bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenotyping of heart failure with preserved ejection faction using health electronic records and echocardiography
Authors: Pierre-Jean M , Bouzille G , L'official G , Cuggia M , Donal E
Published: October 2022

Patients suffering from heart failure (HF) symptoms and a preserved left ventricular ejection fraction (HFpEF) present very different clinical phenotypes that could influence their survival. This study aims to identify phenotypes of this type of HF by using the medical information database from our hospital center.

Methods and results

We develop a POC of machine learning model to predict the phenotype of patients suffering from HFpEF from both clinical and echocardiography data from data warehouse of our hospital center. We performed a retrospective observational study. We used the inpatient clinical data warehouse at our hospital center to identify patients suffering from HFpEF and having echocardiography between January 2018 and December 2019. A list of relevant clinical and echocardiographic variables was established by cardiologists. For clinical variables, we extracted information from the data warehouse using either structured data (ICD-10 codes, lab results, ...) or regular expressions for narratives. The echocardiographic parameters consisted only in structured data. We performed a two-step cluster analysis to identify common characteristics among patients. The final sample eligible included 2500 patients with echocardiography and diagnosed for HFpEF. The variables included in the two-step cluster analysis were both clinical (13 variables) and echographic (17 variables). Four clusters were identified from the clustering algorithm. The groups were relatively well balanced with respectively: 753, 744, 519 and 545 patients. After performing survival analysis, we observed that clusters have significative different survival curves in particular for death. The performances of these two models are satisfying with an AUC upper than 0.97 and an accuracy upper than 0.92) (Figure 1).

Conclusion

In the future, this work could be deployed as a tool for the physician to assess risks and contribute to support better care for patients. The phenotyping of HFpEF could improve the characterization of patients, the definition of the most appropriate treatments, and the care pathways.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Fédération française de cardiologie
Mortality patterns among patients with restrictive cardiomyopathy referred for CMR in a tertiary care center in Latin-America
Authors: Valderrama Achury M D , Higuera S A , Forero J F , Jaimes C P , Guerrero-Chalela C E , Rodriguez M J , Manrique F T , Barragan A , Zuluaga J D , Pino-Marin A , Medina H M
Published: October 2022

Background

Restrictive Cardiomyopathies (R-CMP) represent a wide array of conditions characterized by diastolic heart failure with important impairment in left ventricle filling pressures. These entities require different treatments, rendering etiological diagnosis a key component during the evaluation of these patients.

Purpose

Report the mortality of a select group of patients with R-CMP referred to CMR in a tertiary care center in Latin-America.

Methods

We analyzed all patients with CMR performed in our institution, including hospitalized and ambulatory patients, between 2016 and 2021. We extracted data of patients diagnosed by CMR with amyloidosis, hypertrophic cardiomyopathy (HCM), and endomyocardial fibrosis (EMF). All-cause mortality was extracted from national census data and analyzed using Kaplan-Meier survival estimates and log-rank test.

Results

Between June 1st, 2016, and December 31st, 2021, 5000 CMRs were performed at our institution. Among these, 317 (6.3%) patients were diagnosed with R-CMP by CMR as follows: 52 patients (16.4%) had amyloidosis, 250 patients had HCM (78.9%) and 15 patients (4.7%) had EMF. Of these, 40.7% were female (n=129), the median age was 63 yar-old (IQR 51–71) and 64.7% (n=205) were out-patients. At a mean follow-up of 33.3 months, there was a statistically significant difference in mortality between patients with amyloidosis (49,0%) and those with HCM and EMF (7,1% and 13,3%, respectively; P<0.001), as described in Figure 1.

Conclusions

R-CMP represent a meaningful percentage of patients referred for CMR in our institution with different survival rates. Amyloidosis patients had a significantly higher mortality rate compared to HCM and EMF, at a relatively short follow-up. Increased access to CMR in our region for optimal diagnosis and early treatment may optimize prognosis in these types of patients.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Self funding
Implications of the 2021 CKD-EPI cystatin C/creatinine eGFR equation for eligibility for therapy in HFrEF: insights from PARADIGM-HF
Authors: Tolomeo P , Kondo T , Butt J H , Desai A S , Lefkowitz M P , Rouleau J L , Solomon S D , Swedberg K , Zile M R , Campo G , Jhund P S , Packer M , McMurray J J V
Published: October 2022

Background

Estimated glomerular filtration rate (eGFR) is a key determinant of eligibility for many life-saving therapies in HFrEF. Recently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) provided new equations based on creatinine (CKD-EPIcr), cystatin C (CKD-EPIcys) or both (CKD-EPIcyscr) that do not include race. These new equations may reclassify individuals, irrespective of race, from one eGFR category to another, with implications for eligibility for HFrEF treatments.

Purpose

To assess the difference between eGFR estimation using the 2021 CKD-EPIcyscr equation and the 2009 CKD-EPIcr and Modification of Diet in Renal Disease Study (MDRD)-4 equations which are still standard in many European laboratories.

Methods

We included patients from PARADIGM-HF with cystatin C and creatinine values available at the time of randomization. For each patient, baseline eGFRs were calculated using the 3 equations described. Our focus was on patients with chronic kidney disease (CKD) stages III–V.

