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Kittleson MM, Panjrath GS, Amancherla K, Davis LL, Deswal A, Dixon DL, Januzzi JL, Yancy CW. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2023; 81:1835-1878. [PMID: 37137593 DOI: 10.1016/j.jacc.2023.03.393] [Citation(s) in RCA: 71] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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2
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Meng Y, Zhang Z, Zhao T, Zhang D. Prognostic Significance of Nutrition-Associated Markers in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. Arq Bras Cardiol 2023; 120:e20220523. [PMID: 37162076 PMCID: PMC10263396 DOI: 10.36660/abc.20220523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/23/2022] [Accepted: 02/15/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND The prognostic significance of nutrition indicators in patients with heart failure with preserved ejection fraction (HFpEF) is unclear. OBJECTIVES This systematic review and meta-analysis aimed to assess the prognostic value of serum albumin (SA), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI) in patients with HFpEF. METHODS Databases of PubMed, Embase, The Cochrane Library, and Web of Science were systematically searched for all studies published up to January 2022. The prognostic significance of SA, GNRI, and PNI for HFpEF was explored. Pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the STATA 15.0 software. The Quality of Prognosis Studies tool was used to assess the quality of studies. RESULTS Nine studies met the inclusion criteria, and 5603 adults with HFpEF were included in the meta-analysis. The analyses showed that a decreased SA or GNRI was significantly related to high all-cause mortality (HR: 1.98; 95% CI: 1.282-3.057; p = 0.002; and HR: 1.812;95% CI: 1.064-3.086; p = 0.029, respectively). Furthermore, a lower SA indicates a bad composite outcome of all-cause mortality and HF rehospitalization (HR: 1.768; 95% CI: 1.483-2.108; p = 0.000), and a lower GNRI was significantly associated with high cardiovascular mortality (HR: 1.922; 95% CI: 1.504-2.457;p = 0.000). However, a lower PNI did not correlate with all-cause mortality (HR: 1.176; 95% CI: 0.858-1.612, p=0.314). CONCLUSIONS Our meta-analysis indicates that SA and GNRI may be useful indicators to predict the prognosis of patients with HFpEF.
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Affiliation(s)
- Ying Meng
- Departamento de Medicina GeralSegundo HospitalUniversidade de LanzhouLanzhouGansuChinaDepartamento de Medicina Geral, Segundo Hospital da Universidade de Lanzhou, Lanzhou, Gansu – China
| | - Zhengyi Zhang
- Departamento de Medicina GeralSegundo HospitalUniversidade de LanzhouLanzhouGansuChinaDepartamento de Medicina Geral, Segundo Hospital da Universidade de Lanzhou, Lanzhou, Gansu – China
| | - Tong Zhao
- Departamento de OrtopediaPrimer HospitalUniversidade de LanzhouLanzhouGansuChinaDepartamento de Ortopedia, Primer Hospital da Universidade de Lanzhou, Lanzhou, Gansu – China
| | - Dekui Zhang
- Departamento de GastroenterologiaSegundo HospitalUniversidade de LanzhouLanzhouGansuChinaDepartamento de Gastroenterologia, Segundo Hospital da Universidade de Lanzhou, Lanzhou, Gansu – China
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3
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Romiti GF, Recchia F, Zito A, Visioli G, Basili S, Raparelli V. Sex and Gender-Related Issues in Heart Failure. Cardiol Clin 2022; 40:259-268. [DOI: 10.1016/j.ccl.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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4
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The Global Ambulatory Blood Pressure Monitoring (ABPM) in Heart Failure with Preserved Ejection Fraction (HFpEF) Registry. Rationale, design and objectives. J Hum Hypertens 2021; 35:1029-1037. [PMID: 33239742 DOI: 10.1038/s41371-020-00446-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 02/03/2023]
Abstract
Hypertension is a major risk factor for the development of heart failure with preserved ejection fraction (HFPEF) and blood pressure (BP) in itself is an important marker of prognosis. The association of BP levels, and hemodynamic parameters, measured by ambulatory blood pressure monitoring (ABPM), with outcomes, in patients with HFPEF is largely unknown. Patients with HFPEF have a substantial burden of co-morbidities and frailty. In addition there are marked geographic differences in HFPEF around the world. How these difference influence the association between BP and outcomes in HFPEF are unknown. The Global Ambulatory Blood Pressure Monitoring (ABPM) in Heart Failure with Preserved Ejection Fraction (HFpEF) Registry aims to assess the relevance of BP parameters, measured by ABPM, on the outcome of HFPEF patients worldwide. Additionally, the influence of other relevant factors such as frailty and co-morbidities will be assessed. Stable HFPEF patients with a previous hospitalization, will be included. Patients should be clinically and hemodynamically stable for at least 4 weeks before study inclusion. Specific data related to HF, biochemical markers, ECG and echocardiography will be collected. An ABPM and geriatric and frailty evaluation will be performed and the association with morbidity and mortality assessed. Follow up will be at least one year.
