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Kim NY, Im DJ, Hong YJ, Choi BW, Kang SM, Youn JC, Lee HJ. Feasibility of the Threshold-Based Quantification of Myocardial Fibrosis on Cardiac CT as a Prognostic Marker in Nonischemic Dilated Cardiomyopathy. Korean J Radiol 2024; 25:540-549. [PMID: 38807335 PMCID: PMC11136943 DOI: 10.3348/kjr.2023.1271] [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: 12/21/2023] [Revised: 02/26/2024] [Accepted: 03/22/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE This study investigated the feasibility and prognostic relevance of threshold-based quantification of myocardial delayed enhancement (MDE) on CT in patients with nonischemic dilated cardiomyopathy (NIDCM). MATERIALS AND METHODS Forty-three patients with NIDCM (59.3 ± 17.1 years; 21 male) were included in the study and underwent cardiac CT and MRI. MDE was quantified manually and with a threshold-based quantification method using cutoffs of 2, 3, and 4 standard deviations (SDs) on three sets of CT images (100 kVp, 120 kVp, and 70 keV). Interobserver agreement in MDE quantification was assessed using the intraclass correlation coefficient (ICC). Agreement between CT and MRI was evaluated using the Bland-Altman method and the concordance correlation coefficient (CCC). Patients were followed up for the subsequent occurrence of the primary composite outcome, including cardiac death, heart transplantation, heart failure hospitalization, or appropriate use of an implantable cardioverter-defibrillator. The Kaplan-Meier method was used to estimate event-free survival according to MDE levels. RESULTS Late gadolinium enhancement (LGE) was observed in 29 patients (67%, 29/43), and the mean LGE found with the 5-SD threshold was 4.1% ± 3.6%. The 4-SD threshold on 70-keV CT showed excellent interobserver agreement (ICC = 0.810) and the highest concordance with MRI (CCC = 0.803). This method also yielded the smallest bias with the narrowest range of 95% limits of agreement compared to MRI (bias, -0.119%; 95% limits of agreement, -4.216% to 3.978%). During a median follow-up of 1625 days (interquartile range, 712-1430 days), 10 patients (23%, 10/43) experienced the primary composite outcome. Event-free survival significantly differed between risk subgroups divided by the optimal MDE cutoff of 4.3% (log-rank P = 0.005). CONCLUSION The 4-SD threshold on 70-keV monochromatic CT yielded results comparable to those of MRI for quantifying MDE as a marker of myocardial fibrosis, which showed prognostic value in patients with NIDCM.
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Affiliation(s)
- Na Young Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Li Y, Zhu F, Ren D, Tong J, Xu Q, Zhong M, Zhao W, Duan X, Xu X. Establishment of in-hospital nutrition support program for middle-aged and elderly patients with acute decompendated heart failure. BMC Cardiovasc Disord 2024; 24:259. [PMID: 38762515 PMCID: PMC11102219 DOI: 10.1186/s12872-024-03887-y] [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: 01/12/2024] [Accepted: 04/11/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVE To construct a nutrition support program for middle-aged and elderly patients with acute decompensated heart failure (ADHF) during hospitalization. METHODS Based on the JBI Evidence-Based Health Care Model as the theoretical framework, the best evidence was extracted through literature analysis and a preliminary nutrition support plan for middle-aged and elderly ADHF patients during hospitalization was formed. Two rounds of expert opinion consultation were conducted using the Delphi method. The indicators were modified, supplemented and reduced according to the expert's scoring and feedback, and the expert scoring was calculated. RESULTS The response rates of the experts in the two rounds of consultation were 86.7% and 100%, respectively, and the coefficient of variation (CV) for each round was between 0.00% and 29.67% (all < 0.25). In the first round of expert consultation, 4 items were modified, 3 items were deleted, and 3 items were added. In the second round of the expert consultation, one item was deleted and one item was modified. Through two rounds of expert consultation, expert consensus was reached and a nutrition support plan for ADHF patients was finally formed, including 4 first-level indicators, 7 s-level indicators, and 24 third-level indicators. CONCLUSION The nutrition support program constructed in this study for middle-aged and elderly ADHF patients during hospitalization is authoritative, scientific and practical, and provides a theoretical basis for clinical development of nutrition support program for middle-aged and elderly ADHF patients during hospitalization.
