Characteristics and clinical outcomes of patients with acute heart failure with a supranormal left ventricular ejection fraction

Essen, Bart J van; Tromp, Jasper; Maaten, Jozine M. ter; Greenberg, Barry; Gimpelewicz, Claudio; Felker, G. Michael; Davison, Beth A.; Severin, Thomas; Pang, Peter S.; Cotter, Gad; Teerlink, John R.; Metra, Marco; Voors, Adriaan A.

doi:10.1002/ejhf.2695

Cited by 31 publications

(37 citation statements)

References 28 publications

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“…Left ventricular EF may have a U-shaped relationship with outcome, with patients with supranormal (sn) EF (HFsnEF) having a higher risk of events. 19,[257][258][259] Overall, 2.5% of patients enrolled in the RELAX-AHF-2 trial had an LVEF ≥ 65%. These patients with HFsnEF, compared with HFpEF patients, were more often women, with higher prevalence of non-ischaemic HF, had lower levels of NPs and higher blood urea nitrogen plasma levels, and were less likely to be treated with beta-blockers.…”

Section: Heart Failure With Supranormal Ejection Fractionmentioning

confidence: 99%

“…Left ventricular EF may have a U‐shaped relationship with outcome, with patients with supranormal (sn) EF (HFsnEF) having a higher risk of events 19,257–259 . Overall, 2.5% of patients enrolled in the RELAX‐AHF‐2 trial had an LVEF ≥ 65%.…”

Section: Heart Failure With Supranormal Ejection Fractionmentioning

confidence: 99%

“…These patients with HFsnEF, compared with HFpEF patients, were more often women, with higher prevalence of non‐ischaemic HF, had lower levels of NPs and higher blood urea nitrogen plasma levels, and were less likely to be treated with beta‐blockers. All‐cause mortality was not statistically different between groups, although patients with HFsnEF had the highest numerical rate 258 . Another study investigated the prognostic implication of snLVEF as assessed by CMR and its inter‐relationship with stroke volume.…”

Section: Heart Failure With Supranormal Ejection Fractionmentioning

confidence: 99%

“…All-cause mortality was not statistically different between groups, although patients with HFsnEF had the highest numerical rate. 258 Another study investigated the prognostic implication of snLVEF as assessed by CMR and its inter-relationship with stroke volume. LVEF in the sn range was associated with a higher risk of adverse CV outcomes, particularly in those with lower stroke volume.…”

Section: Heart Failure With Supranormal Ejection Fractionmentioning

confidence: 99%

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Heart failure: an update from the last years and a look at the near future

et al. 2022

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In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.

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Section: Heart Failure With Supranormal Ejection Fractionmentioning

confidence: 99%

Section: Heart Failure With Supranormal Ejection Fractionmentioning

confidence: 99%

Section: Heart Failure With Supranormal Ejection Fractionmentioning

confidence: 99%

Section: Heart Failure With Supranormal Ejection Fractionmentioning

confidence: 99%

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Heart failure: an update from the last years and a look at the near future

et al. 2022

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“…Such patients were more likely to be female, with a high prevalence of non‐ischaemic HF and presented lower levels of natriuretic peptides. This subgroup presented a higher‐risk of non‐cardiovascular mortality, compared to other LVEF ranges 19 …”