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Abstract
Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) constitute a high-risk phenotype with significant morbidity and mortality and poor prognosis. Multiple proinflammatory comorbid conditions influence the pathogenesis of HFpEF and CKD. Renal dysfunction in HFpEF is a consequence of the complex interplay between hemodynamic factors, systemic congestion, inflammation, endothelial dysfunction, and neurohormonal mechanisms. In contrast to heart failure with reduced ejection fraction, there is a dearth of effective targeted therapies for HFpEF. Tailoring study design toward the different phenotypes and delving into their pathophysiology may be fruitful in development of effective phenotype-specific targeted pharmaceutical therapies.
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Affiliation(s)
- Manjula G Ananthram
- Department of Internal Medicine, Division of Cardiology, University of Maryland, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA.
| | - Stephen S Gottlieb
- Department of Internal Medicine, Division of Cardiology, University of Maryland, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA
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6
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El Iskandarani M, El Kurdi B, Murtaza G, Paul TK, Refaat MM. Prognostic role of albumin level in heart failure: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24785. [PMID: 33725833 PMCID: PMC7969328 DOI: 10.1097/md.0000000000024785] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hypoalbuminemia (HA) is common in HF, however, its pathophysiology and clinical implications are poorly understood. While multiple studies have been published in the past decade investigating the role of serum albumin in HF, there is still no consensus on the prognostic value of this widely available measure. The objective of this study is to assess the prognostic role of albumin in heart failure (HF) patient. METHODS Unrestricted searches of MEDLINE, EMBASE, Cochrane databases were performed. The results were screened for relevance and eligibility criteria. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The Begg and Mazumdar rank correlation test was utilized to evaluate for publication bias. RESULTS A total of 48 studies examining 44,048 patients with HF were analyzed. HA was found in 32% (95% confidence interval [CI] 28.4%-37.4%) HF patients with marked heterogeneity (I2 = 98%). In 10 studies evaluating acute HF, in-hospital mortality was almost 4 times more likely in HA with an odds ratios (OR) of 3.77 (95% CI 1.96-7.23). HA was also associated with a significant increase in long-term mortality (OR: 1.5; 95% CI: 1.36-1.64) especially at 1-year post-discharge (OR: 2.44; 95% CI: 2.05-2.91; I2 = 11%). Pooled area under the curve (AUC 0.73; 95% CI 0.67-0.78) was comparable to serum brain natriuretic peptide (BNP) in predicting mortality in HF patients. CONCLUSION Our results suggest that HA is associated with significantly higher in-hospital mortality as well as long-term mortality with a predictive accuracy comparable to that reported for serum BNP. These findings suggest that serum albumin may be useful in determining high-risk patients.
