have been identified from 1989 to 2021. European Journal of Heart Failure and Circulation respectively ranked first in terms of the number of publications and the number of co-citations. A total of 5,698 institutions from 90 countries participated in these publications, with the USA leading with 2,045 documents. The most productive institution was Harvard University. Januzzi, J.L. and Maisel, A.S. were the most productive and most cited authors respectively. Natriuretic peptide, copeptin, valsartan, ferric carboxymaltose, empagliflozin, preserved ejection fraction, myocardial fibrosis, and heart transplantation were hot themes. Conclusions Extensive national and inter-institutional collaboration should be enhanced to bridge the gap between developed and less developed countries in heart failure biomarkers research. The research in this field seems to have reached a relatively mature stage, with a decrease in research fervor in recent years. The study of the natriuretic peptide family still has high centrality, with advances in the study of expression products and inflammatory markers. Cardiac fibrosis, cardiac remodeling, and therapies regarding heart failure have become hot spots.
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Affiliation(s)
- Xin Dong
- Department of Ultrasound, Gansu Provincial Hospital, Lanzhou, China,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Yafei Xie
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,The First Clinical Medical College of Lanzhou University, Lanzhou, China,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
| | - Jianguo Xu
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yu Qin
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qingyong Zheng
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Rui Hu
- The First Operating Room, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Zhang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,The First School of Clinical Medicine of Gansu University of Chinese Medicine, Lanzhou, China
| | - Wenxin Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,The First School of Clinical Medicine of Gansu University of Chinese Medicine, Lanzhou, China
| | - Jinhui Tian
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China,Corresponding author. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199, Donggang West Road, Lanzhou City, Gansu Province, 730000, China.
| | - Kang Yi
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Lanzhou, China,Corresponding author. Department of Cardiovascular Surgery, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou City, Gansu Province,730000, China.
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Siddiqi TJ, Ahmed A, Greene SJ, Shahid I, Usman MS, Oshunbade A, Alkhouli M, Hall ME, Murad MH, Khera R, Jain V, Van Spall HGC, Khan MS. Performance of current risk stratification models for predicting mortality in patients with heart failure: a systematic review and meta-analysis. Eur J Prev Cardiol 2022; 29:2027-2048. [PMID: 35919956 DOI: 10.1093/eurjpc/zwac148] [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: 01/28/2022] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 11/12/2022]
Abstract
AIMS There are several risk scores designed to predict mortality in patients with heart failure (HF). This study aimed to assess performance of risk scores validated for mortality prediction in patients with acute HF (AHF) and chronic HF. METHODS AND RESULTS MEDLINE and Scopus were searched from January 2015 to January 2021 for studies which internally or externally validated risk models for predicting all-cause mortality in patients with AHF and chronic HF. Discrimination data were analysed using C-statistics, and pooled using generic inverse-variance random-effects model. Nineteen studies (n = 494 156 patients; AHF: 24 762; chronic HF mid-term mortality: 62 000; chronic HF long-term mortality: 452 097) and 11 risk scores were included. Overall, discrimination of risk scores was good across the three subgroups: AHF mortality [C-statistic: 0.76 (0.68-0.83)], chronic HF mid-term mortality [1 year; C-statistic: 0.74 (0.68-0.79)], and chronic HF long-term mortality [≥2 years; C-statistic: 0.71 (0.69-0.73)]. MEESSI-AHF [C-statistic: 0.81 (0.80-0.83)] and MARKER-HF [C-statistic: 0.85 (0.80-0.89)] had an excellent discrimination for AHF and chronic HF mid-term mortality, respectively, whereas MECKI had good discrimination [C-statistic: 0.78 (0.73-0.83)] for chronic HF long-term mortality relative to other models. Overall, risk scores predicting short-term mortality in patients with AHF did not have evidence of poor calibration (Hosmer-Lemeshow P > 0.05). However, risk models predicting mid-term and long-term mortality in patients with chronic HF varied in calibration performance. CONCLUSIONS The majority of recently validated risk scores showed good discrimination for mortality in patients with HF. MEESSI-AHF demonstrated excellent discrimination in patients with AHF, and MARKER-HF and MECKI displayed an excellent discrimination in patients with chronic HF. However, modest reporting of calibration and lack of head-to-head comparisons in same populations warrant future studies.
