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Wong A, Sun Q, Latif II, Karwi QG. Macrophage energy metabolism in cardiometabolic disease. Mol Cell Biochem 2024:10.1007/s11010-024-05099-6. [PMID: 39198360 DOI: 10.1007/s11010-024-05099-6] [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: 04/27/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024]
Abstract
In a rapidly expanding body of literature, the major role of energy metabolism in determining the response and polarization status of macrophages has been examined, and it is currently a very active area of research. The metabolic flux through different metabolic pathways in the macrophage is interconnected and complex and could influence the polarization of macrophages. Earlier studies suggested glucose flux through cytosolic glycolysis is a prerequisite to trigger the pro-inflammatory phenotypes of macrophages while proposing that fatty acid oxidation is essential to support anti-inflammatory responses by macrophages. However, recent studies have shown that this understanding is oversimplified and that the metabolic control of macrophage polarization is highly complex and not fully defined yet. In this review, we systematically reviewed and summarized the literature regarding the role of energy metabolism in controlling macrophage activity and how that might be altered in cardiometabolic diseases, namely heart failure, obesity, and diabetes. We critically appraised the experimental studies and methodologies in the published studies. We also highlighted the challenging concepts in macrophage metabolism and identified several research questions yet to be addressed in future investigations.
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Affiliation(s)
- Angela Wong
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Qiuyu Sun
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Ismail I Latif
- Department of Microbiology, College of Medicine, University of Diyala, Baqubaa, Diyala, Iraq
| | - Qutuba G Karwi
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada.
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Lyu L, Xu J, Xv C, Xiao H, Liu Z, He Y, Gao W, Hao B, Liu H. Prognostic value of growth differentiation factor-15 in heart failure among whole ejection fraction phenotypes. ESC Heart Fail 2024; 11:2295-2304. [PMID: 38641904 PMCID: PMC11287306 DOI: 10.1002/ehf2.14807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/21/2024] Open
Abstract
AIMS The utility of growth differentiation factor-15 (GDF-15) in predicting long-term adverse outcomes in heart failure (HF) patients is not well established. This study explored the relationship between GDF-15 levels and adverse outcomes in HF patients across various ejection fraction (EF) phenotypes associated with coronary heart disease (CHD) and evaluated the added prognostic value of incorporating GDF-15 into the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score-based model. METHODS AND RESULTS This single-centre cohort study included 823 HF patients, categorized into 230 (27.9%) reduced EF (HFrEF), 271 (32.9%) mid-range EF (HFmrEF), and 322 (39.1%) preserved EF (HFpEF) groups. The median age was 68.0 years (range: 56.0-77.0), and 245 (29.8%) were females. Compared with the HFrEF and HFmrEF groups, the HFpEF group had a higher GDF-15 concentration (P = 0.002) and a higher MAGGIC risk score (P < 0.001). We examined the associations between GDF-15 levels and the risks of all-cause mortality and HF rehospitalization using Cox regression models. The C-index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) metrics were employed to assess the incremental prognostic value. During the 9.4 year follow-up period, 425 patients died, and 484 were rehospitalized due to HF. Multivariate Cox regression analysis revealed that elevated GDF-15 levels were significantly associated with an increased risk of all-cause mortality [hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.20-1.54; P < 0.001] and HF rehospitalization (HR = 1.75, 95% CI: 1.57-1.95; P < 0.001) across all HF phenotypes. This association remained significant when GDF-15 was treated as a categorical variable (high GDF-15 group: all-cause death: HR = 1.73, 95% CI: 1.40-2.14; P < 0.001; HF rehospitalization: HR = 3.37, 95% CI: 2.73-4.15; P < 0.001). Inclusion of GDF-15 in the MAGGIC risk score-based model provided additional prognostic value for all HF patients (Δ C-index = 0.021, 95% CI: 0.002-0.041; IDI = 0.011, 95% CI: 0.001-0.025; continuous NRI = 0.489, 95% CI: 0.174-0.629) and HF rehospitalization (Δ C-index = 0.034, 95% CI: 0.005-0.063; IDI = 0.021, 95% CI: 0.007-0.032; continuous NRI = 0.307, 95% CI: 0.147-0.548), particularly in the HFpEF subgroup. CONCLUSIONS GDF-15 is identified as an independent risk factor for adverse outcomes in HF patients across the entire EF spectrum in the context of CHD. Integrating GDF-15 into the MAGGIC risk score-based model enhances its prognostic capability for adverse outcomes in the general HF population. This incremental prognostic effect was observed specifically in the HFpEF subgroup and not in other subgroups.
