Characteristics and Outcomes of Adult Outpatients With Heart Failure and Improved or Recovered Ejection Fraction

Kalogeropoulos, Andreas P.; Fonarow, Gregg C.; Georgiopoulou, Vasiliki V.; Burkman, Gregory; Siwamogsatham, Sarawut; Patel, Ankur R.; Li, Song; Papadimitriou, L.; Butler, Javed

doi:10.1001/jamacardio.2016.1325

Cited by 214 publications

(222 citation statements)

References 27 publications

(19 reference statements)

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“…18 However, recent studies have shown that the patients with reverse LV remodeling and normalization of LVEF continue to experience heart failure admissions and heart failure deaths. 6, 19 These and other observations in patients supported with left ventricular assist devices have highlighted the importance of the differences between myocardial recovery, wherein patients remain free from future heart failure events, versus myocardial remission that is characterized by reverse LV remodeling and improved LVEF with recurrent heart failure admissions. 10 Basuray and colleagues have shown that patients with a recovered LVEF >50% continue to experience heart failure admissions and heart failure deaths, suggesting that patients with a recovered LVEF represent a group of patients who have a milder, but persistent heart failure phenotype.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Global Longitudinal Strain Predicts Future Deterioration of Left Ventricular Function in Heart Failure Patients With a Recovered Left Ventricular Ejection Fraction

Adamo

Perry

Novak

et al. 2017

Circ: Heart Failure

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Background Patients with recovery of left ventricular ejection fraction (LVEF) remain at risk for future deterioration of LVEF. However, there are no tools to risk stratify these patients. We hypothesized that global longitudinal strain could predict sustained recovery within this population. Methods and Results We retrospectively identified 96 patients with a reduced LVEF < 50% (screening echocardiogram), whose LVEF had increased by at least 10 % and normalized (>50%) on evidence based medical therapies (baseline echocardiogram). We examined absolute global longitudinal strain (GLS) on the baseline echocardiogram in relation to changes in LVEF on a follow-up echocardiogram. Patients with recovered LVEF had a wide range of GLS. The GLS on the baseline study correlated with the LVEF at the time of follow-up (r=0.33, p<0.001). The likelihood of having an LVEF >50% on follow-up increased by 24% for each point increase in absolute GLS on the baseline study (OR 1.24, p=0.001). An abnormal GLS (≤ 16%) at baseline had a sensitivity of 88%, a specificity of 46%, and an accuracy of 0.67 (p<0.001) as a predictor of a decrease in LVEF > 5% during follow up. A normal GLS (> 16%) on the baseline study had a sensitivity of 47%, a specificity of 83% and an accuracy of 0.65 (p=0.002) for predicting a stable LVEF (−5 to 5 %) on follow-up. Conclusions In patients with a recovered LVEF, an abnormal GLS predicts the likelihood of having a decrease LVEF during follow-up, whereas a normal GLS predicts the likelihood of stable LVEF during recovery.

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Section: Discussionmentioning

confidence: 99%

Abnormal Global Longitudinal Strain Predicts Future Deterioration of Left Ventricular Function in Heart Failure Patients With a Recovered Left Ventricular Ejection Fraction

Adamo

Perry

Novak

et al. 2017

Circ: Heart Failure

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“…Also nearly half of allo patients increased EF to levels above 40% (Figure 3), an accepted cut-off for the diagnosis of NIDCM (1,18). HF with recovered EF is a recognized syndrome that carries an improved prognosis relative to HF with persistently low EF (19). As such, if the present results are replicated in a larger trial, they represent a major clinical advance for NIDCM, a condition affecting individuals of all ages and accounting for approximately half of the heart transplants (2,20).…”

Section: Discussionmentioning

confidence: 99%

Randomized Comparison of Allogeneic Versus Autologous Mesenchymal Stem Cells for Nonischemic Dilated Cardiomyopathy

