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Gioia G, Kresoja KP, Rosch S, Schöber A, Harnisch E, von Roeder M, Scholz M, Henger S, Isermann B, Thiele H, Lurz P, Rommel KP. Clinical Trajectory and Risk Stratification for Heart Failure with Preserved Ejection Fraction in a Real-World Cohort of Patients with Suspected Coronary Artery Disease. J Clin Med 2024; 13:2092. [PMID: 38610857 PMCID: PMC11012700 DOI: 10.3390/jcm13072092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a widespread condition with significant morbidity and mortality. Its clinical heterogeneity may delay the diagnosis. Aim: To identify predictors of HFpEF-related hospitalizations in ambulatory patients presenting with elevated cardiovascular risk, suspected coronary artery diseases (CADs), and positive HFpEF screenings. Methods: Consecutive patients presenting with suspected CAD, enrolled in the observational LIFE-Heart study (2006-2014, NCT00497887), and meeting HFpEF criteria per the 2016 European Society of Cardiology (ESC) guidelines were categorized according to the presence of "overlapping conditions" potentially masking or contributing to their symptoms. Additional stratification using the H2FPEF score (<2: low risk, 2-5: intermediate risk, and ≥6 high risk) was performed. Follow-up for hospitalizations, reasons of hospitalization, and death spanned a median of 6 years. Results: Of 1054 patients (66 ± 10 years, 60% male, NT-pro-BNP 286, IQR 183-574 pg/mL), 53% had overlapping conditions, while 47% had "isolated HFpEF". The H2FPEF scores classified 23%, 57%, and 20% as low-, intermediate-, and high-risk, respectively, with consistent proportions across patients with and without overlapping conditions (p = 0.91). During the follow-up observational phase, 54% were rehospitalized, 22% experienced heart failure (HF) rehospitalizations, and 11% of patients died. Multivariable logistic regression revealed a high-risk H2FPEF category as an independent predictor of HF rehospitalization in the overall cohort (odds ratio: 3.4, CI: 2.4-4.9, p < 0.01) as well as in patients with and without overlapping conditions. Furthermore, a H2FPEF score ≥ 6 was independently associated with higher mortality rates (hazard ratio: 1.8, CI: 1.2-2.6, p < 0.01) in the Cox regression analysis. Conclusions: Ambulatory patients presenting for suspected CAD and meeting HFpEF screening criteria face elevated risks for rehospitalizations over six years. Regardless of concomitant diagnoses, quantifying cardiac damage with the H2FPEF score helps in risk-stratifying patients for HF hospitalization and mortality.
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Affiliation(s)
- Guglielmo Gioia
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Karl-Patrik Kresoja
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Sebastian Rosch
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Anne Schöber
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Elias Harnisch
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Maximilian von Roeder
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Markus Scholz
- LIFE—Leipzig Research Center for Civilization Diseases, University of Leipzig, 04109 Leipzig, Germany;
- Institute of Medical Informatics, Statistic and Epidemiology, University of Leipzig, 04109 Leipzig, Germany;
| | - Sylvia Henger
- Institute of Medical Informatics, Statistic and Epidemiology, University of Leipzig, 04109 Leipzig, Germany;
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Holger Thiele
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Philipp Lurz
- Department of Cardiology, University Hospital Mainz, 55131 Mainz, Germany;
| | - Karl-Philipp Rommel
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
- Cardiovascular Research Foundation, New York, NY 10019, USA
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Rosch S, Rommel K, Blazek S, Kresoja K, Schöber A, von Roeder M, Desch S, Thiele H, Lurz P, Fengler K. Twenty-Four-Month Blood Pressure Results After Renal Denervation Using Endovascular Ultrasound. J Am Heart Assoc 2023; 12:e030767. [PMID: 37581398 PMCID: PMC10492948 DOI: 10.1161/jaha.123.030767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Renal denervation has proven its efficacy to lower blood pressure in comparison to sham treatment in recent randomized clinical trials. Although there is a large body of evidence for the durability and safety of radiofrequency-based renal denervation, there are a paucity of data for endovascular ultrasound-based renal denervation (uRDN). We aimed to assess the long-term efficacy and safety of uRDN in a single-center cohort of patients. METHODS AND RESULTS Data from 2 previous studies on uRDN were pooled. Ambulatory 24-hour blood pressure measurements were taken before as well as 3, 6, 12, and 24 months after treatment with uRDN. A total of 130 patients (mean age 63±9 years, 24% women) underwent uRDN. After 3, 6, 12, and 24 months, systolic mean 24-hour ambulatory blood pressure values were reduced by 10±12, 10±14, 8±15, and 10±15 mm Hg, respectively, when compared with baseline (P<0.001). Corresponding diastolic values were reduced by 6±8, 6±8, 5±9, and 6±9 mm Hg, respectively (P<0.001). Periprocedural adverse events occurred in 16 patients, and all recovered without sequelae. CONCLUSIONS In this single-center study, uRDN effectively lowered blood pressure up to 24 months after treatment.
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Affiliation(s)
- Sebastian Rosch
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl‐Philipp Rommel
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Stephan Blazek
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl‐Patrik Kresoja
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Anne Schöber
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | | | - Steffen Desch
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Holger Thiele
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Philipp Lurz
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl Fengler
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
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Schöber A, Voges I, Jerosch-Herold M, Wegner P, Gabbert D, Scheewe J, Uebing A, Kramer HH, Rickers C. Global Longitudinal Strain of the Left Ventricle in Patients with Transposition of the Great Arteries Is Associated with Aortic Elastic Properties and Left Atrial Function—Assessment of a Complex Interplay with MRI. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A. Schöber
- Herzzentrum Leipzig, Leipzig, Deutschland
| | - I. Voges
- Department of Pediatric Cardiology, Kiel, Deutschland
| | - M. Jerosch-Herold
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - P. Wegner
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - D. Gabbert
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - J. Scheewe
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A. Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | | | - C. Rickers
- University Heart Center Hamburg GmbH, Hamburg, Deutschland
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