Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study

Zannad, Faı̈ez; Briançon, Serge; Juillière, Yves; Mertès, Paul-Michel; Villemot, Jean‐Pierre; Alla, François; Virion, Jean-Marc

doi:10.1016/s0735-1097(98)00634-2

Cited by 269 publications

(175 citation statements)

References 34 publications

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“…One-year mortality rates in population-based studies have been reported to be 25% to 45%. [2][3][4][5] The mortality rate was higher in heart failure with reduced ejection fraction (HFrEF) than heart failure with preserved ejection fraction (HFpEF). 6) Mortality rates of HFrEF (ejection fraction < 50%) patients were reported to be 32% at one year and 68% at 5 years.…”

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confidence: 99%

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

et al. 2016

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SummaryRevascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered for heart failure with reduced ejection fraction (HFrEF). However, revascularization therapy does not always improve left ventricular ejection fraction (LVEF). The purpose of this study was to investigate the determinants of LVEF improvement following revascularization in HFrEF patients. From 2,229 consecutive decompensated heart failure patients, a total of 47 HFrEF patients who underwent revascularization were included in the analysis. Improvement of LVEF was defined as [(LVEF during chronic phase) -(LVEF during acute phase)] ≥ 10%. Univariate and multivariate logistic regression analyses were applied to investigate the determinants of LVEF improvement. The prevalence of revascularization by PCIs including chronic total occlusion (CTO) was significantly greater in the improved EF group (45.0%) as compared to the non-improved EF group (11.1%) (P = 0.02). Multivariate logistic regression analysis revealed that revascularization by PCIs including CTO was the significant determinant of the LVEF improvement after adjusting for confounding factors (OR 5.43, 95% CI 1.06-27.74, P = 0.04). Optimal medical therapy (angiotensin-converting enzyme (ACE) inhibitor and/or angiotensin II receptor blocker (ARB) and beta-blockers) was less frequently prescribed in patients with CABG (50.0% for ACE inhibitor and/or ARB and 41.7% for beta-blocker) than in patients without CABG (94.3% for both) (P < 0.01 and P < 0.001, respectively). In conclusion, revascularization by PCIs including CTO was the significant determinant of LVEF improvement in HFrEF patients. Our results underscore the importance of optimal medical therapy even if patients receive complete revascularization such as CABG. (Int Heart J 2016; 57: 565-572) Key words: Percutaneous coronary intervention, Coronary artery bypass grafting, Chronic total occlusion H eart failure is a common disease with a prevalence of 1-2% in the adult population, 1) and still has high mortality in developed countries. One-year mortality rates in population-based studies have been reported to be 25% to 45%.2-5) The mortality rate was higher in heart failure with reduced ejection fraction (HFrEF) than heart failure with preserved ejection fraction (HFpEF). 6) Mortality rates of HFrEF (ejection fraction < 50%) patients were reported to be 32% at one year and 68% at 5 years.6) The most common cause of HFrEF is coronary artery disease, which accounts for approximately two-thirds of HFrEF. 7)Revascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered in heart failure with coronary artery disease, and sometimes improves clinical outcomes including left ventricular function. [8][9][10][11][12] However, revascularization therapy is not always effective in heart failure with coronary artery disease.13) It is unknown which types of patients receive the benefits such as improvement o...

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confidence: 99%

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

et al. 2016

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“…This allowed us to analyze the sympathetic activation of HF and suppose, considering that this study is not randomized and that high heart rates are associated with a worse prognosis in cardiovascular disease, although it is examination physical data poorly described in publications. The same was confirmed in the study EPICAL 18 , in which heart rate was identified by multivariate analysis as an independent predictor of death, both in ischemic heart disease and in dilated cardiomyopathy 17,19 . Serum creatinine was also an independent predictor of cardiovascular mortality and very much related with the prognosis (HR: 1.17 for each 1 mg/dl, p=0.005), so we chose to use the ROC curve to select the best cutoff point.…”

Section: Survival Analysismentioning

confidence: 52%

“…Another variable that was considered a predictor of survival by the multivariate model of survival was age, also present in other studies 19,[22][23][24][25] . For each additional ten years of age, the prognosis was worse, with HR: 1.37 and p < 0.001.…”

Section: Survival Analysismentioning

confidence: 83%

Análise em longo prazo na síndrome coronariana aguda: existem diferenças na morbimortalidade?

Aguiar

Rocha

Esporcatte

et al. 2010

Arq. Bras. Cardiol.

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“…Hypertension Braunstein et al [6] 55% had HT and 11% severe HT in the Medicare study (n=122,630 patients) Ho et al [7] 39% of men and 59% of women had HT in the Framingham study Levy et al [8] Gustafsson et al [9] 27% of the men and 22% of the women had HT in the Danish Diamond study (n=5491 patients) Himmelman [10] At least 50% of patients with HT develops HF Diabetes Kannel et al [24] Risk for developing HF in young males and females with DM (2.20 and 5.37, respectively) Shindler et al [25] In the SOLVD study 15% in the prevention trial and 26% in the treatment trial had DM Cohn et al [26] Similar results in the V-HeFT II trial (26%) had DM CONSENSUS trial [27] 23% developed DM in the CONSENSUS trial Rydén et al [28] 19% developed DM in the ATLAS study Shindler et al [25] In the SOLVD registry (n=6076 patients) 23% had DM Zannad et al [29] In the French registry study EPICAL 26% had DM Braunstein [6] In the Medicare study (n=122,630 patients) 31% had DM Stratton et al [30] Interrelationship between HbA1c levels and incidence of HF Iribarren et al [31] Each 1% increase in HbA1c was associated with 8% increased risk of developing HF Paolisso et al [32] Whole body insulin resistance is prevalent in HF patients with either ischemic or idiopathic dilated cardiomyopathy Swan et al [33] Similar results as in Paolisso…”

Section: Study Resultsmentioning

confidence: 86%

Frequent non-cardiac comorbidities in patients with chronic heart failure

Dahlström

2005

European Journal of Heart Failure

104

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Heart failure (HF) in elderly patients is associated with more diffuse symptoms and signs due to the presence of other noncardiac comorbidities. This can cause difficulties in assessing the correct diagnosis and initiating appropriate therapy. The four most frequently occurring noncardiac comorbidities and therapies used to treat them are discussed in the present paper.Hypertension is an important precursor of HF, and is still the most common risk factor for HF in the general population. About 50% of patients with untreated hypertension will develop HF. Pressure overload leads to the development of left ventricular hypertrophy (LVH) and diastolic dysfunction.Diabetes, which occurs in about 20-30% of patients with HF, is an important comorbidity resulting in morphological and metabolic disturbances affecting myocardial blood flow and hormonal regulation leading to a poor outcome and necessitating aggressive conventional treatment.Chronic obstructive pulmonary disease (COPD), occurs in approximately 20-30% of heart failure patients, and may complicate HF treatment, it is therefore important to recognize and treat it effectively.Finally, the early detection of anemia, which occurs in 20-30% of HF patients, is important since it is associated with functional impairment and increased mortality and morbidity. Combined treatment with erythropoietin and intravenous iron has shown beneficial effects on clinical symptoms and morbidity.In conclusion early detection of concomitant diseases in patients with HF is important and should be considered carefully when initiating therapy.

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Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study

Abstract: Mortality and hospitalization rate of advanced CHF remain very high despite recent therapeutic progress. Major therapeutic and managed-care research is required.

Cited by 269 publications

References 34 publications

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

Análise em longo prazo na síndrome coronariana aguda: existem diferenças na morbimortalidade?

Frequent non-cardiac comorbidities in patients with chronic heart failure

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