Hare

DiFede

Rieger

et al. 2017

Journal of the American College of Cardiology

303

246

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Background While human mesenchymal stem cells (hMSCs) have been tested in ischemic cardiomyopathy, few studies exist in chronic non-ischemic dilated cardiomyopathy (NIDCM). Objectives The POSEIDON-DCM trial is a randomized comparison of safety and efficacy of autologous (auto) vs. allogeneic (allo) bone marrow-derived hMSCs in NIDCM. Methods Thirty-seven patients were randomized to either allo- or auto-hMSCs in a 1:1 ratio. Patients were recruited between December 2011 and July 2015 at the University of Miami Hospital. Patients (age: 55.8 ± 11.2; 32% female) received hMSCs (100 million) by transendocardial stem cell injection (TESI) in ten left ventricular sites by NOGA Catheter. Treated patients were evaluated at baseline, 30 days, 3-, 6-, and 12-months for safety: serious adverse events (SAE), and efficacy endpoints: Ejection Fraction (EF), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Six Minute Walk Test (6MWT), MACE, and immune-biomarkers. This trial is registered with ClinicalTrials.gov, #NCT01392625. Results There were no 30-day treatment-emergent (TE)-SAEs. 12-month SAE incidence was 28.2% (95% CI: 12.8, 55.1) in allo, and 63.5% (95% CI: 40.8, 85.7; p=0.1004) in auto. One allo-group patient developed an elevated donor specific cPRA. EF increased in allo by 8.0 units (95% Cl: 2.8, 13.2; p=0.004), and in auto: 5.4 units (95% Cl: −1.4, 12.1; p=0.116, allo vs. auto p=0.4887). 6MWT increased for allo: 37.0 meters (95% Cl: 2.0 to 72.0; p=0.04), but not auto: 7.3 meters (95% Cl: −47.8, 33.3; p=0.71, auto vs. allo p=0.0168). MLHFQ score decreased in allo (p=0.0022), and auto (p=0.463; p=0.172). The MACE rate was lower in allo vs. auto (p=0.0186). Tumor necrosis factor alpha (TNF-α) decreased (p=0.0001 for each), to a greater extent in allo vs. auto at six-months (p=0.05). Conclusion These findings demonstrate safety and support greater, clinically meaningful efficacy of allo-hMSC vs. auto-hMSC in NIDCM patients. Pivotal trials of allo-hMSCs are warranted based on these results.

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“…We found that PI-based regimens were associated with an increase in CV mortality among PHIV with HF. The mechanism for this increase in CV mortality related to PI use is unclear, but several possibilities exist, including the following: 1) patients prescribed PIs had an increased 30-day HF readmission rate, which is closely linked to mortality in broad groups of patients with HF (23);2) patients receiving ART had a higher PASP and a lower LVEF, both strong predictors of adverse outcomes, including mortality, in HF (24,25); and 3) PHIV with HF who were taking a PI had increased rates of diabetes and CAD, both independent risk factors for mortality in HF (26,27). Additionally, other factors not addressed in this study may have played a role.…”

Section: Discussionmentioning

confidence: 99%

Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure

Alvi

Neilan

Tariq

et al. 2018

Journal of the American College of Cardiology

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BACKGROUND Incident heart failure (HF) is increased in persons with human immunodeficiency virus (PHIV). Protease inhibitors (PIs) are associated with adverse cardiac remodeling and vascular events; however, there are no data on the use of PIs in PHIV with HF. OBJECTIVES This study sought to compare characteristics, cardiac structure, and outcomes in PHIV with HF who were receiving PI-based versus non-PI (NPI) therapy. METHODS This was a retrospective single-center study of all 394 antiretroviral therapy–treated PHIV who were hospitalized with HF in 2011, stratified by PI and NPI. The primary outcome was cardiovascular (CV) mortality, and the secondary outcome was 30-day HF readmission rate. RESULTS Of the 394 PHIV with HF (47% female, mean age 60 ± 9.5 years, CD4 count 292 ± 206 cells/mm3),145 (37%) were prescribed a PI, whereas 249 (63%) were prescribed NPI regimens. All PI-based antiretroviral therapy contained boosted-dose ritonavir. PHIV who were receiving a PI had higher rates of hyperlipidemia, diabetes mellitus, and coronary artery disease (CAD); higher pulmonary artery systolic pressure (PASP); and lower left ventricular ejection fraction. In follow-up, PI use was associated with increased CV mortality (35% vs. 17%; p < 0.001) and 30-day HF readmission (68% vs. 34%; p < 0.001), effects seen in all HF types. Predictors of CV mortality included PI use, CAD, PASP, and immunosuppression. Overall, PIs were associated with a 2-fold increased risk of CV mortality. CONCLUSIONS PI-based regimens in PHIV with HF are associated with dyslipidemia, diabetes, CAD, a lower left ventricular ejection fraction, and a higher PASP. In follow-up, PHIV with HF who are receiving a PI have increased CV mortality and 30-day HF readmission.

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Characteristics and Outcomes of Adult Outpatients With Heart Failure and Improved or Recovered Ejection Fraction

Abstract: Outpatients with HFrecEF have a different clinical course than patients with HFpEF and HFrEF, with lower mortality, less frequent hospitalizations, and fewer composite end points. These patients may need to be investigated separately in outcomes studies and clinical trials.

Cited by 214 publications

References 27 publications

Abnormal Global Longitudinal Strain Predicts Future Deterioration of Left Ventricular Function in Heart Failure Patients With a Recovered Left Ventricular Ejection Fraction

Abnormal Global Longitudinal Strain Predicts Future Deterioration of Left Ventricular Function in Heart Failure Patients With a Recovered Left Ventricular Ejection Fraction

Randomized Comparison of Allogeneic Versus Autologous Mesenchymal Stem Cells for Nonischemic Dilated Cardiomyopathy

Protease Inhibitors and Cardiovascular Outcomes in Patients With HIV and Heart Failure

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