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Affiliation(s)
| | | | - Ghulam Murtaza
- Cardiology Division, East Tennessee State University, Johnson City, Tennessee
| | - Timir K. Paul
- Cardiology Division, East Tennessee State University, Johnson City, Tennessee
| | - Marwan M. Refaat
- Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
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7
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Kocabaş U, Kıvrak T, Yılmaz Öztekin GM, Tanık VO, Özdemir İ, Kaya E, Yüce Eİ, Avcı Demir F, Doğduş M, Altınsoy M, Üstündağ S, Özyurtlu F, Karagöz U, Karakuş A, Urgun OD, Sinan ÜY, Mutlu İ, Şen T, Astarcıoğlu MA, Kınık M, Özden Tok Ö, Uygur B, Yeni M, Alan B, Dalgıç O, Altay H, Pehlivanoğlu S. Gender-related clinical and management differences in patients with chronic heart failure with reduced ejection fraction. Int J Clin Pract 2021; 75:e13765. [PMID: 33063424 DOI: 10.1111/ijcp.13765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/08/2020] [Accepted: 10/04/2020] [Indexed: 12/28/2022] Open
Abstract
AIM Gender-related differences have been described in the clinical characteristics and management of patients with chronic heart failure with reduced ejection fraction (HFrEF). However, published data are conflictive in this regard. METHODS We investigated differences in clinical and management variables between male and female patients from the ATA study, a prospective, multicentre, observational study that included 1462 outpatients with chronic HFrEF between January and June 2019. RESULTS Study population was predominantly male (70.1%). In comparison to men, women with chronic HFrEF were older (66 ± 11 years vs 69 ± 12 years, P < .001), suffered more hospitalisations and presented more frequently with NYHA class III or IV symptoms. Ischaemic heart disease was more frequent in men, whereas anaemia, thyroid disease and depression were more frequent in women. No difference was seen between genders in the use rate of renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or ivabradine, or in the proportion of patients achieving target doses of these drugs. Regarding device therapies, men were more often treated with an implantable cardioverter-defibrillator (ICD) and women received more cardiac resynchronisation therapy. CONCLUSION In summary, although management seemed to be equivalent between genders, women tended to present with more symptoms, require hospitalisation more frequently and have different comorbidities than men. These results highlight the importance of gender-related differences in HFrEF and call for further research to clarify the causes of these disparities. Gender-specific recommendations should be included in future guidelines in HFrEF.
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Affiliation(s)
- Umut Kocabaş
- Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey
| | - Tarık Kıvrak
- Department of Cardiology, School of Medicine Hospital, Firat University, Elazığ, Turkey
| | - Gülsüm Meral Yılmaz Öztekin
- Department of Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Veysel O Tanık
- Department of Cardiology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - İbrahim Özdemir
- Department of Cardiology, Nizip State Hospital, Gaziantep, Turkey
| | - Ersin Kaya
- Department of Cardiology, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey
| | - Elif İlkay Yüce
- Department of Cardiology, Kelkit State Hospital, Gümüşhane, Turkey
| | - Fulya Avcı Demir
- Department of Cardiology, Elmalı State Hospital, Antalya, Turkey
| | - Mustafa Doğduş
- Department of Cardiology, Karaman State Hospital, Karaman, Turkey
| | - Meltem Altınsoy
- Department of Cardiology, University of Health Sciences Ankara Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Songül Üstündağ
- Department of Cardiology, Erzincan Binali Yıldırım Unıversıty, Mengücek Gazi Educatıon and Research Hospıtal, Erzincan, Turkey
| | - Ferhat Özyurtlu
- Department of Cardiology, Grandmedical Hospital, Manisa, Turkey
| | - Uğur Karagöz
- Department of Cardiology, Izmir Katip Celebi University Atatürk Education and Research Hospital, Izmir, Turkey
| | - Alper Karakuş
- Department of Cardiology, Besni State Hospital, Adıyaman, Turkey
| | - Orsan Deniz Urgun
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Ümit Yaşar Sinan
- Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Istanbul University, Istanbul, Turkey
| | - İnan Mutlu
- Department of Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Taner Şen
- Department of Cardiology, School of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Mehmet Ali Astarcıoğlu
- Department of Cardiology, School of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Mustafa Kınık
- Department of Cardiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey
| | - Özge Özden Tok
- Department of Cardiology, Memorial Hospital, Istanbul, Turkey
| | - Begüm Uygur
- Department of Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehtap Yeni
- Department of Cardiology, Isparta State Hospital, Isparta, Turkey
| | - Bahadır Alan
- Department of Cardiology, School of Medicine, Okan University, Istanbul, Turkey
| | - Onur Dalgıç
- Department of Cardiology, Life Park Hospital, Sivas, Turkey
| | - Hakan Altay
- Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey
| | - Seçkin Pehlivanoğlu
- Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey
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8