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Affiliation(s)
- Lyu Lyu
- Department of CardiologyThe Second Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Juan Xu
- Department of General SurgeryAffiliated Xiaoshan Hospital, Hangzhou Normal UniversityHangzhouChina
| | - Cui Xv
- Department of Medical AdministrationThe 305 Hospital of PLABeijingChina
| | - Hunan Xiao
- Department of CardiologyThe Second Medical Centre, Chinese PLA General HospitalBeijingChina
| | - Zhenzhen Liu
- Department of CardiologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Yanru He
- Department of CardiologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Weiyang Gao
- Department of CardiologyThe Second Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Benchuan Hao
- Department of CardiologyThe Second Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Hongbin Liu
- Department of CardiologyThe Second Medical Centre, Chinese PLA General HospitalBeijingChina
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Andrzejczyk K, Abou Kamar S, van Ommen AM, Canto ED, Petersen TB, Valstar G, Akkerhuis KM, Cramer MJ, Umans V, Rutten FH, Teske A, Boersma E, Menken R, van Dalen BM, Hofstra L, Verhaar M, Brugts J, Asselbergs F, den Ruijter H, Kardys I. Identifying plasma proteomic signatures from health to heart failure, across the ejection fraction spectrum. Sci Rep 2024; 14:14871. [PMID: 38937570 PMCID: PMC11211454 DOI: 10.1038/s41598-024-65667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/23/2024] [Indexed: 06/29/2024] Open
Abstract
Circulating proteins may provide insights into the varying biological mechanisms involved in heart failure (HF) with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). We aimed to identify specific proteomic patterns for HF, by comparing proteomic profiles across the ejection fraction spectrum. We investigated 4210 circulating proteins in 739 patients with normal (Stage A/Healthy) or elevated (Stage B) filling pressures, HFpEF, or ischemic HFrEF (iHFrEF). We found 2122 differentially expressed proteins between iHFrEF-Stage A/Healthy, 1462 between iHFrEF-HFpEF and 52 between HFpEF-Stage A/Healthy. Of these 52 proteins, 50 were also found in iHFrEF vs. Stage A/Healthy, leaving SLITRK6 and NELL2 expressed in lower levels only in HFpEF. Moreover, 108 proteins, linked to regulation of cell fate commitment, differed only between iHFrEF-HFpEF. Proteomics across the HF spectrum reveals overlap in differentially expressed proteins compared to stage A/Healthy. Multiple proteins are unique for distinguishing iHFrEF from HFpEF, supporting the capacity of proteomics to discern between these conditions.
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Affiliation(s)
- Karolina Andrzejczyk
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sabrina Abou Kamar
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Anne-Mar van Ommen
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elisa Dal Canto
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Teun B Petersen
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gideon Valstar
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten Jan Cramer
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Victor Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | - Frans H Rutten
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arco Teske
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roxana Menken
- Cardiology Centers of the Netherlands, Utrecht, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Leonard Hofstra
- Cardiology Centers of the Netherlands, Utrecht, The Netherlands
| | - Marianne Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jasper Brugts
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Folkert Asselbergs
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hester den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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D’Amato A, Severino P, Prosperi S, Mariani MV, Germanò R, De Prisco A, Myftari V, Cestiè C, Labbro Francia A, Marek-Iannucci S, Tabacco L, Vari L, Marano SL, Di Pietro G, Lavalle C, Sardella G, Mancone M, Badagliacca R, Fedele F, Vizza CD. The Role of High-Sensitivity Troponin T Regarding Prognosis and Cardiovascular Outcome across Heart Failure Spectrum. J Clin Med 2024; 13:3533. [PMID: 38930061 PMCID: PMC11204386 DOI: 10.3390/jcm13123533] [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: 05/21/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Cardiac troponin release is related to the cardiomyocyte loss occurring in heart failure (HF). The prognostic role of high-sensitivity cardiac troponin T (hs-cTnT) in several settings of HF is under investigation. The aim of the study is to assess the prognostic role of intrahospital hs-cTnT in patients admitted due to HF. Methods: In this observational, single center, prospective study, patients hospitalized due to HF have been enrolled. Admission, in-hospital peak, and discharge hs-cTnT have been assessed. Patients were followed up for 6 months. Cardiovascular (CV) death, HF hospitalization (HFH), and worsening HF (WHF) (i.e., urgent ambulatory visit/loop diuretics escalation) events have been assessed at 6-month follow up. Results: 253 consecutive patients have been enrolled in the study. The hs-cTnT median values at admission and discharge were 0.031 ng/mL (IQR 0.02-0.078) and 0.031 ng/mL (IQR 0.02-0.077), respectively. The risk of CV death/HFH was higher in patients with admission hs-cTnT values above the median (p = 0.02) and in patients who had an increase in hs-cTnT during hospitalization (p = 0.03). Multivariate Cox regression analysis confirmed that hs-cTnT above the median (OR: 2.06; 95% CI: 1.02-4.1; p = 0.04) and increase in hs-cTnT during hospitalization (OR:1.95; 95%CI: 1.006-3.769; p = 0.04) were predictors of CV death/HFH. In a subgroup analysis of patients with chronic HF, hs-cTnT above the median was associated with increased risk of CV death/HFH (p = 0.03), while in the subgroup of patients with HFmrEF/HFpEF, hs-cTnT above the median was associated with outpatient WHF events (p = 0.03). Conclusions: Inpatient hs-cTnT levels predict CV death/HFH in patients with HF. In particular, in the subgroup of chronic HF patients, hs-cTnT is predictive of CV death/HFH; while in patients with HFmrEF/HFpEF, hs-cTnT predicts WHF events.