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Affiliation(s)
- Yongliang Li
- CCU, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, 201800, China
| | - Fang Zhu
- CCU, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, 201800, China
| | - Dongmei Ren
- Department of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, 201800, China
| | - Jianping Tong
- Department of Cardiovascular Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, 201204, China
| | - Qin Xu
- Department of Emergency, Jiad-ing District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, Shanghai, 201800, China
| | - Minhui Zhong
- Department of Nursing, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Wei Zhao
- Suzhou Science & Technology Town Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Xia Duan
- Department of Nursing, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Xiangdong Xu
- Department of Cardiovascular Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, 201204, China.
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Cho DH, Park SM. Epicardial Adipose Tissue and Heart Failure, Friend or Foe? Diabetes Metab J 2024; 48:373-384. [PMID: 38310880 PMCID: PMC11140396 DOI: 10.4093/dmj.2023.0190] [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: 06/20/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024] Open
Abstract
Heart failure (HF) management guidelines recommend individualized assessments based on HF phenotypes. Adiposity is a known risk factor for HF. Recently, there has been an increased interest in organ-specific adiposity, specifically the role of the epicardial adipose tissue (EAT), in HF risk. EAT is easily assessable through various imaging modalities and is anatomically and functionally connected to the myocardium. In pathological conditions, EAT secretes inflammatory cytokines, releases excessive fatty acids, and increases mechanical load on the myocardium, resulting in myocardial remodeling. EAT plays a pathophysiological role in characterizing both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). In HFrEF, EAT volume is reduced, reflecting an impaired metabolic reservoir, whereas in HFpEF, the amount of EAT is associated with worse biomarker and hemodynamic profiles, indicating increased EAT activity. Studies have examined the possibility of therapeutically targeting EAT, and recent studies using sodium glucose cotransporter 2 inhibitors have shown potential in reducing EAT volume. However, further research is required to determine the clinical implications of reducing EAT activity in patients with HF.
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Affiliation(s)
- Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Yoon M, Lee S, Choi JY, Jung MH, Youn JC, Shim CY, Choi JO, Kim EJ, Kim H, Yoo BS, Son YJ, Choi DJ. Effectiveness of a Smartphone App-Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial. J Med Internet Res 2024; 26:e52075. [PMID: 38683665 PMCID: PMC11091801 DOI: 10.2196/52075] [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: 08/22/2023] [Revised: 11/07/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. OBJECTIVE We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app-based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. METHODS In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. RESULTS At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean -1.3, SD 2.1 vs mean -0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. CONCLUSIONS The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app-based self-care strategies and feedback for patients with HF. TRIAL REGISTRATION ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000.
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Affiliation(s)
- Minjae Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seognam, Republic of Korea
| | - Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Oh Choi
- Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Woonju, Republic of Korea
| | - Yeon Joo Son
- Healthcare Business Department, AI/DX Convergence Business Group, KT, Seoul, Republic of Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seognam, Republic of Korea
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Rosano GM, Vitale C, Spoletini I. Precision Cardiology: Phenotype-targeted Therapies for HFmrEF and HFpEF. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:47-55. [PMID: 38694928 PMCID: PMC11058434 DOI: 10.36628/ijhf.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 05/04/2024]
Abstract
Heart failure with mid-range ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) represent over half of heart failure cases but lack proven effective therapies beyond sodium-glucose cotransporter 2 inhibitor and diuretics. HFmrEF and HFpEF are heterogeneous conditions requiring precision phenotyping to enable tailored therapies. This review covers concepts on precision medicine approaches for HFmrEF and HFpEF. Areas discussed include HFmrEF mechanisms, anti-inflammatory and antifibrotic treatments for obesity-related HFpEF, If inhibition for HFpEF with atrial fibrillation, and mineralocorticoid receptor antagonism for chronic kidney disease-HFpEF. Incorporating precision phenotyping and matched interventions in HFmrEF and HFpEF trials will further advance therapy compared to blanket approaches.