Results

Overall, 1910 patients were eligible. Mean age was 67.3 (10.1) year and 385 (18.7%) were female. Using 2009 CKD-EPIcr, 779 patients were in CKD stages 3–5, of which 233 (30%) were reclassified to a better CKD stage (higher eGFR) with the 2021 CKD-EPIcyscr equation (Table 1). Similar reclassification was seen when comparing MDRD-4 with the 2021 CKD-EPIcyscr equation: 277 (33%) of 831 patients in CKD stages 3–5 were reclassified to a better CKD stage (Figure 1).

Conclusions

The 2021 CKD-EPIcyscr equation favourably reclassified CKD stage in a large percentage of patients with HFrEF and a low eGFR, potentially increasing the proportion of these patients considered eligible for guideline-recommended therapies.

Funding Acknowledgement

Type of funding sources: None.
Further prognostic stratification in patients with oscillatory ventilation with exercise: is there more to it than just ups and downs?
Authors: Lopes Da Cunha G J , Rocha B , Maltes S , Freitas P , Gama F , Aguiar C , Moreno L , Durazzo A , Mendes M
Published: October 2022

Introduction

Exercise Oscillatory Ventilation (EOV) has numerous definitions, but the common foundation is the presence of an oscillatory phenomenon of the ventilation/minute graph with a given amplitude and frequency. Recently, it was proposed that the presence of a delay in O2 consumption (VO2) peak to minute ventilation (VE) peak during ventilatory oscillation was a predictor of worse prognosis in patients with heart failure (HF) and left ventricular ejection fraction (LVEF) <50%.

The aim of this work was to assess whether these characteristics add further prognostic value to the subset of patients with HF and EOV.

Methods

This was a single-centre retrospective cohort of consecutive patients with HF and LVEF <50% that underwent cardiopulmonary exercise testing (CPET) from 2016–2020. EOV was defined as per Vainshelboim 2017 (≥3 consecutive cyclic fluctuations of ventilation during exercise, average amplitude over 3 ventilatory oscillations ≥5L and an average length of three oscillatory cycles 40s to 140s). The presence of EOV was evaluated by 3 independent observers after observing a VE over time plot. For the creation of this plot, data was collected as a rolling average of 5 consecutive breaths. The presence of EOV was established if at least 2 observers agreed on the classification.

Afterwards, a second graph was plotted, with both VO2 and VE over time and the mean delay between VO2 peak to VE peak during EOV was manually calculated (Figure 1).

The primary endpoint was a composite of time to all-cause death, heart transplantation or left ventricular assistance device (LVAD) implantation.

Results

Of the 285 patients, 78 (27%) were classified as having EOV. These HF patients were mostly male (75%) with a mean age of 58±12 years, mean LVEF 31±10% with 63% having ischemic etiology. During a median follow up of 27 (17 to 43) months, 4 LVAD implantations, 12 heart transplantations and 18 deaths. The rate of primary outcome was 19% and 36% at 1- and 2-years. The amplitude, frequency, and maximum number of EOV cycles were not associated with the development of the primary endpoint. Only the mean delay between VO2 peak to VE peak during EOV was predictive of time to primary endpoint, even when adjusted for peak VO2 and VE VCO2 slope (adjusted HR 1.06 95% CI 1.009–1.114) (Figure 2). The cut-off of 5 seconds for mean VO2 peak to VE peak delay seems to be the most useful to predict the primary outcome at 2 years, with a sensitivity of 48% and specificity of 84%.

Conclusion

This novel parameter seems to be the only EOV-related parameter to enable further stratification of prognosis in a cohort of patients with severe HF, with the best cut-off of mean delay between VO2 peak to VE peak during EOV being 5 seconds.

Funding Acknowledgement

Type of funding sources: None.
Looking beyond left ventricular ejection fraction – a new multiparametric CMR score to refine the prognostic assessment of HF patients
Authors: Lopes Da Cunha G J , Rocha B , Sousa J , Maltes S , Brizido C , Strong C , Guerreiro S , Abecasis J , Andrade M J , Aguiar C , Saraiva C , Freitas P , Mendes M , Ferreira A
Published: October 2022

Background

Cardiac magnetic resonance (CMR) is recommended in Heart Failure (HF) to assess myocardial structure and function. Recently, the quantification of pulmonary congestion and skeletal muscle mass using CMR have been shown to predict adverse events in HF, but a tool integrating this information is currently unavailable. The purpose of this study was to develop and test a new multiparametric CMR-derived score.

Methods

We conducted a single-center retrospective study of consecutive HF patients with left ventricular ejection fraction (LVEF) <50% who underwent CMR. Several CMR parameters with known prognostic value were assessed, including: LVEF, Lung Water Density (LWD), Pectoralis Major Muscle (PMM) area, and presence of Late Gadolinium Enhancement. PMM area was outlined at the level of the carina – Figure 1A, B – and LWD was defined as the lung-to-liver signal ratio multiplied by 0.7, as previously described. Both parameters were measured in standard HASTE images - Figure 1C. The primary endpoint was a composite of all-cause death or HF hospitalization. Using the Cox regression Hazard Ratios of designated variables, a risk score was developed.