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Affiliation(s)
- Andrea D’Amato
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
- Department of Cardiology, Ospedale Fabrizio Spaziani, 03100 Frosinone, Italy
| | - Paolo Severino
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Silvia Prosperi
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Rosanna Germanò
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Andrea De Prisco
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Claudia Cestiè
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Stefanie Marek-Iannucci
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Leonardo Tabacco
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Leonardo Vari
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Silvia Luisa Marano
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Gianluca Di Pietro
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Gennaro Sardella
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | | | - Carmine Dario Vizza
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
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5
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Deharo F, Grapsa J. Global longitudinal strain as a predictor of risk in patients with heart failure with preserved ejection fraction: A deserved role? Eur J Heart Fail 2024; 26:882-884. [PMID: 38528727 DOI: 10.1002/ejhf.3211] [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: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
- Francois Deharo
- Cardiology Department, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Julia Grapsa
- Cardiology Department, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
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6
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Hossri C, Araujo F, Baldi B, Otterstetter R, Uemoto V, Carvalho C, Mastrocola L, Albuquerque A. Association among cardiopulmonary and metabolic rehabilitation, arrhythmias, and myocardial ischemia responses of patients with HFpEF or HFmrEF. Braz J Med Biol Res 2024; 57:e13174. [PMID: 38451608 PMCID: PMC10913385 DOI: 10.1590/1414-431x2024e13174] [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: 10/28/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
There's limited evidence of the potential benefits of cardiopulmonary and metabolic rehabilitation (CPMR) in patients with heart failure with preserved ejection fraction (HFpEF) or mildly reduced ejection fraction (HFmrEF) and coronary artery disease (CAD). The aim of this study was to investigate the impact of CPMR on the myocardial ischemia response (MIR), exercise-induced arrhythmias (EIA), New York Heart Association (NYHA) functional class, heart rate recovery (HRR), Borg CR10 perceived symptoms, and the SF-36 physical and mental health summary scores. A prospective cohort study was conducted with 106 patients undergoing 12 weeks of CPMR who completed two exercise tests pre- and post-CPMR: 1) maximum incremental test (CPX) and 2) submaximal constant load test (SUB). After CPMR, the effects on MIR, EIA, NYHA functional class, and HRR during both tests were analyzed. There was a significant change in NYHA functional classes after CPMR, with 96% of the patients in class I (vs 62% pre-CPMR, P<0.0001), 4% in class II (vs 32%), and none in class III (vs 6%). There was a significant reduction in the frequency of EIA (P<0.05) and MIR (P<0.001) and a significantly improved performance on both CPX and SUB tests (P<0.0001). Lastly, there was significant progress in the recovery metrics like HRR (P<0.0001), the Borg CR10 (P<0.0001), and the SF-36 summary scores (P<0.0001). The CPMR resulted in a significant decrease in EIA, delayed ischemia threshold in CPX and SUB tests, increased functional capacity, and improved quality of life.
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Affiliation(s)
- C.A.C. Hossri
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
- Pneumologia-Incor, Instituto do Coração, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - B.G. Baldi
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
- Pneumologia-Incor, Instituto do Coração, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R. Otterstetter
- School of Exercise and Nutrition Sciences, University of Akron, Akron, OH, USA
| | - V.R. Uemoto
- Setor da Bioengenharia, Instituto Dante Pazzanese, São Paulo, SP, Brasil
| | - C.R.R. Carvalho
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
- Pneumologia-Incor, Instituto do Coração, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L.E. Mastrocola
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
| | - A.L.P. Albuquerque
- Hospital do Coração, Associação Beneficente Síria, São Paulo, SP, Brasil
- Pneumologia-Incor, Instituto do Coração, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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7
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Dies RM, Jackson CN, Flanagan CJ, Sinnathamby ES, Spillers NJ, Potharaju P, Singh N, Varrassi G, Ahmadzadeh S, Shekoohi S, Kaye AD. The Evolving Role of Vericiguat in Patients With Chronic Heart Failure. Cureus 2023; 15:e49782. [PMID: 38161537 PMCID: PMC10757766 DOI: 10.7759/cureus.49782] [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: 10/23/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Heart failure (HF) is a chronic and progressive clinical disorder characterized by an inability to pump sufficient blood to meet metabolic demands. It poses a substantial global healthcare burden, leading to high morbidity, mortality, and economic impact. Current treatments for HF include lifestyle modifications, guideline-directed medical therapies (GDMT), and device interventions, but the need for novel therapeutic approaches remains significant. The introduction of vericiguat, a soluble guanylate cyclase stimulator, has shown promise in improving outcomes for heart failure patients. Vericiguat addresses the underlying pathophysiological mechanisms of heart failure by augmenting the cyclic guanosine monophosphate (cGMP) pathway, leading to enhanced cardiac contractility and vasodilation. Clinical trials evaluating the efficacy and safety of vericiguat, such as the Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial, have demonstrated promising results. It has been shown that vericiguat, when added to standard therapy, reduces the risk of HF hospitalization and cardiovascular death in patients with symptomatic chronic HF with reduced ejection fraction (HFrEF). The addition of vericiguat to the current armamentarium of HF treatments provides clinicians with a novel therapeutic option to further optimize patient outcomes. Its potential benefits extend beyond symptom management, aiming to reduce hospitalizations and mortality rates associated with HF. As with any new treatment, the appropriate patient selection, monitoring, and management of potential adverse effects are essential. Further research is warranted to determine the long-term benefits, optimal dosing strategies, and potential combination therapies involving vericiguat. Its ability to target the cGMP pathway provides a unique mechanism of action, offering potential benefits in improving clinical outcomes for HF patients. Continued investigation and clinical experience will further elucidate the role of vericiguat in the management of HF and its overall impact on reducing the healthcare burden associated with this debilitating condition.
