Abstract
BackgroundInflammation is a key feature of heart failure including HFpEF. The leukocyte count is a marker of inflammation that is widely used in clinical practice. However, there is little available evidence for the relationship between leukocyte count and the outcomes of HFpEF.MethodsWe analyzed data from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. The primary outcome was all-cause mortality, the secondary outcome was composite cardiovascular events and hospitalization for heart failure. Multivariable Cox proportional hazard models were used to compare the risk profiles of patients with leukocyte quartiles, subgroup study divided by sex was also analyzed.ResultsThe present study included 2898 patients with HFpEF.429 deaths, 671 composite cardiovascular events and 386 hospitalization for heart failure occurred during a mean 3.4 years follow-up. The association between leukocyte count and adverse outcomes followed a U-shaped curve. After multivariable adjustment, the patients with the lowest leukocyte count (Q1) and the highest leukocyte count (Q4) faced higher risk of all-cause death(Q1 vs. Q2, adjusted HR: 1.439; 95% CI: 1.060–1.953, p = 0.020; Q4 vs. Q2, adjusted HR, 1.901; 95%CI: 1.424–2.539, p < 0.001). The subgroup analysis showed a consistent result in female but not male patients.ConclusionsThe association between leukocyte count and risk of adverse outcomes followed a U-shaped curve. Both higher and lower leukocyte count are associated with worse outcomes in patients with HFpEF, which may be attributed to the two sides of inflammation in cardiac remodeling.
Highlights
Inflammation is a key feature of heart failure including Heart failure with preserved ejection fraction (HFpEF)
Male sex, smoker, dyslipidemia, previous myocardial infarction, percutaneous coronary intervention (PCI), Coronary artery bypass graft (CABG), diabetes mellitus, atrial fibrillation, chronic obstructive pulmonary disease (COPD), asthma, thyroid disease, peripheral arterial disease, use of statins and loop diuretics were more prevalent in participants the higherleukocyte quartiles.At the same time, higher leukocytecount was associated with higher heart rate, body mass index, Urea nitrogen (BUN), hemoglobin and platelet.The higher leukocyte count was associated with lower diastolic blood pressure, eGFR and prevalence of New York Heart Association class III-IV
ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; Body Mass Index (BMI), body mass index; Brain natriuretic peptide (BNP), B-type natriuretic peptide; BUN, blood urea nitrogen; implantable cardioverter defibrillators (ICD), Implantable Cardioverter Defibrillator; COPD, chronic obstructive pulmonary disease; CABG, Coronary Artery Bypass Grafting;PCI, percutaneous coronary intervention;DBP,diastolic blood pressure; eGFR, estimated glomerular filtration rate; HR, heart rate; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; SBP, systolic blood pressure eGFR by the Chronic Kidney Disease Epidemiology Collaboration formula
Summary
Inflammation is a key feature of heart failure including HFpEF. The leukocyte count is a marker of inflammation that is widely used in clinical practice. Heart failure with preserved ejection fraction (HFpEF) has emerged as anpivotal problem with increasing prevalence and poor prognosis in recent years [1]. It is still not fully understood of the pathophysiology of HFpEF, which retards the improvement of its accurate diagnosis and efficient treatment.proven effective medical treatment has not yet appeared for this disease [2, 3]. Limit evidences indicateinflammation biomarkers are associated with adverse outcomes in patients with HFpEF [14, 15], the relationship between leukocyte count and HFpEF is still not fully clear. This study aimed to examine the prognostic significance of leukocyte count on clinicaloutcomes in patients with HFpEF in the Treatment ofPreserved Cardiac Function Heart FailureWith an Aldosterone Antagonist Trial(TOPCAT)
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