Results

Overall, 436 patients were included. During a median follow-up of 27 (17–37) months, 43 (9.9%) patients died and 57 (13.2%) had at least one hospitalization for HF. LVEF, LWD and PMM were independent predictors of the primary endpoint and were included in the CMR-HF score – Figure 2. The annual rate of events increased from 4.7 to 7.5 and 20.0% from lowest to highest tertile of the score. Roughly half of the events (54%) occurred in patients in the highest tertile of the CMR-HF score. In multivariate analysis, the new score independently predicted the primary endpoint (HR per 5 points: 1.54; 95% CI: 1.21–1.97; p<0.001) even after adjustment for age, body mass index, NYHA class, NT-proBNP, estimated glomerular filtration rate, presence of implantable cardioverter-defibrillator, and ischemic etiology.

Conclusions

This novel multidimensional CMR-HF score, combining easily obtainable data on left ventricular pump failure, lung congestion and muscular wasting, is a promising tool identifying HF patients with an LVEF <50% at higher risk of death or HF hospitalization.

Funding Acknowledgement

Type of funding sources: None.
Sudden cardiac death in heart failure. A 20 years perspective from a Mediterranean cohort
Authors: Codina Verdaguer P , Zamora E , Levy W C , Domingo M , Santiago-Vacas E , Cediel G , Santesmases J , Ruiz-Cueto M , Diez-Quevedo C , Roig T , Troya M I , Casquete D , Sarrias A , Lupon J , Bayes-Genis A
Published: October 2022

Background

Although sudden cardiac death (SCD) has progressively decreased in the last decade, it remains an important cause of death in patients with heart failure (HF). Differences based on clinical management and regional characteristics might be important.

Purpose

To assess the prevalence of SCD along 20 years of study in HF outpatients of different aetiologies managed in a multidisciplinary HF Clinic, and compare this prevalence with the expected proportional occurrence according to the acknowledged Seattle Proportional Risk Model (SPRM) score.

Methods

In a prospective observational registry of real-life HF outpatients, modes of death were classified as SCD (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death) and non-SCD (progression of HF, acute myocardial infarction, stroke, procedural, other cardiovascular causes and non-cardiovascular).

Results

From August 2001 to May 2021, 2772 outpatients with known cause of death and with SPRM score available were included. Out of them, 1351 (48.7%) died during a median follow-up of 3.8 years [IQR 1.6–7.8], up to 20 years. Observed prevalence of SCD in the 1351 dead patients was 13.6% while predicted SPRM prevalence was 39.6%. Annual SPRM predicted SCD mortality rate was 3.0% while observed SCD annual mortality rate was 1.3%. Figure 1 depicts cumulative incidence of causes of death through the study period. A lower prevalence of SCD was observed in every quintile of SPRM risk (Figure 2). This lower prevalence of SCD was observed independently of left ventricular ejection fraction group, ischemic or non-ischaemic aetiology and implantable cardiac defibrillator (ICD). Although the baseline SPRM predicted risk of SCD showed a significant decreasing trend (p=0.005) along the periods of admission at the Unit, the lower observed prevalence of SCD was seen in all periods of admission.

Conclusions

The prevalence of SCD through a perspective of 20 years in a Mediterranean HF outpatient cohort managed in a multidisciplinary HF Clinic was significantly lower than that expected according to the SPRM independently of degree of predicted risk, ischaemic aetiology, period of admission and implanted ICD. Regional lifestyle and dietary habits may have an impact on the lower rate of SCD in this Mediterranean cohort, and deserve further in-depth analyses.

Funding Acknowledgement

Type of funding sources: None.
Mortality and predictors of death in women and men with congestive heart failure of different types of cardiomyopathies
Authors: Mansur A D P , Del Carlo C H , Ramos Neto J A , Abreu A B , Scipioni A R , Pereira-Barreto A C
Published: October 2022

Background

Congestive heart failure (CHF) is one of the leading causes of death from cardiovascular disease and years lived with disability. Studies showed that women had better survival than men despite higher hospitalizations in women. However, there is evidence of a gender-associated risk of dying of heart failure of different types of cardiomyopathies (CMP).

Purpose

To analyze the mortality of CHF due to different types of CMP in women and men

Methods

From February 2017 to September 2020, we analyzed the mortality and the predictors of death in women and men with CHF (Framingham criteria) in five types of CMP (ischemic, idiopathic, hypertensive, Chagas, and valve disease). Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses used the Kaplan-Meier (K-M) method and the Cox proportional hazards methods to analyze death rates and search for predictors of death for women and men for each CMP.

Results

We studied 12,015 patients, mean of 63.8±14.3 years, 6637 (55%) males. For all patients, death occurred in 27.5%, 15.3%, 17.5%, 40.1%, and 24.4%, respectively, for ischemic, idiopathic, hypertensive, Chagas, and valve CMPs (p<0.0001). HFrEF was more prevalent in idiopathic (51.2%) and Chagas (49.9%), and for HFpEF valve disease (80.4%), hypertensive (51.9%), and ischemic (44.4%). Compared to men, women were older, had a higher baseline mean left ventricular ejection fraction (LVEF), and a lower left ventricular diastolic diameter (LVDD) for all five types of CMP (p<0,001). Over a 3-years follow-up period, the cumulative incidence of death was higher in men with ischemic CMP (38% vs. 31%; p=0.037) and Chagas CMP (48% vs. 38%; p<0,001) but similar for idiopathic, hypertensive, and valve disease CMP (figure). Cox regression analysis for death, for each CMP, adjusted for confounders such as age, sex, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation (AF), any cardiac surgery, cardiac pacemakers, and LVEF showed that men were an independent predictor of death only for Chagas CMP (HR=1,28; 95% CI: 1.08–1.43; p=0.009).

