Universal Definition and Classification of Heart Failure

Bozkurt, Biykem; Coats, Andrew J.S.; Tsutsui, Hiroyuki; Abdelhamid, Magdy; Adamopoulos, Stamatis; Albert, Nancy M.; Anker, Stefan D.; Atherton, J.; Böhm, Michael; Butler, Javed; Drazner, Mark H.; Felker, G. Michael; Filippatos, Gerasimos; Fonarow, Gregg C.; Fiuzat, Mona; Gomez-Mesa, Juan–Esteban E.; Heidenreich, Paul A.; Imamura, Teruhiko; Januzzi, James L.; Jankowska, Ewa A.; Khazanie, Prateeti; Kinugawa, Koichiro; Lam, Carolyn S.P.; Matsue, Yuya; Metra, Marco; Ohtani, Tomohito; Piepoli, Massimo F; Ponikowski, Piotr; Rosano, Giuseppe; Sakata, Yasushi; Seferović, Petar; Starling, Randall C.; Teerlink, John R.; Vardeny, Orly; Yamamoto, Kazuhide; Yancy, Clyde W.; Zhang, Jiän; Zieroth, Shelley

doi:10.1016/j.cardfail.2021.01.022

Cited by 503 publications

(120 citation statements)

References 109 publications

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“…Five RCTs ( 11 , 12 , 14 , 21 , 22 ) recruited patients with heart failure and reduced ejection fraction [defined as a left ventricular ejection fraction of <40% ( 31 )]. In HFrEF patients, empagliflozin was associated with significantly better NT-proBNP reduction [MD: −121.56 (95% CI −242.17 to −0.95); I 2 = 68%; P = 0.05; Figure 8 ].…”

Section: Resultsmentioning

confidence: 99%

Empagliflozin in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Pan

Lin

Chen

et al. 2021

Front. Cardiovasc. Med.

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Purpose: The purpose of the study is to evaluate the effect of empagliflozin in patients with heart failure (HF).Method: We performed a systematic search of PubMed, EMBASE, and the Cochrane Library database through January 20, 2021. Randomized controlled trials (RCTs) were included that compared empagliflozin and placebo in patients with HF. Dichotomous variables were expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Continuous variables were calculated and expressed as mean differences (MD) and standard deviation (SD). Meta-analysis was conducted using a random-effects model on outcomes with high heterogeneity.Results: Seven studies were included in our meta-analysis (n = 5,150). Significant differences were observed in a composite of cardiovascular death or hospitalization for worsening heart failure [RR: 0.77 (95% CI 0.68–0.87); I2 = 18%; P < 0.0001), hospitalization for worsening heart failure [RR: 0.71 (95% CI 0.61–0.82); I2 = 0%; P < 0.00001], changes in Kansas City Cardiomyopathy Questionnaire (KCCQ) score [MD: 1.70 (95% CI 1.67–1.73); I2 = 0%; P < 0.00001], and changes in body weight [MD: −1.43 (95% CI −2.15 to −0.72); I2 = 84%; P < 0.0001) from baseline. However, empagliflozin did not show a better change in the 6-min walk test (6MWT) [MD: 34.06 (95% CI −29.75–97.88); I2 = 97%; P = 0.30] or NT-proBNP [MD: −98.36 (95% CI, −225.83–29.11); I2 = 68%; P = 0.13] from baseline.Conclusion: The findings suggest that empagliflozin was effective in reducing a composite of cardiovascular death or hospitalization for worsening heart failure. Further well-designed RCTs are needed to evaluate the long-term effect of empagliflozin in patients with HF.PROSPERO: CRD42021231712.

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Section: Resultsmentioning

confidence: 99%

Empagliflozin in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Pan

Lin

Chen

et al. 2021

Front. Cardiovasc. Med.

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“…For the calculation of the GuIDER score (Glucose, Injury and Dysfunction in the Emergency-setting for cardiovascular-Risk) the following algorithm was used: glucose ≥ 5.6 mmol/L = 1 point; NT-proBNP ≥ 125 ng/L = 1 point; with Abbott hs-cTnI concentration between 4-14 ng/L = 1 point/15-30 ng/L = 2 points/>30 ng/L = 3 points (Abbott GuIDER) and Roche hs-cTnT concentration between 8-18 ng/L = 1 point/19-30 ng/L = 2 points/>30 ng/L = 3 points (Roche GuIDER). The glucose and hs-cTn cutoffs were obtained from the CCS [4] with the 125 ng/L cutoff for NT-proBNP obtained from the proposed definition of HF and machine-based learning with population attributable risk percentage [2,3]. The GuIDER score ranged from 0 to 5 with the primary outcome (composite outcome) assessed based on each value.…”

Section: Discussionmentioning

confidence: 99%

“…Natriuretic peptide (NP) testing is of clinical value in the diagnosis of heart failure (HF) but also in patients with suspected acute coronary syndrome (ACS) [1,2]. The HF definition includes NP measurement interpretation and cutoffs for both ambulatory and acute settings.…”

Section: Introductionmentioning

confidence: 99%

Can the Addition of NT-proBNP and Glucose Measurements Improve the Prognostication of High-Sensitivity Cardiac Troponin Measurements for Patients with Suspected Acute Coronary Syndrome?