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Uijl A, Veenis JF, Brunner-La Rocca HP, van Empel V, Linssen GCM, Asselbergs FW, van der Lee C, Eurlings LWM, Kragten H, Al-Windy NYY, van der Spank A, Koudstaal S, Brugts JJ, Hoes AW. Clinical profile and contemporary management of patients with heart failure with preserved ejection fraction: results from the CHECK-HF registry. Neth Heart J 2021; 29:370-376. [PMID: 33439465 PMCID: PMC8271056 DOI: 10.1007/s12471-020-01534-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background Clinical management of heart failure with preserved ejection fraction (HFpEF) centres on treating comorbidities and is likely to vary between countries. Thus, to provide insight into the current management of HFpEF, studies from multiple countries are required. We evaluated the clinical profiles and current management of patients with HFpEF in the Netherlands. Methods We included 2153 patients with HFpEF (defined as a left ventricular ejection fraction ≥ 50%) from the CHECK-HF registry, which included patients from 2013 to 2016. Results Median age was 77 (IQR 15) years, 55% were women and the most frequent comorbidities were hypertension (51%), renal insufficiency (45%) and atrial fibrillation (AF, 38%). Patients between 65 and 80 years and those over 80 years had on average more comorbidities (up to 64% and 74%, respectively, with two or more comorbidities) than patients younger than 65 years (38% with two or more comorbidities, p-value < 0.001). Although no specific drugs are available for HFpEF, treating comorbidities is advised. Beta-blockers were most frequently prescribed (78%), followed by loop diuretics (74%), renin-angiotensin system (RAS) inhibitors (67%) and mineralocorticoid receptor antagonists (MRAs, 39%). Strongest predictors for loop-diuretic use were older age, higher New York Heart Association class and AF. Conclusion The medical HFpEF profile is determined by the underlying comorbidities, sex and age. Comorbidities are highly prevalent in HFpEF patients, especially in elderly HFpEF patients. Despite the lack of evidence, many HFpEF patients receive regular beta-blockers, RAS inhibitors and MRAs, often for the treatment of comorbidities. Supplementary Information The online version of this article (10.1007/s12471-020-01534-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Uijl
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J F Veenis
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Thoraxcenter, Rotterdam, Rotterdam, The Netherlands.
| | - H P Brunner-La Rocca
- Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - V van Empel
- Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, Almelo, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - C van der Lee
- Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands
| | | | - H Kragten
- Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | | | | | - S Koudstaal
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J J Brugts
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Thoraxcenter, Rotterdam, Rotterdam, The Netherlands
| | - A W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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9
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Dong B, He X, Xue R, Chen Y, Zhao J, Zhu W, Liang W, Wu Z, Wu D, Huang H, Zhou Y, Dong Y, Liu C. Clinical implication of pulmonary hospitalization in heart failure with preserved ejection fraction: from the TOPCAT. ESC Heart Fail 2020; 7:3801-3809. [PMID: 32964677 PMCID: PMC7754907 DOI: 10.1002/ehf2.12966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/07/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022] Open
Abstract
Aims The aim of the study was to explore the risk factors and evaluate the prognostic implication of pulmonary hospitalization on heart failure (HF) with preserved ejection fraction (HFpEF). Methods and results We performed a secondary analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT). A total of 1714 patients with HFpEF were analysed in our study. In the multivariate Cox proportional hazards regression analysis, history of chronic obstructive pulmonary disease (COPD), smoking, bone fracture after the age of 45, and previous HF hospitalization were identified as independent risk factors for pulmonary hospitalization. To evaluate the prognostic significance of pulmonary hospitalization, patients were categorized into five groups according to the causes of their first hospitalization. The all‐cause and cardiovascular (CV) mortality risks in these five groups were compared using time‐varying Cox proportional hazards model. Compared with patients without hospitalization during follow‐up, those with pulmonary hospitalization were associated with a 204% increase [hazard ratio (HR) 3.04, 95% confidence interval (CI) 2.07–4.47, P < 0.001] and 164% increase (HR 2.64, 95% CI 1.60–4.36, P < 0.001) in risks of all‐cause and CV mortality, respectively, while the corresponding risk increases associated with HF hospitalization were 146% (HR 2.46, 95% CI 1.74–3.48, P < 0.001) for all‐cause mortality and 186% (HR 2.86, 95% CI 1.87–4.36, P < 0.001) for CV mortality. Conclusions Pulmonary hospitalization was associated with a significant increase in risks of all‐cause and CV mortality, which was comparable with that associated with HF hospitalization. The results suggested that pulmonary hospitalization could be another important clinical endpoint of HFpEF.