Conclusion

Men were at a higher risk of death in ischemic and Chagas CMP but not for idiopathic, hypertensive, and valve CMP. The other main predictors of death were similar for all types of CMP, namely CKD, stroke, diabetes, and AF.

Funding Acknowledgement

Type of funding sources: None.
Legacy effects of infection in patients with heart failure: a national cohort study of 31,318 patients in Taiwan
Authors: Chen C Y , Li Y H , Lee C H , Lin H W , Lin S H
Published: October 2022

Background

Although infection is a common cause of hospitalization in patients (pts) with heart failure (HF), the long-term cardiovascular (CV) prognosis in HF after infection is not well studied.

Methods and results

From 2009 to 2015, 310,485 pts with their first HF admissions and survival to discharge were identified from the National Health Insurance Research Database. Among the pts, 103,505 (33.3%) were readmitted within 1 year after HF discharge for infection, including pneumonia (44.2%), urinary tract infection (UTI) (37.9%), skin and soft tissue infections (9.7%), and others (8.1%). Those without admission for any infection were controls. We compared the primary composite endpoint, including all-cause death, acute myocardial infarction (AMI), stroke, and hospitalization for HF (HHF) between the 2 groups after the infection episode. After propensity score matching, the clinical characteristics (age 71.7±13.9 years, male 52.0%) and treatment were similar between the groups (n=15,659 in each group). In a mean follow-up time of 4.3±2.9 years, 86.2% pts with a history of infection admission and 63.6% pts in the control group met the primary endpoint. Multivariate Cox proportional hazards analysis showed the infection group had a higher risk of the primary composite endpoint (HR 1.760, 95% CI 1.714–1.807), including all-cause death (HR 1.587, 95% CI: 1.540–1.636), HHF (HR 1.993, 95% CI 1.922–2.066), AMI (HR 1.332, 95% CI 1.224–1.450), and stroke (HR 1.769, 95% CI 1.664–1.882). In infection group, HHF was the earliest outcome event with a mean time of 17.5 months and mortality is the second early event with a mean time of 23 months after discharge from the infection episode. Pneumonia carried a higher risk than UTI for the primary composite endpoint (HR 1.140, 95% CI 1.104–1.178).

Conclusions

One-third of HF pts discharged from the hospital experienced acute infection that required readmission. The pts had worse CV prognosis after readmission for infectious disease compared to those without infection

Funding Acknowledgement

Type of funding sources: Private hospital(s). Main funding source(s): This study is supported by National Cheng Kung University Hospital and Tainan Hospital, Ministry of Health and Welfare, Taiwan.
Heart failure admission to a cardiology department versus other internal medicine department is associated with improved long-term survival
Authors: Myhre P , Odegaard K M , Ravn J , Schirmer H
Published: October 2022

Background

Hospitalization for heart failure (HF) is associated with a high risk of in-hospital mortality, but also poor long-term outcomes. Although most hospital systems aim to admit patients with HF to cardiology departments, a significant proportion is admitted to other internal medicine departments due to shortages of beds and limited resources. The prognostic importance of being admitted to different departments is unknown.

Purpose

To compare the long-term mortality rate in patients admitted to hospital with a first diagnosis for HF to a cardiology department versus other internal medicine departments at a large academic hospital in Norway with a catchment area of 560,000 individuals.

Methods

Adult patients with a first ICD-10 diagnosis of HF (I11.0, I13.0, I13.2, I42.x, I50.x) admitted to an internal medicine department at our University Hospital between 2011 and 2019 were included. All-cause mortality was obtained from the Norwegian Cause of death registry until December 31, 2021.

Results

In total, we included 7,692 patients aged 76.1±13.0 years, of whom 46.0% were women, 57.4% had hypertension, 24.1% diabetes, 47.0% established coronary artery disease (CAD) and 36.0% a previous acute myocardial infarction (AMI). Of these, 50.7% were admitted to the cardiology department, 13.5% to the pulmonary department, 7.6% to the infectious disease department and the rest to other internal medicine departments. Patients admitted to the cardiology department were younger and more frequently men with established heart disease. They were more frequently examined with echocardiography during the first 30 days after admission, but had comparable levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) to those admitted to other departments (Table 1). During mean 5.9 years of follow-up, 56.6% of patients died. Patients admitted to the cardiology department had 37% lower mortality risk compared to other departments (HR 0.63 [95% CI 0.59–0.66], p<0.001). This association persisted after adjusting for age, sex, comorbidities (listed in the Table), NT-proBNP and undergoing echocardiographic examination (HR 0.75 [0.70–0.80], p<0.001). Having an echocardiographic examination was also associated with lower mortality risk in the same multivariable model (HR 0.92 [95% CI 0.86–0.97], p<0.001).