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Affiliation(s)
- Ross M Dies
- College of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Corrie N Jackson
- College of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Chelsi J Flanagan
- College of Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Evan S Sinnathamby
- College of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Noah J Spillers
- College of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Pooja Potharaju
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Naina Singh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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8
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Booth D, Davis JA, McEwan P, Solomon SD, McMurray JJV, De Boer RA, Comin-Colet J, Bachus E, Chen J. The cost-effectiveness of dapagliflozin in heart failure with preserved or mildly reduced ejection fraction: A European health-economic analysis of the DELIVER trial. Eur J Heart Fail 2023; 25:1386-1395. [PMID: 37344985 DOI: 10.1002/ejhf.2940] [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: 01/18/2023] [Revised: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023] Open
Abstract
AIMS To determine the cost-effectiveness of dapagliflozin, added to usual care, in patients with heart failure (HF) with mildly reduced or preserved ejection fraction for the UK, German and Spanish payers using detailed patient-level data from the Dapagliflozin Evaluation to Improve the LIVEs of Patients with Preserved Ejection Fraction Heart Failure (DELIVER) trial. METHODS AND RESULTS A lifetime Markov state-transition cohort model was developed. Quartiles of the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ-TSS) defined health states and monthly transition count data informed transition probabilities. Multivariable generalized estimating equations captured the incidence of HF hospitalizations and urgent HF visits, while cardiovascular deaths and all-cause mortality were estimated using adjusted parametric survival models. Health state costs were assigned to KCCQ-TSS quartiles (2021 British pound [GBP]/Euro) and patient-reported outcomes were sourced from DELIVER. Future values of costs and effects were discounted according to country-specific rates. In the UK, dapagliflozin treatment was predicted to increase quality-adjusted life years (QALYs) and life-years by 0.231 and 0.354, respectively, and extend the time spent in the best quartile of KCCQ-TSS by 4.2 months. Comparable outcomes were projected for Germany and Spain. The incremental cost-effectiveness ratios were £7761, €9540 and €5343/QALY in the UK, Germany and Spain, respectively. According to regional willingness-to-pay thresholds, 91%, 89% and 92% of simulations in the UK, Germany and Spain, respectively, were cost-effective following probabilistic sensitivity analyses. CONCLUSION Dapagliflozin, added to usual care, is very likely cost-effective for HF with mildly reduced or preserved ejection fraction in several European countries.
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Affiliation(s)
- David Booth
- Health Economics and Outcomes Research Ltd., Cardiff, UK
| | - Jason A Davis
- Health Economics and Outcomes Research Ltd., Cardiff, UK
| | - Phil McEwan
- Health Economics and Outcomes Research Ltd., Cardiff, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Rudolf A De Boer
- Erasmus Medical Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Josep Comin-Colet
- Cardiology Department, Bellvitge University Hospital (IDIBELL), University of Barcelona and CIBERCV, Barcelona, Spain
| | - Erasmus Bachus
- AstraZeneca R&D BioPharmaceuticals, One Medimmune Way, Gaithersburg, MD, USA
| | - Jieling Chen
- AstraZeneca R&D BioPharmaceuticals, One Medimmune Way, Gaithersburg, MD, USA
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9
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Zhou Y, Wang C, Che H, Cheng L, Zhu D, Rao C, Zhong Q, Li Z, Wang X, Wu Z, He K. Association between the triglyceride-glucose index and the risk of mortality among patients with chronic heart failure: results from a retrospective cohort study in China. Cardiovasc Diabetol 2023; 22:171. [PMID: 37420232 PMCID: PMC10329381 DOI: 10.1186/s12933-023-01895-4] [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: 05/16/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index has been demonstrated to be a reliable surrogate marker of insulin resistance (IR) and an effective predictive index of cardiovascular (CV) disease risk. However, its long-term prognostic value in patients with chronic heart failure (CHF) remains uncertain. METHODS A total of 6697 consecutive patients with CHF were enrolled in this study. Patients were divided into tertiles according to their TyG index. The incidence of primary outcomes, including all-cause death and CV death, was recorded. The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. RESULTS During a median follow-up of 3.9 years, a total of 2158 (32.2%) all-cause deaths and 1305 (19.5%) CV deaths were documented. The incidence of primary events from the lowest to the highest TyG index tertiles were 50.61, 64.64, and 92.25 per 1000 person-years for all-cause death and 29.05, 39.40, and 57.21 per 1000 person-years for CV death. The multivariate Cox hazards regression analysis revealed hazard ratios for all-cause and CV deaths of 1.84 (95% CI 1.61-2.10; P for trend < 0.001) and 1.94 (95% CI 1.63-2.30; P for trend < 0.001) when the highest and lowest TyG index tertiles were compared. In addition, the predictive ability of the TyG index against all-cause death was more prominent among patients with metabolic syndrome and those with heart failure with preserved ejection fraction phenotype (both P for interaction < 0.05). Furthermore, adding the TyG index to the established model for all-cause death improved the C‑statistic value (0.710 for the established model vs. 0.723 for the established model + TyG index, P < 0.01), the integrated discrimination improvement value (0.011, P < 0.01), the net reclassification improvement value (0.273, P < 0.01), and the clinical net benefit (probability range, 0.07-0.36). CONCLUSIONS The TyG index was significantly associated with the risk of mortality, suggesting that it may be a reliable and valuable predictor for risk stratification and an effective prognostic indicator in patients with CHF.
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Affiliation(s)
- You Zhou
- School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Chi Wang
- Medical Big Data Research Center, Medical Innovation Research Department of PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
- Chinese PLA General Hospital and Medical School, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hebin Che
- Medical Big Data Research Center, Medical Innovation Research Department of PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Liting Cheng
- School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Di Zhu
- Medical Big Data Research Center, Medical Innovation Research Department of PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
- Chinese PLA General Hospital and Medical School, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Chongyou Rao
- Medical Big Data Research Center, Medical Innovation Research Department of PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
- Chinese PLA General Hospital and Medical School, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Qin Zhong
- Medical Big Data Research Center, Medical Innovation Research Department of PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
- Chinese PLA General Hospital and Medical School, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zongren Li
- Medical Big Data Research Center, Medical Innovation Research Department of PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
- Chinese PLA General Hospital and Medical School, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiao Wang
- Medical Big Data Research Center, Medical Innovation Research Department of PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
- Chinese PLA General Hospital and Medical School, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zisheng Wu
- Chinese PLA General Hospital and Medical School, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Kunlun He
- School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, Tianjin, 300071, China.