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Affiliation(s)
- Bin Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Xin He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Ruicong Xue
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Yili Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Jingjing Zhao
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Weihao Liang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Zexuan Wu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Dexi Wu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Huiling Huang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Yuanyuan Zhou
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, China
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11
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Abstract
Elevated blood pressure (BP) has a strong and continuous association with Stage B and C heart failure (HF) and carries the highest attributable risk for HF. Intensive treatment of hypertension is crucial, as progression from hypertension (Stage A HF) to left ventricular hypertrophy (LVH) or other structural damage (Stage B HF) is common despite therapy. Echo cardiography is the modality of choice to detect Stage B HF. Ideally, Stage B HF should be prevented. However, regression of established LVH and other structural damage is feasible and improves prognosis. Despite differences among antihypertensive agents, control of BP remains the most important goal.
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Affiliation(s)
- Andreas P Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook University Medical Center, Health Sciences Center, 101 Nicolls Road, T-16, Rm 080, Stony Brook, NY 11794-8167, USA.
| | - Clive Goulbourne
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook University Medical Center, Health Sciences Center, 101 Nicolls Road, T-16, Rm 080, Stony Brook, NY 11794-8167, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, USA
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12
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Kalogeropoulos AP, Kim S, Rawal S, Jadonath A, Tangutoori R, Georgiopoulou V. Serial Changes in Left Ventricular Ejection Fraction and Outcomes in Outpatients With Heart Failure and Preserved Ejection Fraction. Am J Cardiol 2019; 124:729-735. [PMID: 31272702 DOI: 10.1016/j.amjcard.2019.05.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 02/07/2023]
Abstract
Limited data exist on the course of left ventricle ejection fraction (LVEF) among outpatients with heart failure (HF) and preserved ejection fraction (HFpEF) and its impact on outcomes. We evaluated 322 consecutive outpatients with confirmed HF, LVEF >40%, no previous LVEF ≤40%, and no specific cardiomyopathies or primary right-sided or valvular heart disease. Median age was 73 years (interquartile range: 63 to 82); 57.1% were women, 50.3% White, and 45.0% Black; median LVEF was 55% (50% to 60%); and 45.6% had coronary artery disease. After a median of 37 months (32 to 38) and 4.5 follow-up echocardiograms (4 to 6) per patient, 11.4% of patients (95% confidence interval [CI] 5.2% to 17.7%) developed LVEF <40%. The average drop in LVEF among these patients was 19.4 units (95%CI 15.0 to 23.8) to an average LVEF of 30.3% (95%CI 27.4% to 33.2%). Baseline systolic blood pressure >130 mm Hg was associated with more LVEF decline. During follow-up, 50 patients died (3-year mortality 15.3%) and 67 additional patients were hospitalized for HF (3-year death plus HF hospitalization 35.6%). Development of LVEF <40% was subsequently followed by 5-fold higher mortality in time-updated models (adjusted HR 4.91; 95%CI 2.00 to 12.0; p = 0.001) and 3.5-fold higher rates of death or HF hospitalization (adjusted HR 3.70; 95%CI 1.67 to 8.19; p = 0.001). Interval coronary events were infrequent (10%) among patients with deteriorated LVEF. The impact of LVEF changes on outcomes was similar in White and Black patients. In conclusion, a proportion of patients with HFpEF will develop reduced LVEF over time. These patients have worse prognosis subsequently.