Conclusion

Admission to a cardiology department with HF is associated with better long-term outcomes compared to admission to other internal medicine departments. These findings support health care policy efforts to expand capacity at cardiology departments to allow best care for these vulnerable patients.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was in part funded by research grants from Novartis.
Aortic valve calcium in relation to subclinical cardiac dysfunction and risk of heart failure in the general population
Authors: Zhu F , Kaiser Y , Boersma H , Bos D , Kavousi M
Published: October 2022

Background

Emerging evidence suggests that aortic valve calcium (AVC) is associated with adverse cardiovascular outcomes, while the association of (early) AVC with subclinical cardiac dysfunction and with risk of heart failure (HF) remains unclear.

Purpose

To determine the association of CT-assessed AVC with echocardiographic measurements of cardiac dysfunction, and with HF in the general population.

Methods

We included 2,348 participants (mean age 68.5 years, 52% women) of the Rotterdam Study, who had AVC measured between 2003 and 2006, and without a history of HF at baseline. Linear regression models were used to explore cross-sectional associations of AVC with echocardiographic measures at baseline. All participants were followed for HF event until December 2016. Cox proportional hazard models were used to assess the association of AVC with incident HF. Models were adjusted for potential confounders.

Results

The presence of AVC was associated with 3.14 g/m2 (95% CI, 1.50 to 4.79) higher mean left ventricular mass indexed by body surface area. One-unit larger log (AVC+1) was associated with 0.01 mm (95% CI 0.01 to 0.02) larger mean left atrial size. During a median follow-up of 9.8 years, 182 incident HF cases were identified. Presence of AVC was associated with 37% greater risk for HF (HR, 1.37; 95% CI, 1.01 to 1.87). One-unit larger log (AVC+1) was associated with 11% larger risk of HF (HR, 1.11; 95% CI, 1.04 to 1.18). Compared with the AVC =0, AVC ≥100 had 1.70 folded risk of HF (HR, 1.70; 95% CI, 1.17 to 2.49).

Conclusions

The levels of AVC were associated with markers of left ventricular structure and with risk of HF, independent of traditional cardiovascular risk factors. Larger CT-assessed AVC is an indicative of increased risk for development of HF.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Netherlands Organization for the Health Research and Development (ZonMw)Dutch Heart Foundation (03-004-2021-T050)
Developing and validating a prognostic model for mortality in patients with heart failure
Authors: Muhammad-Kamal H , Iyen B , Weng S
Published: October 2022

Background

Heart Failure (HF) constitutes a major public health problem which remains highly prevalent in the UK and globally. Primary care plays a role in the long-term management of patients with heart failure but there are no clinically useful prognostic models to guide primary care professionals in determining those at increased risk of mortality, who could benefit from appropriate advanced care planning or escalation of treatment. Several predictive models exist but due to several limitations, clinical utility of these in the UK are limited.

Purpose

This study developed and validated a prognostic algorithm, the Nottingham Heart Failure Model, to predict the one-year risk of all-cause mortality in patients with HF.

Methods

This was a retrospective open cohort study using electronic primary care records from the UK Clinical Practice Research Datalink (CPRD) linked with secondary care records from Hospital Episode Statistics (HES) and death registration data from the Office for National Statistics (ONS). Adults with a diagnosis of heart failure were identified and multivariable Cox regression models were used to identify the risk factors that were independently associated with mortality. A prognostic model was developed to predict the one-year risk of mortality in patients with heart failure, and this was validated by bootstrapping 200 samples of the derivation data. The cohort was then split into even quartiles based on predicted risk scores from the model. These risk groups ranged from one to four with one indicating the quartile of scores with the lowest risk. Kaplan Meier curves were then produced for each group. The Royston D-statistic was then used to assess the discrimination of these quartiles by quantifying the observed separation between these groups.

Results

A total of 109,577 patients with diagnoses of heart failure were followed up from 1 January 2000 to 31 December. There were 16,437 deaths during the period of follow up. We identified 29 factors which were significantly associated with mortality risk and a prognostic model which incorporated these factors, was developed. The resulting prognostic model obtained a model validation score (C-statistic) of 0.79. The agreement between the observed and predicted proportion of events showed excellent apparent calibration. The D statistic of 1.65 suggests that the model provides a reasonably high amount of prognostic separation.

Conclusion(s)

Several patient characteristics including comorbidities, treatments, and biomarkers are significantly associated with heart failure mortality. This new model has the potential to accurately predict heart failure mortality within one year and will enable primary care professionals to better risk stratify their patients with heart failure.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Aziz Foundation
Plasma amyloid-beta in relation to cardiac function and risk of heart failure in the general population
Authors: Zhu F , Wolters F J , Yaqub A , Boersma H , Ikram M A , Kavousi M
Published: October 2022

Background

Amyloid-β is a major hallmark of Alzheimer's disease, and its pathology has been hypothesized as a multiple organ syndrome that may also affect cardiac function. There are limited data on association of plasma amyloid-β with cardiac dysfunction and risk of HF in the general population.

Objective

To determine the association of plasma amyloid-β40 (Aβ40) and amyloid-β42 (Aβ42) with echocardiographic measurements of cardiac dysfunction, and with incident heart failure (HF) in the general population.

Methods

We included 4156 participants of the population-based cohort (mean age 71.4 years, 57.1% women), who had plasma amyloid-β measured between 2002 and 2005, and were free of dementia and HF at baseline. Multivariable linear regression models were used to explore the associations of plasma Aβ40 and Aβ42 with echocardiographic measures. Participants were followed for the occurrence of HF until December 2016. Cause-specific hazard models were used to assess the association of plasma amyloid-β with incident HF and competing risk event. Models were adjusted for cardiovascular risk factors.

