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- Title
Unfavourable outcomes in patients with heart failure with higher preserved left ventricular ejection fraction.
- Authors
Ohte, Nobuyuki; Kikuchi, Shohei; Iwahashi, Noriaki; Kinugasa, Yoshiharu; Dohi, Kaoru; Takase, Hiroyuki; Masai, Kumiko; Inoue, Katsuji; Okumura, Takahiro; Hachiya, Kenta; Kitada, Shuichi; Seo, Yoshihiro; Investigators, EASY HFpEF
- Abstract
Aims Newly introduced drugs for heart failure (HF) have been reported to improve the prognosis of HF with preserved ejection fraction (HFpEF) in the lower range of left ventricular ejection fraction (LVEF). We hypothesized that a higher LVEF is related to an unfavourable prognosis in patients with HFpEF. Methods and results We tested this hypothesis by analysing the data from a prospective multicentre cohort study in 255 patients admitted to the hospital due to decompensated HF (LVEF > 40% at discharge). The primary endpoint of this study was a composite outcome of all-cause death and readmission due to HF, and the secondary endpoint was readmission due to HF. LVEF and the mitral E / e ′ ratio were measured using echocardiography. In multicovariate parametric survival time analysis, LVEF [hazard ratio (HR) = 1.046 per 1% increase, P = 0.001], concurrent atrial fibrillation (AF) (HR = 3.203, P < 0.001), and E / e ′ (HR = 1.083 per 1.0 increase, P < 0.001) were significantly correlated with the primary endpoint. In addition to these covariates, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use was significantly correlated with the secondary endpoint (HR = 0.451, P = 0.008). Diagnostic performance plot analysis demonstrated that the discrimination threshold value for LVEF that could identify patients prone to reaching the primary endpoint was ≥57.2%. The prevalence of AF or E / e ′ ratio did not differ significantly between patients with LVEF ≥ 58% and with 40% < LVEF < 58%. Conclusion A higher LVEF is independently related to poor prognosis in patients with HFpEF, in addition to concurrent AF and an elevated E / e ′ ratio. ACEI/ARB use, in contrast, was associated with improved prognosis, especially with regard to readmission due to HF. Clinical Trial Registration https://www.umin.ac.jp/ctr/index.htm Unique identifier UMIN000017725
- Subjects
MORTALITY risk factors; LEFT heart ventricle; EVALUATION of medical care; ECHOCARDIOGRAPHY; VENTRICULAR ejection fraction; PATIENT readmissions; ATRIAL fibrillation; ACE inhibitors; SURVIVAL analysis (Biometry); RESEARCH funding; HEART failure; SECONDARY analysis; PROPORTIONAL hazards models; DISEASE complications
- Publication
European Heart Journal - Cardiovascular Imaging, 2023, Vol 24, Issue 3, p293
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jeac240