Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction

Liu, Dan; Hu, Kai; Lau, Kolja; Kiwitz, Tobias; Robitzkat, K; Hammel, C; Lengenfelder, Björn; Ertl, Georg; Frantz, Stefan; Nordbeck, Peter

doi:10.1002/ehf2.13352

Cited by 17 publications

(17 citation statements)

References 25 publications

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“…Our results showed that among HFmrEF patients with or without increased blood biomarkers (from 0 to 4), CV events rate increased from 10.4% to 31.1% at 3 months after discharge, from 14.4% to 45.1% at 12 months after discharge, and from 47.0% to 64.6% at 33 months after discharge. Determination of these 4 circulating biomarkers, together with increased E/e′ (>18) and PASP (>35 mmHg), two echocardiographic indices indicating the presence of diastolic dysfunction, 22 might thus be a reliable strategy of risk stratification of HFmrEF patients to filter out the high‐risk HFmrEF patients. It is reasonable to administrate a more intensive HF medication plan and closer follow‐up for patients with high‐risk HFmrEF, which defined by above 4 serum biomarkers in combination with or without the two echocardiographic indices (E/e′ > 18 and PASP >35 mmHg).…”

Section: Discussionmentioning

confidence: 99%

Risk factors of short‐term, intermediate‐term, and long‐term cardiac events in patients hospitalized for HFmrEF

Zhu

Peng

et al. 2022

ESC Heart Failure

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Aims Clinical data on the prognostic determinants over varying periods within the same cohort of heart failure with mid‐range or mildly reduced ejection fraction (HFmrEF) remain scarce. This study aimed to identify the short‐term, intermediate‐term, and long‐term risk factors of adverse cardiovascular (CV) outcomes in patients hospitalized for HFmrEF. Methods and results This retrospective study included 1691 consecutive HFmrEF patients admitted to our hospital between January 2015 and August 2020. Baseline data including clinical characteristics, laboratory and cardiac imaging examinations were obtained. Patients completed at least 1 year clinical follow‐up after discharge by telephone interview, clinical visit, or community visit. The primary endpoint was defined as a composite of CV death or rehospitalization for heart failure (CV events) at 3, 12, and 33 months after the diagnosis of HFmrEF. Mean age of the whole cohort was 69 (61–77) years and 64.8% were male. The median clinical follow‐up was 33 (20–50) months. CV events were 17.5%, 28.2%, and 57.8% at 3, 12, and 33 months after discharge, respectively. Independent risk factors for CV events were uric acid >382 μmol/L, creatinine >100 μmol/L, N‐terminal pro‐B type natriuretic peptide (NT‐proBNP) > 3368 pg/mL and haemoglobin <120 g/L for men and <110 g/L for women at 3 and 12 months. Pulmonary artery systolic pressure >35 mmHg and the ratio of early transmitral flow velocity to early mitral annular velocity >18 served as independent risk factors for CV events at 12 months. At 33 months, uric acid > 382 μmol/L, NT‐proBNP >3368 pg/mL, and pulmonary artery systolic pressure >35 mmHg were the independent risk factors of CV events. Conclusions Higher uric acid, creatinine, NT‐proBNP, and lower haemoglobin levels at baseline are valuable serum biomarkers for risk stratification of short‐term and long‐term CV outcomes of HFmrEF patients. Future studies are needed to verify if intensive heart failure therapy for identified high‐risk HFmrEF patients based on these four serum biomarkers could improve their short‐term and long‐term CV outcomes or not.

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Section: Discussionmentioning

confidence: 99%

Risk factors of short‐term, intermediate‐term, and long‐term cardiac events in patients hospitalized for HFmrEF

Zhu

Peng

et al. 2022

ESC Heart Failure

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“…The prognostic implications of E/e' have been investigated mainly in non-surgical patients with various heart diseases. A retrospective review of 2018 hospitalized patients with heart failure, the all-cause mortality over more than 6 years increased in proportion to the severity of diastolic dysfunction, and in patients with EF < 40%, severe diastolic dysfunction was independently associated with increased all-cause mortality [23]. In a study enrolling 230 patients with non-valvular AF, the cumulative survival during follow-up (average 245 days) was signi cantly lower in subjects with E/e' > 15 than in those with E/e' ≤ 15, and the high E/e' was an independent predictor of mortality [24].…”