Results

Higher plasma Aβ40 concentrations were associated with lower left ventricular ejection fraction (β, −0.39; 95% CI, −0.68 to −0.10) and larger left ventricular mass (β, 0.70; 95% CI, 0.06 to 1.34). Aβ42 was not significantly associated with echocardiographic measures cross-sectionally. During follow-up (median 10.2 years), 472 incident HF cases were identified. Higher plasma Aβ40 was associated with an increased risk of incident HF (HR, 1.32; 95% CI, 1.15 to 1.51), more profound in men than in women (P value for interaction: 0.022). One SD increase in Aβ40 was associated with a 31% increase in the hazard of HF in men (HR, 1.32; 95% CI, 1.14 to 1.54) but the association was not significant in women (HR, 1.06; 95% CI, 0.93 to 1.20). Higher plasma Aβ42 concentrations were associated with increased risk of HF (HR, 1.12; 95% CI, 1.02 to 1.24), while further adjustment for concomitant Aβ40 attenuated this association (HR, 1.03; 95% CI, 0.92 to 1.16).

Conclusion

Higher levels of plasma Aβ40 were independently associated with worse cardiac function and higher risk of new-onset HF in the general population, in particular among men.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): The Netherlands Organization for Health Research and Development (ZonMw); the Dutch Heart Foundation;This study is further funded by the European Union's Horizon 2020 research and innovation programme as part of the Common mechanisms and pathways in Stroke and Alzheimer's disease (CoSTREAM) project.
Hypertension is associated with more advanced heart failure in african americans with suspected cardiac amyloidosis
Authors: Manjunath S , Deych E , Lenihan D J , Zhang K W
Published: October 2022

Background

Prior studies have shown worse clinical outcomes for African Americans with transthyretin and light chain cardiac amyloidosis as compared to Caucasians. Hypertensive heart disease is common among African Americans, and a known echocardiographic mimic of cardiac amyloidosis. The association between hypertension and heart failure severity in patients with suspected cardiac amyloidosis has not been well characterized.

Purpose

We sought to identify phenotypic differences between African American and Caucasian patients with suspected cardiac amyloidosis with and without hypertension.

Methods

We retrospectively identified consecutive patients who underwent cardiac biopsy for evaluation of cardiac amyloidosis at our institution between 2000–2018. Clinical and demographic data were obtained from the medical record. Electrocardiograms and echocardiograms performed at the time of cardiac biopsy were interpreted by study personnel.

Results

Among 230 patients with suspected cardiac amyloidosis, 144 (58%) had a prior diagnosis of hypertension. Hypertension was more common among African Americans (71 of 91, 78%) than among Caucasians (73 of 139, 52%). Among African Americans with suspected cardiac amyloidosis, those with hypertension had higher left ventricular mass index (156 versus 119 g/m2), lower left ventricular ejection fraction (47% versus 56%), worse global longitudinal strain (−9.0% versus −11.7%), and higher creatine (1.95 versus 1.43 mg/dL) than those without hypertension (p<0.05 for all). There were no differences in these parameters among Caucasians with and without hypertension.

Conclusions

Among African Americans with suspected cardiac amyloidosis, those with hypertension had worse systolic function and more advanced heart failure than those without hypertension. Targeted screening and/or surveillance strategies are needed to improve early diagnosis of cardiac amyloidosis in African American patients with hypertension.

Funding Acknowledgement

Type of funding sources: None.
Prognostic impact of the serial change of a systemic inflammation-nutrition index in patients with heart failure with preserved ejection fraction: insights from pursuit-hfpef registry
Authors: Sakamoto D , Seo M , Yamada T , Yano M , Hayashi T , Yasumura Y , Hikoso S , Sotomi Y , Sakata Y
Published: October 2022

Background

Malnutrition and inflammation are associated with poor outcomes with heart failure (HF). It has been reported that advanced lung cancer inflammation index (ALI), calculated by body mass index × serum albumin level / neutrophil to lymphocyte ratio (NLR) can be useful for the risk stratification and predicting the post-discharge prognosis of the patients with acute decompensated heart failure (ADHF). However, there is no information available on the prognostic value of the serial ALI change in ADHF patients with preserved ejection fraction (HFpEF).

Methods and results

Patients' data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for ADHF-HFpEF in Osaka. Laboratory data and body weight measurements were performed at the discharge and 1 year after the discharge. We analyzed 527 patients after exclusion of patients on dialysis, in-hospital death, missing follow-up data, or missing data to calculate ALI. The study patients were categorized by the serial change from baseline to 1 year after the discharge (ΔALI) as follows: low tertile: ΔALI <−6.99 (n=176), middle tertile: −6.99 ≤ ALI <8.44 (n=176), and high tertile: 8.44 ≤ ΔALI (n=175). The endpoints of the present study were all-cause death (ACD) and cardiovascular death (CVD). During a mean follow-up period of 1.5±1.0 years, 94 patients had ACD and 40 patients had CVD. The Kaplan-Meier analysis revealed that the patients with middle and low ΔALI at 1 year after heart failure hospitalization had a significantly greater risk of reaching the ACD and CVD than those with high ΔALI (ACD: 22% vs 22% vs 10%, p=0.0011, CVD: 10% vs 9% vs 3%, p=0.014). On multivariate Cox analysis, ΔALI was significantly associated with ACD independently of age, gender, serum NT-proBNP level, and baseline ALI after adjustment for NYHA functional class, serum creatinine level, serum hemoglobin level, serum CRP level, serum sodium level and LVEF.