Kavsak

Mondoux

Hewitt

et al. 2021

JCDD

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Guidelines published in 2021 have supported natriuretic peptide (NP) testing for the prognostication in patients with acute coronary syndrome (ACS) and for the diagnosis of chronic and acute heart failure (HF). Our objective was to determine if the addition of N-terminal pro B-type NP (NT-proBNP) and glucose to high-sensitivity cardiac troponin (hs-cTn) could better identify emergency department (ED) patients with potential ACS at low- and high-risk for a serious cardiovascular outcome over the next 72 h. The presentation sample in two different ED cohorts which enrolled patients with symptoms suggestive of ACS within six hours of pain onset (Cohort-1, n = 126 and Cohort-2, n = 143) that had Abbott hs-cTnI, Roche hs-cTnT, NT-proBNP and glucose were evaluated for NT-proBNP alone and combined with hs-cTn and glucose for the primary outcome (composite which included death, myocardial infarction, HF, serious arrhythmia and refractory angina) via receiver-operating characteristic (ROC) curve analyses with area under the curve (AUC) and diagnostic estimates derived. The AUC for NT-proBNP for the primary outcome was 0.68 (95% confidence interval (CI): 0.59–0.76) and 0.75 (95%CI: 0.67–0.82) in Cohort-1 and 2, respectively, with the 125 ng/L cutoff yielding a higher sensitivity (≥75%) as compared to the 300 ng/L cutoff (≥58%). Using the 125 ng/L cutoff for NT-proBNP with the published glucose and hs-cTn cutoffs for risk-stratification produced a new score (GuIDER score for Glucose, Injury and Dysfunction in the Emergency-setting for cardiovascular-Risk) and yielded higher AUCs as compared to NT-proBNP (p < 0.05). GuIDER scores of 0 and 5 using either hs-cTnI/T yielded sensitivity estimates of 100% and specificity estimates > 92% for the primary outcome. A secondary analysis assessing MI alone in the overall population (combined Cohorts 1 and 2) also achieved 100% sensitivity for MI with a GuIDER cutoff ≥ 2, ruling-out 48% (Roche) and 38% (Abbott) of the population at presentation for MI. Additional studies are needed for the GuIDER score in both the acute and ambulatory setting to further refine the utility, however, the preliminary findings reported here may present a pathway forward for inclusion of NP testing for ruling-out serious cardiac events and MI in the emergency setting.

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“…This will lead to a refinement of the definition, the diagnostic criteria and the therapeutic approach. Very recently, a universal definition and classification of HF has been proposed (10). In this position paper issued by all of the important HF societies, a fourth HF class has been suggested: HF with improved LVEF, i.e., HF with an initial LVEF ≤40% and an improvement by at least 10 percent points to an LVEF >40% (10).…”

Section: Future Perspectivesmentioning

confidence: 99%

“…Whether or not this group of patients requires a different treatment than patients with (stable) HFmrEF or HFpEF will have to be shown. The 2021 ESC HF guidelines are about to be published and will define the diagnostic criteria and thereby probably follow the universal definition and classification of HF (10). For the treatment of HFmrEF in general and most likely also PH in HFmrEF the data on the effect of sodium-glucose co-transporter 2 (SGLT2) inhibitors will be very important (88,89).…”

Section: Future Perspectivesmentioning

confidence: 99%

Pulmonary Hypertension in Patients With Heart Failure With Mid-Range Ejection Fraction

Maeder

Weber

Buser

et al. 2021

Front. Cardiovasc. Med.

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Pulmonary hypertension (PH) is common in patients with heart failure (HF). The role of PH in patients with HF with reduced (HFrEF) and preserved (HFpEF) left ventricular ejection fraction (LVEF) has been extensively characterized during the last years. In contrast, the pathophysiology of HF with mid-range LVEF (HFmrEF), and in particular the role of PH in this context, are largely unknown. There is a paucity of data in this field, and the prevalence of PH, the underlying mechanisms, and the optimal therapy are not well-defined. Although often studied together there is increasing evidence that despite similarities with both HFrEF and HFpEF, HFmrEF also differs from both entities. The present review provides a summary of the current concepts of the mechanisms and clinical impact of PH in patients with HFmrEF, a proposal for the non-invasive and invasive diagnostic approach required to define the pathophysiology of PH and its management, and a discussion of future directions based on insights from mechanistic studies and randomized trials. We also provide an outlook regarding gaps in evidence, future clinical challenges, and research opportunities.

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Universal Definition and Classification of Heart Failure

Cited by 503 publications

References 109 publications

Empagliflozin in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Empagliflozin in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Can the Addition of NT-proBNP and Glucose Measurements Improve the Prognostication of High-Sensitivity Cardiac Troponin Measurements for Patients with Suspected Acute Coronary Syndrome?

Pulmonary Hypertension in Patients With Heart Failure With Mid-Range Ejection Fraction

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