Section: Discussionmentioning

confidence: 99%

Combined impact of elevated arterial stiffness and left ventricular filling pressure on outcomes after off-pump coronary artery bypass grafting

Choi

2022

Preprint

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Background: Brachial-ankle pulse wave velocity (baPWV) and early diastolic transmitral flow velocity to mitral annular tissue velocity (E/e’), markers of arterial stiffness and left ventricular (LV) filling pressure, respectively, have been associated with morbidity and mortality. We investigated their combined impact on postoperative complications and long-term survival of patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods: A cohort of 164 patients were divided into four groups: baPWV≤19m/s and E/e’≤15 (reference), baPWV>19m/s and E/e’≤15 (high-PWV-only), baPWV≤19m/s and E/e’>15 (high-E/e’-only), and baPWV>19 m/s and E/e’>15 (high-PWV-and-E/e’). Each group was compared with the reference group to analyze the odds ratios of postoperative complications and the Kaplan-Meier survival curves, and to identify the group representing an independent prognostic predictor. Results: The median age and follow-up duration were 66.2 years and 57.2 months, respectively. Postoperative acute kidney injury (POAKI) was higher in the high-PWV-only group and substantially higher in high-PWV-and-E/e’ group (adjusted odds ratio (OR)=4.8; 95% confidence interval (CI), 1.3-17.1; p=0.016 vs. OR=22.6; CI, 5.9–86.1; p<0.001). ORs of postoperative atrial fibrillation (POAF) and postoperative stroke/delirium (POSD) were significantly higher only in the high-PWV-and-E/e’ group. The 7-year survival rates differed across the groups (p<0.001). The high-E/e’-only and high-PWV-and-E/e’ groups showed significantly lower survival rates than the reference group (75.6% and 53.5% vs. 93.9%). After adjustment for covariates, however, only the high-PWV-and-E/e’ group turned out to be an independent predictor group for all-cause mortality. Conclusion: Concurrent elevation in PWV and E/e’ may independently affect not only the rates of POAKI, POAF, and POSD but also long-term survival after OPCAB.

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“…This finding might be interpreted as a hint for DD being the ‘straw that breaks the camel’s back’ for CV death in HFrEF, but not in HFmrEF patients. MEE might be a part of mechanism ( Liu et al, 2021 ). As a simple, feasible and noninvasive way to evaluate MEE, we showed that echocardiogram-derived MEE correlates well the severity of diastolic dysfunction in patients with HFpEF.…”

Section: Discussionmentioning

confidence: 99%

Impact of Myocardial Energy Expenditure and Diastolic Dysfunction on One Year Outcome Patients With HFpEF

et al. 2022

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Objective: To explore the correlation between characteristics of myocardial energy expenditure (MEE) and the degree of diastolic dysfunction in patients of heart failure with preserved ejection fraction (HFpEF) and its clinical significance.Methods: 125 consecutive patients diagnosed with HFpEF in the Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University from January 2018 to October 2018 were enrolled. According to the degree of diastolic dysfunction, patients were divided into group A (8 ≤ E/e' ≤15) and group B (E/e'> 15), and MEE was calculated, patients finished 1-year clinical follow-up.Results: The level of MEE in group A was significantly lower than that in group B (p < 0.05). During 1-year follow up, MEE over 3145.69 kcal/systole was associated with increased risk of death as compared to patients with MEE less 3145.69 kcal/systole, and in patients with MEE over 101.68 kcal/min than in patients with MEE less than 101.68 kcal/min.Conclusion: There is a significant correlation between MEE and diastolic dysfunction and MEE over 3145.69 kcal/systole as well as MEE over 101.68 kcal/min are linked with increased risk of 1-year mortality in HFpEF.

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Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction

Cited by 17 publications

References 25 publications

Risk factors of short‐term, intermediate‐term, and long‐term cardiac events in patients hospitalized for HFmrEF

Risk factors of short‐term, intermediate‐term, and long‐term cardiac events in patients hospitalized for HFmrEF

Combined impact of elevated arterial stiffness and left ventricular filling pressure on outcomes after off-pump coronary artery bypass grafting

Impact of Myocardial Energy Expenditure and Diastolic Dysfunction on One Year Outcome Patients With HFpEF

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