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Affiliation(s)
| | - Samuel Kim
- School of Medicine, Stony Brook University, Stony Brook, New York
| | - Sahil Rawal
- School of Medicine, Stony Brook University, Stony Brook, New York
| | - Arvin Jadonath
- School of Medicine, Stony Brook University, Stony Brook, New York
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Özlek B, Özlek E, Ağuş HZ, Tekinalp M, Kahraman S, Çil C, Çelik O, Başaran Ö, Doğan V, Kaya BC, Rencüzoğulları I, Ösken A, Bekar L, Çakır MO, Çelik Y, Mert KU, Sancar KM, Sevinç S, Mert GÖ, Biteker M. Patients with HFpEF and HFmrEF have different clinical characteristics in Turkey: A multicenter observational study. Eur J Intern Med 2019; 61:88-95. [PMID: 30446354 DOI: 10.1016/j.ejim.2018.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/28/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To determine and compare the demographic characteristics, clinical profile and management of patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) in a Turkish cohort. METHODS The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is an observational and multicenter study conducted in Turkey. Consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had HFmrEF or HFpEF were included (NCT03026114). RESULTS The study population included 1065 (mean age of 67.1 ± 10.6 years, 54% women) patients from 12 sites in Turkey. Among participants, 246 (23.1%) had HFmrEF and 819 (76.9%) had HFpEF. Compared to patients with HFpEF, those with HFmrEF were more likely to be male (57.7 vs 42.2%; p < 0.001), had higher N-terminal pro-B-type natriuretic peptide levels (853 vs 528 pg/ml, p < 0.001), were more likely to have ECG abnormalities (72.4 vs 53.5%, p < 0.001) and hospitalization history for heart failure (28 vs 18.6%; p = 0.002). HFmrEF patients were more likely to use β-blockers (69.9 vs 55.2%, p < 0.001), aldosterone receptor antagonists (24 vs 14.7%, p = 0.001), statins (37 vs 23%, p < .001), and loop diuretics (39.8 vs 30.5%, p = 0.006) compared to patients with HFpEF. CONCLUSIONS The results of APOLLON study support that the basic characteristics and etiology of HFmrEF are significantly different from HFpEF. This registry also showed that the patients with HFmrEF and HFpEF were younger but undertreated in Turkey compared to patients in western countries.
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Affiliation(s)
- Bülent Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey.