- Medical Big Data Research Center, Medical Innovation Research Department of PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.
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10
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Sheng Y, Ma X, Liu Y, Yang X, Sun F. Study on the Efficacy of Sacubitril/Valsartan in Patients with Heart Failure with Preserved Ejection Fraction Undergoing Peritoneal Dialysis. Cardiology 2023; 148:385-394. [PMID: 37253340 DOI: 10.1159/000531217] [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: 12/06/2022] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Cardiovascular disease is the most common cause of death and morbidity in patients with end-stage renal disease. Sacubitril/valsartan (SAC/VAL) can reduce the risk of cardiovascular mortality among patients with heart failure (HF). The present study set out to evaluate the efficacy of SAC/VAL in the treatment of patients with HF with preserved ejection fraction (HFpEF) undergoing peritoneal dialysis (PD) (HFpEF&PD). METHODS A total of 160 patients with HFpEF&PD were enrolled and randomly divided into the control group (N = 80) and SAC/VAL group (N = 80). The cardiac function efficacy, HF scoring efficacy, echocardiographic parameters, serological indicators, and 6-minute walking test were compared before and after treatment. RESULTS After 6 months of treatment, the total number of patients who responded to treatment in the SAC/VAL group was higher than that of the control group in terms of cardiac function and HF scoring efficacy. After treatment, levels of early diastolic/late diastolic filling velocity and left ventricular ejection fraction were increased in both groups, while the levels of left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, inter-ventricular septal diameter, and left ventricular posterior wall diameter were decreased; the NT-proBNP levels were diminished in both groups, while hemoglobin levels and the 6-minute walk distance were increased; the systolic blood pressure, diastolic blood pressure, and 24-h ultrafiltration volume were lowered in all patients. The changes in these indexes in the SAC/VAL group were more obvious than those in the controls. CONCLUSION SAC/VAL can significantly improve cardiac function in patients with HFpEF&PD.
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Affiliation(s)
- Yuping Sheng
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
| | - Xiaoying Ma
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
| | - Ye Liu
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
| | - Xingmeng Yang
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
| | - Fuyun Sun
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou, China
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11
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Montero-Pérez-Barquero M, Escobar-Cervantes C, Llàcer P, Quirós-López R, Trullás JC, Cerqueiro JM, Epelde-Gonzálo F, Carrera-Izquierdo M, Formiga F, González-Franco A, Casado-Cerrada J. Projected clinical benefits of dapagliflozin in patients with heart failure with preserved ejection fraction. Future Cardiol 2023; 19:333-342. [PMID: 37382199 DOI: 10.2217/fca-2023-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Aims: To address the projected clinical benefits of dapagliflozin among patients with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF). Methods: A multicenter, prospective, cohort study of patients ≥50 years admitted with HF to Spanish internal medicine departments. The projected clinical benefits of dapagliflozin were calculated from the DELIVER trial. Results: A total of 4049 patients were included; 3271 (80.8%) were eligible for dapagliflozin treatment, according to DELIVER criteria. Within 1 year after discharge, 22.2% were rehospitalized for HF and 21.6% died. Implementation of dapagliflozin would translate into an absolute risk reduction of 1.3% for mortality and 5.1% for HF readmission. Conclusion: HF patients with preserved or mildly reduced ejection fraction have a high risk of events. The use of dapagliflozin could substantially reduce the HF burden.
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Affiliation(s)
| | | | - Pau Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, 28034, Madrid, Spain
| | - Raúl Quirós-López
- Servicio de Medicina Interna, Hospital de la Costa del Sol, Marbella, 29603, Málaga, Spain
| | - Joan C Trullás
- Internal Medicine Department, Hospital d'Olot, Tissue Repair & Regeneration Laboratory (TR2Lab), Universitat Central de Catalunya, Vic, 17800, Barcelona, Spain
| | - Jose M Cerqueiro
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, 27003, Lugo, Spain
| | | | | | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | - Alvaro González-Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, 33011, Oviedo, Spain
| | - Jesús Casado-Cerrada
- Internal Medicine Department, University Hospital of Getafe, 28905, Madrid, Spain
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12
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Ong SC, Low JZ, Yew WY, Yen CH, Abdul Kader MASK, Liew HB, Abdul Ghapar AK. Cost analysis of chronic heart failure management in Malaysia: A multi-centred retrospective study. Front Cardiovasc Med 2022; 9:971592. [PMID: 36407426 PMCID: PMC9666382 DOI: 10.3389/fcvm.2022.971592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Background Estimation of the economic burden of heart failure (HF) through a complete evaluation is essential for improved treatment planning in the future. This estimation also helps in reimbursement decisions for newer HF treatments. This study aims to estimate the cost of HF treatment in Malaysia from the Ministry of Health’s perspective. Materials and methods A prevalence-based, bottom-up cost analysis study was conducted in three tertiary hospitals in Malaysia. Chronic HF patients who received treatment between 1 January 2016 and 31 December 2018 were included in the study. The direct cost of HF was estimated from the patients’ healthcare resource utilisation throughout a one-year follow-up period extracted from patients’ medical records. The total costs consisted of outpatient, hospitalisation, medications, laboratory tests and procedure costs, categorised according to ejection fraction (EF) and the New York Heart Association (NYHA) functional classification. Results A total of 329 patients were included in the study. The mean ± standard deviation of total cost per HF patient per-year (PPPY) was USD 1,971 ± USD 1,255, of which inpatient cost accounted for 74.7% of the total cost. Medication costs (42.0%) and procedure cost (40.8%) contributed to the largest proportion of outpatient and inpatient costs. HF patients with preserved EF had the highest mean total cost of PPPY, at USD 2,410 ± USD 1,226. The mean cost PPPY of NYHA class II was USD 2,044 ± USD 1,528, the highest among all the functional classes. Patients with underlying coronary artery disease had the highest mean total cost, at USD 2,438 ± USD 1,456, compared to other comorbidities. HF patients receiving angiotensin-receptor neprilysin-inhibitor (ARNi) had significantly higher total cost of HF PPPY in comparison to patients without ARNi consumption (USD 2,439 vs. USD 1,933, p < 0.001). Hospitalisation, percutaneous coronary intervention, coronary angiogram, and comorbidities were the cost predictors of HF. Conclusion Inpatient cost was the main driver of healthcare cost for HF. Efficient strategies for preventing HF-related hospitalisation and improving HF management may potentially reduce the healthcare cost for HF treatment in Malaysia.
