Rest Cardiac Power Predicts All-cause Death and Heart Failure Hospitalization in Heart Failure Patients With Preserved Ejection Fraction

Abstract

Background: Cardiac power as an integrated indicator of cardiac performance that incorporates both pressure and volume factors. It has been studied in patients with reduced left ventricular (LV) ejection fraction (EF), and in the present study we aimed to explore its significance and role in predicting adverse outcome in patients with heart failure with preserved ejection fraction (HFpEF).Methods: This retrospective cohort study included 2089 community-dwelling patients with HFpEF and without significant valve diseases or right ventricular dysfunction. We normalized cardiac power to LV mass and expressed it in W/100 g of LV myocardium. Univariate analysis with log-rank test and multivariate analysis with Cox regression model were used to evaluate the association between rest cardiac power/mass and all-cause death and heart failure (HF) hospitalization. Results: After a median follow-up of 4.4 (0.5–10.1) years, 331 (15.84%) experienced all-cause death and 391 (18.72%) experienced HF hospitalization. Patients with the lower rest power/mass were older and had higher New York Heart Association class, N-terminal pro-brain natriuretic peptide (NT-proBNP) level and more comorbidities. After adjusting for multiple covariates, rest power/mass ≤0.7 W/m2 was independently associated with all-cause death and HF hospitalization, with the hazard ratio (HR) of 1.753 [95% confidence interval (CI) 1.394–2.203, P<0.001] and 1.266 (95% CI 1.033–1.551, P=0.023), respectively. The C statistic increased significantly when the rest cardiac power/mass were incorporated into a model with established risk factors. For all-cause death, the continuous net reclassification index (NRI) after adding rest cardiac power/mass in the model with established risk factors and NT-proBNP was 17.0% (95% CI 11.4–28.3, P=0.04), and the integrated discrimination index (IDI) was 2.3% (95% CI 0.7–8.7, P=0.02); for HF hospitalization, the corresponding continuous NRI and IDI were 6.0% (95% CI 4.7–15.2, P=0.026) and 1.7% (95% CI 1.2–4.3, P=0.007), respectively.Conclusion: Rest cardiac power by non-invasive echocardiography is independently associated with risks of adverse outcomes in patients with HFpEF and provides incremental prognostic information.

Resting Cardiac Power Predicts Adverse Outcome in Heart Failure Patients With Preserved Ejection Fraction: A Prospective Study

“…We thank John Daniel from Liwen Bianji (Edanz) ( www.liwenbianji.cn/ac ) for editing the English text of a draft of this manuscript. This manuscript has been preprinted (DOI: 10.21203/rs.3.rs-430111/v1 ) ( 22 ).…”