| | - Eda Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Hicaz Zencirkıran Ağuş
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Tekinalp
- Department of Cardiology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey
| | - Serkan Kahraman
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cem Çil
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Özcan Başaran
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Volkan Doğan
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Bedri Caner Kaya
- Department of Cardiology, Mehmet Akif İnan Training and Research Hospital, Sanlıurfa, Turkey
| | | | - Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Corum Erol Olcok Training and Research Hospital, Corum, Turkey
| | - Mustafa Ozan Çakır
- Department of Cardiology, Bulent Ecevit Universiy Medical Faculty, Zonguldak, Turkey
| | - Yunus Çelik
- Department of Cardiology, Kirikkale Yuksek İhtisas Hospital, Kirikkale, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Kadriye Memiç Sancar
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Samet Sevinç
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gurbet Özge Mert
- Department of Cardiology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey; Department of Cardiology, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Murat Biteker
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
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Alex L, Russo I, Holoborodko V, Frangogiannis NG. Characterization of a mouse model of obesity-related fibrotic cardiomyopathy that recapitulates features of human heart failure with preserved ejection fraction. Am J Physiol Heart Circ Physiol 2018; 315:H934-H949. [PMID: 30004258 PMCID: PMC6230908 DOI: 10.1152/ajpheart.00238.2018] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 12/12/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is caused, or exacerbated by, a wide range of extracardiac conditions. Diabetes, obesity, and metabolic dysfunction are associated with a unique HFpEF phenotype, characterized by inflammation, cardiac fibrosis, and microvascular dysfunction. Development of new therapies for HFpEF is hampered by the absence of reliable animal models. The leptin-resistant db/ db mouse has been extensively studied as a model of diabetes-associated cardiomyopathy; however, data on the functional and morphological alterations in db/ db hearts are conflicting. In the present study, we report a systematic characterization of the cardiac phenotype in db/ db mice, focusing on the time course of functional and histopathological alterations and on the identification of sex-specific cellular events. Although both male and female db/ db mice developed severe obesity, increased adiposity, and hyperglycemia, female mice had more impressive weight gain and exhibited a modest but significant increase in blood pressure. db/ db mice had hypertrophic ventricular remodeling and diastolic dysfunction with preserved ejection fraction; the increase in left ventricular mass was accentuated in female mice. Histological analysis showed that both male and female db/ db mice had cardiomyocyte hypertrophy and interstitial fibrosis, associated with marked thickening of the perimysial collagen, and expansion of the periarteriolar collagen network, in the absence of replacement fibrosis. In vivo and in vitro experiments showed that fibrotic changes in db/ db hearts were associated with increased collagen synthesis by cardiac fibroblasts, in the absence of periostin, α-smooth muscle actin, or fibroblast activation protein overexpression. Male db/ db mice exhibited microvascular rarefaction. In conclusion, the db/ db mouse model recapitulates functional and histological features of human HFpEF associated with metabolic dysfunction. Development of fibrosis in db/ db hearts, in the absence of myofibroblast conversion, suggests that metabolic dysfunction may activate an alternative profibrotic pathway associated with accentuated extracellular matrix protein synthesis. NEW & NOTEWORTHY We provide a systematic analysis of the sex-specific functional and structural myocardial alterations in db/ db mice. Obese diabetic C57BL6J db/ db mice exhibit diastolic dysfunction with preserved ejection fraction, associated with cardiomyocyte hypertrophy, interstitial/perivascular fibrosis, and microvascular rarefaction, thus recapitulating aspects of human obesity-related heart failure with preserved ejection fraction. Myocardial fibrosis in db/ db mice is associated with a matrix-producing fibroblast phenotype, in the absence of myofibroblast conversion, suggesting an alternative mechanism of activation.
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MESH Headings
- Adiposity
- Animals
- Cardiomyopathies/etiology
- Cardiomyopathies/metabolism
- Cardiomyopathies/pathology
- Cardiomyopathies/physiopathology
- Cells, Cultured
- Disease Models, Animal
- Echocardiography, Doppler
- Extracellular Matrix/metabolism
- Extracellular Matrix/pathology
- Extracellular Matrix Proteins/metabolism
- Female
- Fibroblasts/metabolism
- Fibroblasts/pathology
- Fibrosis
- Heart Failure/etiology
- Heart Failure/metabolism
- Heart Failure/pathology
- Heart Failure/physiopathology
- Heart Ventricles/metabolism
- Heart Ventricles/pathology
- Heart Ventricles/physiopathology
- Humans
- Hypertension/etiology
- Hypertension/physiopathology
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Mice, Inbred C57BL
- Mice, Obese
- Myocardium/metabolism
- Myocardium/pathology
- Obesity/complications
- Obesity/genetics
- Obesity/physiopathology
- Sex Factors
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Remodeling
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Affiliation(s)
- Linda Alex
- Department of Medicine (Cardiology), The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Ilaria Russo
- Department of Medicine (Cardiology), The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Volodymir Holoborodko
- Department of Medicine (Cardiology), The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
| | - Nikolaos G Frangogiannis
- Department of Medicine (Cardiology), The Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
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