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Affiliation(s)
- Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinag, Malaysia
- *Correspondence: Siew Chin Ong, ,
| | - Joo Zheng Low
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinag, Malaysia
- Hospital Sultan Ismail Petra, Ministry of Health, Kelantan, Malaysia
| | - Wing Yee Yew
- Hospital Queen Elizabeth, Ministry of Health, Sabah, Malaysia
| | - Chia How Yen
- Institute for Clinical Research, National Institute of Health, Ministry of Health, Selangor, Malaysia
- Clinical Research Centre Hospital Queen Elizabeth II, Ministry of Health, Sabah, Malaysia
| | | | - Houng Bang Liew
- Hospital Queen Elizabeth II, Ministry of Health, Sabah, Malaysia
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13
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Lee D, Chang T, Chang S, Lin Y, Lo L, Hu Y, Chung F, Tuan T, Chao T, Liao J, Lin C, Kuo L, Liu C, Chen S. Clinical outcomes and structural remodelling after ablation of atrial fibrillation in heart failure with mildly reduced or mid-range ejection fraction. ESC Heart Fail 2022; 10:177-188. [PMID: 36178105 PMCID: PMC9871718 DOI: 10.1002/ehf2.14178] [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: 06/22/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS The efficacy of catheter ablation (CA) on clinical outcomes and cardiac structural remodelling in atrial fibrillation (AF) patients with HF with mildly reduced or mid-range ejection fraction (HFmrEF) remains unclear. We aimed to compare the efficacy of CA with medical therapy (MT) in AF patients with HFmrEF. METHODS AND RESULTS We retrospectively screened a total of 36 879 patients with AF between 2005 and 2020. Patients who were initially diagnosed with echocardiography-proved HFmrEF and had follow-up echocardiography were enrolled. After applying propensity score matching in a 1:1 ratio, 72 patients treated by CA (Group 1) and 72 patients receiving MT (Group 2) were taken into further analysis. The co-morbidities were similar between the two groups, except for hyperlipidaemia. After a mean follow-up duration of 58.9 ± 42.6 months, Group 1 had a lower HF hospitalization and all-cause mortality compared with Group 2 (hazard ratio (HR), 0.089 [95% confidence interval (CI), 0.011-0.747]; P = 0.026 and HR, 0.121 [95% CI, 0.016-0.894]; P = 0.038, respectively). As for cardiac structural remodelling, the Group 1 had a better improvement in left ventricular ejection fraction (LVEF) and a more decreased left atrium (LA) diameter than Group 2 (+25.0% ± 18.0% vs. +6.2% ± 21.6%, P = <0.0001 and -1.6 ± 4.7 mm vs. +1.5 ± 8.2 mm, P = 0.008, respectively). CONCLUSIONS In patients with HFmrEF and AF, CA of AF could reduce both HF hospitalization and all-cause mortality as compared with those with MT. A significant improvement in LVEF and decrease in LA diameter were also observed in the CA group. Early rhythm control with CA should be taken into consideration in patients with HFmrEF and AF.
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Affiliation(s)
- Dan‐Ying Lee
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ting‐Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,National Taipei University of Nursing and Health SciencesTaipeiTaiwan
| | - Shih‐Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yenn‐Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Li‐Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yu‐Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Fa‐Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ta‐Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Tze‐Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Jo‐Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chin‐Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chih‐Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Shih‐Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Cardiovascular CenterTaichung Veterans General HospitalTaichungTaiwan
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14
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Shi Y, Liu J, Liu C, Shuang X, Yang C, Qiao W, Dong G. Diagnostic and prognostic value of serum soluble suppression of tumorigenicity-2 in heart failure with preserved ejection fraction: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:937291. [PMID: 36204571 PMCID: PMC9530661 DOI: 10.3389/fcvm.2022.937291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Heart failure (HF) with preserved ejection fraction (HFpEF) is a growing public health burden, with mortality and rehospitalization rates comparable to HF with reduced ejection fraction (HFrEF). The evidence for the clinical usefulness of soluble suppression of tumorigenicity 2 (sST2) in HFpEF is contradictory. Therefore, we conducted the following systematic review and meta-analysis to assess the diagnostic and prognostic value of serum sST2 in HFpEF. Methods PubMed and Scopus were searched exhaustively from their inception until March 15, 2022. In diagnostic analysis, we compared the diagnostic value of serum sST2 in HFpEF to NT pro-BNP. We separately pooled the unadjusted and multivariate-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) in prognostic analysis. Results A total of 16 publications from 2008 to 2021 were examined. The results of this analysis were as follow: Firstly, compared with NT pro-BNP, sST2 obtains poor diagnostic performance in independently identifying HFpEF from healthy controls, hypertensive patients, and HFrEF patient. Nevertheless, it may provide incremental value to other biomarkers for diagnosing HFpEF and deserves further investigation. Secondly, log sST2 was independently associated with adverse endpoints on multivariable analysis after adjusting for variables such as age, sex, race, and NYHA class. Per log unit rise in sST2, there was a 2.76-fold increased risk of all-cause death [HR:2.76; 95% CI (1.24, 6.16); p = 0.516, I2 = 0%; P = 0.013] and a 6.52-fold increased risk in the composite endpoint of all-cause death and HF hospitalization [HR:6.52; 95% CI (2.34, 18.19); p = 0.985, I2 = 0%; P = 0.000]. Finally, the optimal threshold levels of serum sST2 need further determined. Conclusions Higher sST2 was strongly linked to an increased risk of adverse outcomes in HFpEE. Especially, log sST2 independently predicted all-cause death and the composite endpoint of all-cause death and HF hospitalization. However, prospective and multicenter studies with large-sample and extended follow-up periods are required to validate our results due to limitations in our research.