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Affiliation(s)
- Giuseppe M.C. Rosano
- Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy
- Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
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Yoon M, Kim EJ, Han SW, Park SM, Kim IC, Cho MC, Ahn HS, Shin MS, Hwang SJ, Jeong JO, Yang DH, Kim JJ, Choi JO, Cho HJ, Yoo BS, Kang SM, Choi DJ. The Third Nationwide Korean Heart Failure III Registry (KorHF III): The Study Design Paper. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:70-75. [PMID: 38694931 PMCID: PMC11058439 DOI: 10.36628/ijhf.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/06/2024] [Accepted: 03/22/2024] [Indexed: 05/04/2024]
Abstract
With advancements in both pharmacologic and non-pharmacologic treatments, significant changes have occurred in heart failure (HF) management. The previous Korean HF registries, namely the Korea Heart Failure Registry (KorHF-registry) and Korean Acute Heart Failure Registry (KorAHF-registry), no longer accurately reflect contemporary acute heart failure (AHF) patients. Our objective is to assess contemporary AHF patients through a nationwide registry encompassing various aspects, such as clinical characteristics, management approaches, hospital course, and long-term outcomes of individuals hospitalized for AHF in Korea. This prospective observational multicenter cohort study (KorHF III) is organized by the Korean Society of Heart Failure. We aim to prospectively enroll 7,000 or more patients hospitalized for AHF at 47 tertiary hospitals in Korea starting from March 2018. Eligible patients exhibit signs and symptoms of HF and demonstrate either lung congestion or objective evidence of structural or functional cardiac abnormalities in echocardiography, or isolated right-sided HF. Patients will be followed up for up to 5 years after enrollment in the registry to evaluate long-term clinical outcomes. KorHF III represents the nationwide AHF registry that will elucidate the clinical characteristics, management strategies, and outcomes of contemporary AHF patients in Korea. Trial Registration ClinicalTrials.gov Identifier: NCT04329234.
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Affiliation(s)
- Minjae Yoon
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Seong Woo Han
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Keimyung University, Dongsan Hospital, Daegu, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Hyo-Suk Ahn
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seok Jae Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Dong Heon Yang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Oh Choi
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Yoon M, Park JJ, Hur T, Hua CH, Hussain M, Lee S, Choi DJ. Application and Potential of Artificial Intelligence in Heart Failure: Past, Present, and Future. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:11-19. [PMID: 38303917 PMCID: PMC10827704 DOI: 10.36628/ijhf.2023.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 02/03/2024]
Abstract
The prevalence of heart failure (HF) is increasing, necessitating accurate diagnosis and tailored treatment. The accumulation of clinical information from patients with HF generates big data, which poses challenges for traditional analytical methods. To address this, big data approaches and artificial intelligence (AI) have been developed that can effectively predict future observations and outcomes, enabling precise diagnoses and personalized treatments of patients with HF. Machine learning (ML) is a subfield of AI that allows computers to analyze data, find patterns, and make predictions without explicit instructions. ML can be supervised, unsupervised, or semi-supervised. Deep learning is a branch of ML that uses artificial neural networks with multiple layers to find complex patterns. These AI technologies have shown significant potential in various aspects of HF research, including diagnosis, outcome prediction, classification of HF phenotypes, and optimization of treatment strategies. In addition, integrating multiple data sources, such as electrocardiography, electronic health records, and imaging data, can enhance the diagnostic accuracy of AI algorithms. Currently, wearable devices and remote monitoring aided by AI enable the earlier detection of HF and improved patient care. This review focuses on the rationale behind utilizing AI in HF and explores its various applications.