Conclusion

This study showed that patients with the increased ALI after the discharge had improved outcome in comparison to those without the increased ALI. The serial change of ALI, a systemic inflammation-nutrition index, might be useful for stratifying ADHF patients with HFpEF at risk for the total mortality and cardiovascular mortality.

Funding Acknowledgement

Type of funding sources: None.
Sex versus gender-related differences in new-onset heart failure with preserved and reduced left ventricular ejection fraction
Authors: Qin H , Santema B T , Emmens J E , Van Essen B J , Gansevoort R T , Bakker S J L , De Boer R A , Voors A A
Published: October 2022

Aims

Sex refers to genetic and biological characteristics, whereas gender reflects psychosocial norms, roles and behaviors. Sex differences in new-onset heart failure are well described, but gender differences in new-onset heart failure with preserved (HFpEF) and reduced left ventricular ejection fraction (HFrEF) are unknown.

Methods

A total of 6830 participants (50.3% women, mean age of 54 years) from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) observational Dutch cohort were enrolled in the study. Gender-related characteristics were assessed using self-administered questionnaires. LASSO regression analysis selected the psychosocial variables related to sex, whose coefficient estimates were used to calculate the gender-related scores for each subject [1–2]. The participants were grouped by sex and further analyzed according to tertiles of the gender-related score. Competing-risk regression analysis was used to assess whether sex and gender were associated with new-onset HFrEF (LVEF ≤40%) and HFpEF (LVEF ≥50%).

Results

Women with predominantly masculine gender had lower BMI, were more often Caucasian and had higher total cholesterol and high-density lipoprotein (HDL) levels than women with a predominantly feminine gender. Men with predominantly feminine gender were less often Caucasian with lower total cholesterol and HDL cholesterol levels than men with a predominantly masculine gender. During a median follow-up of 8.3 years, 227 (3.3%) subjects were diagnosed with heart failure (57.3% HFrEF and 43.7% HFpEF). In the total population including both men and women, feminine gender was significantly and independently associated with a higher risk of new-onset HFpEF compared with masculine gender (HR per 10 point: 1.17, 95% CI: 1.06–1.30; p=0.003). However, sex was not associated with new-onset HFpEF (HR: 1.09, 95% CI: 0.73–1.62; p=0.670). Separately in men, feminine gender was associated with a higher risk of new-onset HFpEF (HR: 1.37, 95% CI: 1.06–1.78; p=0.017), but not in women (HR: 1.13, 95% CI: 0.90–1.41; p=0.310).

Conclusions

Gender and sex are different constructs and feminine gender was associated with an increased risk of new-onset HFpEF, whereas sex was not associated with new-onset HFpEF.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Dutch Kidney Foundation
Sex-related differences in long-term outcome of heart failure in low-risk patients with atrial fibrillation. A Swedish registry case-control study
Authors: Basic C , Hansson P O , Zverkova Sandstrom T , Johansson B , Fu M , Mandalenakis Z
Published: October 2022

Background

Knowledge about sex-related differences regarding long-term risk of heart failure (HF) among patients with atrial fibrillation (AF) is limited.

Aim

To evaluate the impact of sex on risks for new onset HF in patients with AF.

Methods

All patients from the Swedish National Patient Register, with a first-time diagnosis of AF between 1987 and 2018 were identified and compared with two matched controls without AF from the Total Population Register. Patients <18 years, or any previous cardiovascular disease, diabetes mellitus and renal failure at the baseline were excluded.

Results

In total 227,811 patients and 452,712 controls were included; 44.5% were women. The mean age (SD) for men was 65.5 (15) vs. 72.7 (13) in women (p<0.0001). The incidence rate for HF onset per 1000 person-years within one and five years after AF diagnosis was 77.3 (75.5–79.1) and 45.0 (44.3–45.7) in women vs. 66.5 (65.0–68.0) and 35.3 (34.8–35.9) in men, respectively. The incidence rate for HF onset increased with age in both patients with AF and controls, but was generally more pronounced in women. Women had 26% and 34% higher risk for HF onset, within five and thirty years, respectively. The highest risk for HF onset was found in women 18–34 years and 35–49 years of age, HR 24.64 (95%, confidence interval (CI) 7.59–80.0) and 8.09 (95%, CI 6.34–10.33) vs. 9.86 (95%, CI 6.81–14.27) and 6.52 (95%, CI 5.87–7.25) in equally old men. The mortality rate after HF was 42.3% and 33.1% in women and men with AF (p<0.0001).

Conclusion

In this nationwide, register-based cohort study, when compared to matched controls we found that the risk for HF onset was higher in women with AF, particularly in reproductive age, highlighting great importance of further research for prevention of HF in young women with AF but without any other cardiovascular risk factors.