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Affiliation(s)
- Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Aymen Ahmed
- Department of Medicine, DOW University of Health Sciences, Karachi, Pakistan
| | - Stephen J Greene
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | | | - Adebamike Oshunbade
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Vardhmaan Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Research Institute of St Joe's Hamilton and Population Health Research Institute, Hamilton, Canada
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Berezin AA, Fushtey IM, Berezin AE. Discriminative Utility of Apelin-to-NT-Pro-Brain Natriuretic Peptide Ratio for Heart Failure with Preserved Ejection Fraction among Type 2 Diabetes Mellitus Patients. J Cardiovasc Dev Dis 2022; 9:23. [PMID: 35050233 PMCID: PMC8779441 DOI: 10.3390/jcdd9010023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/01/2022] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Apelin is a regulatory vasoactive peptide, which plays a pivotal role in adverse cardiac remodeling and heart failure (HF) with reduced ejection fraction. The purpose of the study was to investigate whether serum levels of apelin is associated with HF with preserved election fraction (HFpEF) in patients with T2DM. METHODS The study retrospectively involved 101 T2DM patients aged 41 to 62 years (48 patients with HFpEF and 28 non-HFpEF patients). The healthy control group consisted of 25 individuals with matched age and sex. Data collection included demographic and anthropometric information, hemodynamic performances and biomarkers of the disease. Transthoracic B-mode echocardiography, Doppler and TDI were performed at baseline. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and apelin were measured by ELISA in all patients at the study entry. RESULTS Unadjusted multivariate logistic model yielded the only apelin to NT-proBNP ratio (OR = 1.44; p = 0.001), BMI > 34 кг/м2 (OR = 1.07; p = 0.036), NT-proBNP > 458 pmol/mL (OR = 1.17; p = 0.042), LAVI > 34 mL/m2 (OR = 1.06; p = 0.042) and E/e' > 11 (OR = 1.04; p = 0.044) remained to be strong predictors for HFpEF. After obesity adjustment, multivariate logistic regression showed that the apelin to NT-proBNP ratio < 0.82 × 10-2 units remained sole independent predictor for HFpEF (OR = 1.44; 95% CI: 1.18-2.77; p = 0.001) HFpEF in T2DM patients. In conclusion, we found that apelin to NT-proBNP ratio < 0.82 × 10-2 units better predicted HFpEF in T2DM patients than apelin and NT-proBNP alone. This finding could open new approach for CV risk stratification of T2DM at higher risk of HF.
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Affiliation(s)
- Alexander A. Berezin
- Internal Medicine Department, Medical Academy of Postgraduate Education, 69096 Zaporozhye, Ukraine; (A.A.B.); (I.M.F.)
| | - Ivan M. Fushtey
- Internal Medicine Department, Medical Academy of Postgraduate Education, 69096 Zaporozhye, Ukraine; (A.A.B.); (I.M.F.)
| | - Alexander E. Berezin
- Internal Medicine Department, State Medical University, 69096 Zaporozhye, Ukraine
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8
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Zhang X, Sun Y, Zhang Y, Chen F, Dai M, Si J, Yang J, Li X, Li J, Xia Y, Tse G, Liu Y. Characteristics and outcomes of heart failure with recovered left ventricular ejection fraction. ESC Heart Fail 2021; 8:5383-5391. [PMID: 34569712 PMCID: PMC8712904 DOI: 10.1002/ehf2.13630] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/16/2021] [Accepted: 09/11/2021] [Indexed: 12/18/2022] Open
Abstract
Aims There is an emerging interest in elucidating the natural history and prognosis for patients with heart failure with reduced ejection fraction (HFrEF) in whom left ventricular ejection fraction (LVEF) subsequently improves. The characteristics and outcomes were compared between heart failure with recovered ejection fraction (HFrecEF) and persistent HFrEF. Methods and results This is a retrospective study of adults who underwent at least two echocardiograms 3 months apart between 1 November 2015 and 31 October 2019 with an initial diagnosis of HFrEF. The subjects were divided into HFrecEF group (second LVEF > 40%, ≥10% absolute improvement in LVEF) and persistent HFrEF group (<10% absolute improvement in LVEF) according to the second LVEF. To further study the characteristics of HFrecEF patients, the cohort was further divided into LVEF improvement of 10–20% and >20% subgroups. The primary outcomes were all‐cause mortality and rehospitalization. A total of 1160 HFrEF patients were included [70.2% male, mean (standard deviation) age: 62 ± 13 years]. On the second echocardiogram, 284 patients (24.5%) showed HFrecEF and 876 patients (75.5%) showed persistent HFrEF. All‐cause mortality was identified in 23 (8.10%) HFrecEF and 165 (18.84%) persistent HFrEF, whilst 76 (26.76%) and 426 (48.63%) showed rehospitalizations, respectively. Survival analysis showed that the persistent HFrEF subgroup experienced a significantly higher mortality at 12 and 24 months and a higher hospitalization at 12, 24, 48, and more than 48 months following discharge. Multivariate Cox regression showed that persistent HFrEF had a higher risk of all‐cause mortality [hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.49–3.56, P = 0.000] and rehospitalization (HR 1.85, 95% CI 1.45–2.36, P = 0.000) than the HFrecEF group. Subgroup analysis showed that the LVEF ≥ 20% improvement subgroup had lower rates of adverse outcomes compared with those with less improvement of 10–20%. Conclusions Heart failure with recovered ejection fraction is a distinct HF phenotype with better clinical outcomes compared with those with persistent HFrEF. HFrecEF patients have a relatively better short‐term mortality at 24 months but not thereafter.
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Affiliation(s)
- Xinxin Zhang
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuxi Sun
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanli Zhang
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Feifei Chen
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mengyuan Dai
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinping Si
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing Yang
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiao Li
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiaxin Li
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Kent and Medway Medical School, Canterbury, UK
| | - Ying Liu
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
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