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Affiliation(s)
- Minjae Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Joo Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Taeho Hur
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Computer Science and Engineering, Kyung Hee University, Yongin, Korea
| | - Cam-Hao Hua
- Department of Computer Science and Engineering, Kyung Hee University, Yongin, Korea
| | - Musarrat Hussain
- Department of Computer Science and Engineering, Kyung Hee University, Yongin, Korea
| | - Sungyoung Lee
- Department of Computer Science and Engineering, Kyung Hee University, Yongin, Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Park HK, Park JS, Kim MS, Lee E, Choi H, Park YJ, Park BE, Kim HN, Kim N, Bae MH, Lee JH, Park HS, Cho Y, Jang SY, Yang DH. Long-term impact of angiotensin receptor-neprilysin inhibitor based on short-term treatment response in heart failure. ESC Heart Fail 2023; 10:3430-3437. [PMID: 37705397 PMCID: PMC10682893 DOI: 10.1002/ehf2.14505] [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: 05/02/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023] Open
Abstract
AIMS The long-term effect of angiotensin receptor-neprilysin inhibitor (ARNI) remains uncertain in patients who have experienced improvements in left ventricular (LV) systolic function or significant LV reverse remodelling following a certain period of treatment. It is also unclear how ARNI performs in patients who have not shown these improvements. This study aimed to assess the impact of prolonged ARNI use compared with angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) in patients with and without significant treatment response after 1 year of heart failure (HF) treatment. METHODS AND RESULTS The present study enrolled patients with HF with reduced ejection fraction (HFrEF) who were treated with either ARNI or ACEIs/ARBs within 1 year of undergoing index echocardiography. After 1 year of treatment, patients were reclassified into the following groups: (i) patients with HF with improved ejection fraction and persistent HFrEF and (ii) patients with and without LV reverse remodelling based on the follow-up echocardiography. The effect of ARNI versus that of ACEIs/ARBs in each group was assessed from the time of categorizing into new groups using the composite event of all-cause mortality and HF hospitalization. A total of 671 patients with HFrEF (age, 66.4 ± 14.1 years; males, 66.8%) were included, and 133 (19.8%) composite events of death and rehospitalization for HF were observed during the follow-up (median follow-up, 44 [interquartile range, 34-51] months). ARNI had a significantly lower event rate than ACEIs/ARBs in patients with HF with improved ejection fraction (7.0% vs. 30.4%, P = 0.020) and those with persistent HFrEF (17.6% vs. 49.7%, P < 0.001). Irrespective of whether patients exhibited LV reverse remodelling (15.8% vs. 31.1%, P = 0.001) or not (15.0% vs. 54.9%, P < 0.001), ARNIs were associated with a significantly lower event rate than ACEIs/ARBs. CONCLUSIONS Regardless of significant treatment response measured by either LVEF or LV reverse remodelling after 1 year of treatment, the extended utilization of ARNI demonstrated a more favourable prognosis than that of ACEIs/ARBs in patients with HFrEF.
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Affiliation(s)
- Hyuk Kyoon Park
- Department of Internal MedicineDaegu Fatima HospitalDaeguRepublic of Korea
| | - Jong Sung Park
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
| | - Myeong Seop Kim
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
| | - Eunkyu Lee
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
| | - Hyohun Choi
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
| | - Yoon Jung Park
- Department of Internal MedicineKyungpook National University Chilgok HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Bo Eun Park
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Hong Nyun Kim
- Department of Internal MedicineKyungpook National University Chilgok HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Namkyun Kim
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Myung Hwan Bae
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Jang Hoon Lee
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Hun Sik Park
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Yongkeun Cho
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Se Yong Jang
- Department of Internal MedicineKyungpook National University Chilgok HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Dong Heon Yang
- Department of Internal MedicineKyungpook National University HospitalDaeguRepublic of Korea
- Department of Internal MedicineKyungpook National University Chilgok HospitalDaeguRepublic of Korea
- School of MedicineKyungpook National UniversityDaeguRepublic of Korea
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9
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Bak M, Choi JO. Optimization of guideline-directed medical treatment for heart failure patients with reduced ejection fraction. Korean J Intern Med 2023; 38:595-606. [PMID: 37680097 PMCID: PMC10493440 DOI: 10.3904/kjim.2023.223] [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: 05/18/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
With the increasing number of medications demonstrating mortality benefits in heart failure with reduced ejection fraction (HFrEF), the pharmacological treatment of HFrEF is entering a new phase. To enhance outcomes in heart failure patients through medical treatment, the choice of appropriate medications and simultaneous and rapid uptitration are critical. However, there are several challenges encountered during this medication uptitration, including issues like hypotension, fatigue, worsening renal function, and hyperkalemia. This paper addresses strategies for effectively managing these challenges to successfully reach the maximum tolerated dose in patients. Additionally, it will discuss the management of comorbidities often associated with heart failure, the importance of exercise and rehabilitation, and the significance of proper nutrition intake, in addition to guideline-directed medical therapy.
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Affiliation(s)
- Minjung Bak
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Hyun J. Association of Blood Pressure and Prognosis of Heart Failure With Systolic Dysfunction: A Myth That Should Be Solved. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:146-147. [PMID: 37554690 PMCID: PMC10406560 DOI: 10.36628/ijhf.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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