Section: Acute Heart Failurementioning

confidence: 81%

January 2023 at a glance: focus on acute heart failure and medical therapy

Tomasoni

Adamo

Metra

2023

European J of Heart Fail

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Several factors may favour development of heart failure (HF). 1,2 Shi et al. 3 assessed the association between clonal haematopoiesis of indeterminate potential (CHIP) and incident HF. A total of 374 participants with incident HF from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort were matched 1:1 by age and sex with healthy controls. The frequency of CHIP was overlapping between the two groups and CHIP was not significantly associated with incident HF at multivariable Cox regression models. However, the association was modified by age (p for interaction = 0.002) and CHIP was more frequent in the case cohort compared to controls among those younger than 65 years.Miranda et al. 4 compared exercise haemodynamics between 24 adult patients post-Fontan palliation, 48 patients with HF and preserved ejection fraction (HFpEF) and 48 subjects with non-cardiac dyspnoea (NCD). Resting and exercise pulmonary artery wedge pressure (PAWP) was lower in the Fontan group than HFpEF, but higher than NCD. However, there were no differences in ΔPAWP/ΔQs ratios between post-Fontan and HFpEF patients. Acute heart failureAcute heart failure (AHF) has a dramatic burden in terms of symptoms, morbidity and mortality. [5][6][7][8] Lee et al. 9 investigated the relationship between patient-reported symptoms, evaluated by the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ-TSS) (range 0-100; 0 worst), and pulmonary congestion, assessed by lung ultrasound, physical examination and chest X-ray, in patients with AHF. A lower KCCQ-TSS was associated with worse New York Heart Association functional class and peripheral oedema but not with pulmonary congestion.Intravenous diuretics are the first option for the treatment of congestion in patients with AHF. Data regarding the optimal strategy of their administration are limited. 10,11 Their early administration is often considered as crucial. Among 15 078 patients included in the REPORT-HF registry from seven regions of the world, the median time-to-diuretics was 67 min. Time-to-diuretic administration did not have an impact on in-hospital mortality, but was associated with an increase in mortality risk at 30 days, especially in patients at higher risk. 12

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β-Blocker Withdrawal and Functional Capacity Improvement in Patients With Heart Failure With Preserved Ejection Fraction

Palau,

de la Espriella,

Seller

et al. 2024

JAMA Cardiol

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ImportanceIncreasing the patient’s heart rate (HR) has emerged as a therapeutic option in patients with heart failure with preserved ejection fraction (HFpEF). However, the evidence is conflicting, and the profile of patients who benefit most from this strategy remains unclear.ObjectiveTo assess the association of β-blocker treatment withdrawal with changes in the percentage of predicted peak oxygen consumption (VO2) across indexed left ventricular diastolic (iLVEDV) and indexed left ventricular systolic volumes (iLVESV), and left ventricular ejection fraction (LVEF) in patients with HFpEF and chronotropic incompetence.Design, Setting, and ParticipantsThis post hoc analysis was conducted using data from the investigator-blinded multicenter, randomized, and crossover clinical trial, PRESERVE-HR, that took place from October 1, 2018, through December 31, 2020, to investigate the short-term effects (2 weeks) of β-blocker withdrawal on peak oxygen consumption (peak VO2). Patients with stable HFpEF (New York Heart Association functional class II to III) receiving treatment with β-blocker and chronotropic incompetence were included.InterventionParticipants in the PRESERVE-HR trial were randomized to withdraw vs continue with β-blocker treatment. After 2 weeks, they were crossed over to receive the opposite intervention. This crossover randomized clinical trial examined the short-term effect of β-blocker withdrawal on peak VO2.Main Outcomes and MeasuresThe primary outcome was to evaluate the association between β-blocker withdrawal and short-term changes in percentage of peak VO2 across iLVEDV, iLVESV, and LVEF in patients with HFpEF and chronotropic incompetence treated with β-blocker.ResultsA total of 52 patients (mean age, 73 [SD, 13] years; 60% female) were randomized. The mean resting HR, peak HR, peak VO2, and percentage of peak VO2 were 65 (SD, 9) beats per minute (bpm), 97 (SD, 15) bpm, 12.4 (SD, 2.9) mL/kg per minute, and 72.4% (SD, 17.7%), respectively. The medians (minimum-maximum) of iLVEDV, iLVESV, and LVEF were 44 mL/m2 (IQR, 19-82), 15 mL/m2 (IQR, 7-32), and 64% (IQR, 52%-78%), respectively. After stopping β-blocker treatment, the median increase in peak HR was plus 30 bpm (95% CI, 25-35; P &lt; .001). β-Blocker cessation was differentially associated with change of percentage of peak VO2 across the continuum of iLVESV (P for interaction = .02), indicating a greater benefit in those with lower iLVESV.Conclusions and RelevanceIn this study, results showed that in patients with HFpEF and chronotropic incompetence receiving treatment with β-blocker, lower iLVESV may identify those with a greater short-term improvement in maximal functional capacity after stopping β-blocker treatment. Further studies are warranted for further investigation.Trial RegistrationClinicalTrials.gov (NCT03871803)

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Characteristics and clinical outcomes of patients with acute heart failure with a supranormal left ventricular ejection fraction

Cited by 31 publications

References 28 publications

Heart failure: an update from the last years and a look at the near future

Heart failure: an update from the last years and a look at the near future

January 2023 at a glance: focus on acute heart failure and medical therapy

β-Blocker Withdrawal and Functional Capacity Improvement in Patients With Heart Failure With Preserved Ejection Fraction

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