Funding Acknowledgement

Type of funding sources: None.
The HFFI, a new frailty index for assessing long-term outcomes in heart failure
Authors: Santos J , Neto V , Correia J , Ferreira G , Correia E
Published: October 2022

Introduction

Patients hospitalized due to heart failure (HF) compose a heterogeneous population whose prognosis is difficult to forecast. Frailty is a well-recognized prognostic marker in multiple chronic diseases, including HF; however, frailty evaluation is often subjective and standardized and objective prediction models are lacking. We aimed to evaluate if an objective and simple index – Heart Failure Frailty Index (HFFI)– can predict long-term outcomes in this population.

Methods

A retrospective analysis of 258 patients admitted to a Cardiology ward due to HF was performed. The variables albumin, C-reactive protein levels, age and body mass index (BMI) were selected for frailty assessment. After attributing points for each variable, according to odds ratio on univariate analysis, the HFFI was calculated (range 0–8), resulting from the sum of the points attributed to each variable. Kaplan-Meyer and Cox-regression analysis were performed to evaluate HFFI association with 24-month mortality (24MM) and 24-month composite endpoint of rehospitalization or death (24MH).

Results

Mean patient age was 75 (±11) years; 51% were men. 45.7% had atrial fibrillation, 15.9% hat history of acute myocardial infarction, 67.8% had hypertension. Mean LVEF was 47% (±17). A LVEF <40% was present in 40% of patients. 24MM was 11.5% and 24 MH was 58%. Patients were considered frail if they had an HFFI ≥3. Kaplan-Meyer curve analysis revealed a significantly lower median time to 24MM in frail patients, as assessed by HFFI, comparing to non-frail patients (585±33 days vs 697±12 days, mortality rate: 25.4% vs 5.7%, χ2=18.156, p<0.001). There was also a significantly lower median time to 24MH in frail patients (336±34 days vs 449±24 days, combined endpoint rate: 76.1% vs 50.3%, χ2=10.884, p=0.001). Cox regression analysis demonstrated that HFFI independently predicts 24MM (HR: 1.364, p=0.002) and 24MH (HR: 1.106, p=0.035), even after adjustment for other prognostic markers, such as history of atrial fibrillation, previous myocardial infarction, diabetes and natriuretic peptides serum level at index event.

Conclusion

HFFI is a simple and objective frailty index correlated with 24MM and 24MH, being an independent prognostic marker in this population. Its use may help to identify patients with a high risk of mortality or readmission, in need of specialized care.

Funding Acknowledgement

Type of funding sources: None.
Ten year survival after an acute heart failure episode
Authors: Carreira M , Madureira S , Neves A , Elias C , Ribeirinho-Soares J P , Pereira J , Amorim M , Lourenco P
Published: October 2022

Background

Heart failure (HF) hospitalizations foreshadow a very gloomy outcome. In the first 3 months, the vulnerable period, mortality is around 10% and 28% of patients die in the first-year post hospitalization. Reports on 10-year survival are scarce.

Purpose

We assessed the 10-year survival rate in a 21st century cohort of acute HF patients and studied survival predictors.

Methods

We studied a cohort of HF patients that were included in an acute HF registry between March 2009 and December 2010. All patients hospitalized in the Internal Medicine Ward with the primary diagnosis of acute HF were eligible. Both patients with left ventricular systolic dysfunction and those with HF with preserved ejection fraction were included. As part of the registries protocol all patients had a complete examination and a venous blood sample collection both at admission and discharge. Patients were followed up to 10 years and all-cause mortality was the endpoint under analysis. A multivariate Cox-regression model was used to assess variables independently associated with 10-year death. A Receiver operator characteristic (ROC) curve was used to choose the best brain natriuretic peptide (BNP) cut-off for mortality prediction.

Results

A total of 591 patients surviving an HF decompensation episode were included in the analysis. Mean age was 76 (±12) years, 44.8% were male and 37.9% had preserved ejection fraction. Comorbidity burden was high: 76.6% had arterial hypertension and 50.6% had diabetes. Only 69 (11.7%) patients were alive 10-years post discharge. Survivors were younger (63 vs 78 years), less often presented diabetes, they had higher haemoglobin and albumin levels, better renal function and lower BNP and uric acid levels. Independent predictors of 10-year mortality were higher BNP, increasing age, lower albumin and atrial fibrillation. The area under the ROC curve for the association of BNP with 10-year death was of 0.71 (0.65–0.77), p<0.001. The best BNP cut-off for 10-year mortality prediction was 800pg/mL with a sensitivity of 50.4%, specificity=85.3%, positive predictive value (PPV) =96.3% and negative predictive value (NPV) of 18.6%. Patients with BNP≥800pg/mL have 96.6% probability of dying in the upcoming 10-years, and a HR of 1.95 (1.60–2.38), p<0.001 than those with lower values. Using a discharge BNP cut-off of 50pg/mL the negative predictive value is 66.0% and a PPV is 89.9% of being dead at 10-years. The PPV of dying in the upcoming 10-years was of 100% for patients with discharge BNP≥1864pg/mL.

Conclusions

The ten year survival rate of a real-world acute HF population was of 11.7%. The variables more strongly associated with 10-year mortality were higher BNP and age. Patients discharged with BNP ≥800pg/mL have 2-fold higher risk of dying in the upcoming 10 years than the remaining. All patients discharged with BNP ≥1864pg/mL were dead 10-years later.

Funding Acknowledgement

Type of funding sources: None.