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Affiliation(s)
- Yujiao Shi
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Jiangang Liu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Chunqiu Liu
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Xiong Shuang
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Chenguang Yang
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Wenbo Qiao
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Guoju Dong
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
- Department of Cardiovascular Internal Medicine, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
- *Correspondence: Guoju Dong
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15
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Escobar C, Palacios B, Varela L, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain. J Clin Med 2022; 11:5199. [PMID: 36079133 PMCID: PMC9456780 DOI: 10.3390/jcm11175199] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To estimate the prevalence, incidence, and describe the characteristics and management of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. Methods: Adults with ≥1 inpatient or outpatient HF diagnosis between 1 January 2013 and 30 September 2019 were identified through the BIG-PAC database. Annual incidence and prevalence by EF phenotype were estimated. Characteristics by EF phenotype were described in the 2016 and 2019 HF prevalent cohorts and outcomes in the 2016 HF prevalent cohort. Results: Overall, HF incidence and prevalence were 0.32/100 person-years and 2.34%, respectively, but increased every year. In 2019, 49.3% had HFrEF, 38.1% had HFpEF, and 4.3% had HFmrEF (in 8.3%, EF was not available). Compared with HFrEF, patients with HFpEF were largely female, older, and had more atrial fibrillation but less atherosclerotic cardiovascular disease. Among patients with HFrEF, 76.3% were taking renin-angiotensin system inhibitors, 69.5% beta-blockers, 36.8% aldosterone antagonists, 12.5% sacubitril/valsartan and 6.7% SGLT2 inhibitors. Patients with HFpEF and HFmrEF took fewer HF drugs compared to HFrEF. Overall, the event rates of HF hospitalization were 231.6/1000 person-years, which is more common in HFrEF patients. No clinically relevant differences were found in patients with HFpEF, regardless EF (50- < 60% vs. ≥60%). Conclusions: >2% of patients have HF, of which around 50% have HFrEF and 40% have HFpEF. The prevalence of HF is increasing over time. Clinical characteristics by EF phenotype are consistent with previous studies. The risk of outcomes, particularly HF hospitalization, remains high, likely related to insufficient HF treatment.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | | | - Luis Varela
- AstraZeneca Farmaceutica, 28033 Madrid, Spain
| | | | | | | | - Nahila Justo
- Evidera, 113 21 Stockholm, Sweden
- Karolinska Institute, Department of Neurobiology, Care Sciences, and Society, 171 77 Stockholm, Sweden
| | | | | | | | - Juan F. Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, 28041 Madrid, Spain
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16
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Stevens TW, Khalaf FK, Soehnlen S, Hegde P, Storm K, Meenakshisundaram C, Dworkin LD, Malhotra D, Haller ST, Kennedy DJ, Dube P. Dirty Jobs: Macrophages at the Heart of Cardiovascular Disease. Biomedicines 2022; 10:1579. [PMID: 35884884 PMCID: PMC9312498 DOI: 10.3390/biomedicines10071579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular disease (CVD) is one of the greatest public health concerns and is the leading cause of morbidity and mortality in the United States and worldwide. CVD is a broad yet complex term referring to numerous heart and vascular conditions, all with varying pathologies. Macrophages are one of the key factors in the development of these conditions. Macrophages play diverse roles in the maintenance of cardiovascular homeostasis, and an imbalance of these mechanisms contributes to the development of CVD. In the current review, we provide an in-depth analysis of the diversity of macrophages, their roles in maintaining tissue homeostasis within the heart and vasculature, and the mechanisms through which imbalances in homeostasis may lead to CVD. Through this review, we aim to highlight the potential importance of macrophages in the identification of preventative, diagnostic, and therapeutic strategies for patients with CVD.
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Affiliation(s)
- Travis W. Stevens
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
| | - Fatimah K. Khalaf
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
- Department of Clinical Pharmacy, University of Alkafeel, Najaf 54001, Iraq
| | - Sophia Soehnlen
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
| | - Prajwal Hegde
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
| | - Kyle Storm
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
| | - Chandramohan Meenakshisundaram
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
| | - Lance D. Dworkin
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
| | - Deepak Malhotra
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
| | - Steven T. Haller
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
| | - David J. Kennedy
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
| | - Prabhatchandra Dube
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA; (T.W.S.); (F.K.K.); (S.S.); (P.H.); (K.S.); (C.M.); (L.D.D.); (D.M.); (S.T.H.)
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17
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Deschaine B, Verma S, Rayatzadeh H. Clinical Evidence and Proposed Mechanisms of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure with Preserved Ejection Fraction: A Class Effect? Card Fail Rev 2022; 8:e23. [PMID: 35846984 PMCID: PMC9272408 DOI: 10.15420/cfr.2022.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/22/2022] [Indexed: 11/04/2022] Open
Abstract
Effective treatment for heart failure with preserved ejection fraction (HFpEF) is an unmet need in cardiovascular medicine. The pathophysiological drivers of HFpEF are complex, differing depending on phenotype, making a one-size-fits-all treatment approach unlikely. Remarkably, sodium-glucose cotransporter 2 inhibitors (SGLT2is) may be the first drug class to improve cardiovascular outcomes in HFpEF. Randomised controlled trials suggest a benefit in mortality, and demonstrate decreased hospitalisations and improvement in functional status. Limitations in trials exist, either due to small sample sizes, differing results between trials or decreased efficacy at higher ejection fractions. SGLT2is may provide a class effect by targeting various pathophysiological HFpEF mechanisms. Inhibition of SGLT2 and Na+/H+ exchanger 3 in the kidney promotes glycosuria, osmotic diuresis and natriuresis. The glucose deprivation activates sirtuins - protecting against oxidation and beneficially regulating metabolism. SGLT2is reduce excess epicardial adipose tissue and its deleterious adipokines. Na+/H+ exchanger 1 inhibition in the heart and lungs reduces sodium-induced calcium overload and pulmonary hypertension, respectively.
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Affiliation(s)
- Brent Deschaine
- University of Florida College of Medicine Gainesville, FL, US
| | - Sahil Verma
- Florida State University College of Medicine Tallahassee, FL, US
| | - Hussein Rayatzadeh
- Florida State University College of Medicine Tallahassee, FL, US.,Tallahassee Research Institute Tallahassee, FL, US.,Southern Medical Group Tallahassee, FL, US
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18
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Alkhodari M, Jelinek HF, Karlas A, Soulaidopoulos S, Arsenos P, Doundoulakis I, Gatzoulis KA, Tsioufis K, Hadjileontiadis LJ, Khandoker AH. Deep Learning Predicts Heart Failure With Preserved, Mid-Range, and Reduced Left Ventricular Ejection Fraction From Patient Clinical Profiles. Front Cardiovasc Med 2021; 8:755968. [PMID: 34881307 PMCID: PMC8645593 DOI: 10.3389/fcvm.2021.755968] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Left ventricular ejection fraction (LVEF) is the gold standard for evaluating heart failure (HF) in coronary artery disease (CAD) patients. It is an essential metric in categorizing HF patients as preserved (HFpEF), mid-range (HFmEF), and reduced (HFrEF) ejection fraction but differs, depending on whether the ASE/EACVI or ESC guidelines are used to classify HF. Objectives: We sought to investigate the effectiveness of using deep learning as an automated tool to predict LVEF from patient clinical profiles using regression and classification trained models. We further investigate the effect of utilizing other LVEF-based thresholds to examine the discrimination ability of deep learning between HF categories grouped with narrower ranges. Methods: Data from 303 CAD patients were obtained from American and Greek patient databases and categorized based on the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) guidelines into HFpEF (EF > 55%), HFmEF (50% ≤ EF ≤ 55%), and HFrEF (EF < 50%). Clinical profiles included 13 demographical and clinical markers grouped as cardiovascular risk factors, medication, and history. The most significant and important markers were determined using linear regression fitting and Chi-squared test combined with a novel dimensionality reduction algorithm based on arc radial visualization (ArcViz). Two deep learning-based models were then developed and trained using convolutional neural networks (CNN) to estimate LVEF levels from the clinical information and for classification into one of three LVEF-based HF categories. Results: A total of seven clinical markers were found important for discriminating between the three HF categories. Using statistical analysis, diabetes, diuretics medication, and prior myocardial infarction were found statistically significant (p < 0.001). Furthermore, age, body mass index (BMI), anti-arrhythmics medication, and previous ventricular tachycardia were found important after projections on the ArcViz convex hull with an average nearest centroid (NC) accuracy of 94%. The regression model estimated LVEF levels successfully with an overall accuracy of 90%, average root mean square error (RMSE) of 4.13, and correlation coefficient of 0.85. A significant improvement was then obtained with the classification model, which predicted HF categories with an accuracy ≥93%, sensitivity ≥89%, 1-specificity <5%, and average area under the receiver operating characteristics curve (AUROC) of 0.98. Conclusions: Our study suggests the potential of implementing deep learning-based models clinically to ensure faster, yet accurate, automatic prediction of HF based on the ASE/EACVI LVEF guidelines with only clinical profiles and corresponding information as input to the models. Invasive, expensive, and time-consuming clinical testing could thus be avoided, enabling reduced stress in patients and simpler triage for further intervention.
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Affiliation(s)
- Mohanad Alkhodari
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Biomedical Engineering, Biotechnology Center (BTC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Angelos Karlas
- Chair of Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Department for Vascular and Endovascular Surgery, Rechts der Isar University Hospital, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Stergios Soulaidopoulos
- First Cardiology Department, School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Arsenos
- First Cardiology Department, School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Doundoulakis
- First Cardiology Department, School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos A Gatzoulis
- First Cardiology Department, School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Department, School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Leontios J Hadjileontiadis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Electrical Engineering and Computer Science, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ahsan H Khandoker
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
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