Different Types Of Heart Failure Research Articles

#2970 Heart failure with preserved ejection fraction on chronic kidney patients: innocent bystander? A cohort study in Portuguese population

Abstract Background and Aims Heart failure (HF) consists in a significant public health challenge, with high prevalence worldwide and a substantial impact on morbidity and mortality. In chronic kidney disease (CKD), HF can act both as a risk factor and a complication, exacerbating the overall outcomes for affected individuals. This study aims to elucidate the prevalence of distinct types of heart failure, encompassing preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF) in CKD patients. Moreover, we purpose to identify the potential of these subtypes to influence the outcomes of mortality and start of kidney replacement therapy (KRT), as a different therapeutic approach is suitable for each. Method Observational retrospective cohort study of 3008 CKD patients, with follow-up in Nephrology out-patient clinic in a Portuguese hospital, from February, 2012 to October, 2019. Ejection fraction was accessed by echocardiogram and information was collected from health records. To access mortality, patients who started KRT along the study were excluded. Results A total of 3008 patients, of which 91.7% Caucasians and 54.5% males, with an average age of 68.2 (±15.9) years was enrolled in the study. The mean follow-up time was 3.21 (±1.97) years and the mean estimated glomerular filtration rate at baseline was 47.63 ± 33.1 ml/min/1.73 m2. Among the participants, 769 individuals (25.5%) were diagnosed with HF. Specifically, 319 patients (41.5%) exhibited HFpEF; 85 patients (11%) had HFmrEF, and 117 patients (15.2%) had HFrEF, while the ejection fraction (EF) was unknown in 32.2% of cases. In the HF group, the incidence of diabetes was 55.6%, compared to 37.5% in the non-HF group. As for hypertension, the prevalence of was 91.8% in the HF group and 78.6% in the non-HF group. When assessing all-cause mortality during the follow-up, the hazard ratio (HR) for the HF group was 3.54 (95% CI, 2.94-4.26) compared to the non-HF group. Furthermore, for the initiation of KRT, the HR was 1.57 (95% CI, 1.19-2.06), favoring patients without heart failure. Across different types of HF, in comparison to the group without HF, the hazard ratio during follow up were notably different. Specifically, the HR was 5.39 (95% CI, 3.66-7.94) for patients with HFrEF, 3.43 (95% CI, 2.18-5.40) for patients with HFmrEF and 2.99 (95% CI, 2.32-3.87) for the HFpEF. When assessing the initiation of kidney replacement therapy (KRT), HFrEF and HFpEF also exhibited statistically different data comparing to those without HF. Specifically, HFrEF showed a HR of 2.14 (95%, 1.27-3.63), while HFpEF had a HR of 1.79 (95%, 1.25-2.56). The Kaplan-Meier analysis demonstrated a steeper descent curve for both survival and start of KRT for the HF group compared to the non-HF group (log-rank p < 0.0001) over the study period. Within the HF group, the worst survival outcomes were observed in the HFrEF subgroup, followed by HFmrEF and HFpEF (log-rank p < 0.0001). Conclusion Heart failure is a prevalent condition in CKD patients and worsens outcomes. Our analysis of real-world data suggests a threefold higher risk of mortality among for patients with HF, and a fivefold increase in the subgroup of HFrEF, comparing to patients without HF. Notably, preserved EF yielded a HR of 3.3 for mortality when compared to those without heart failure, underscoring the importance of clinical accurate assessment, since both entities may present with preserved ejection fraction in echocardiogram. Despite the study's sample limitations and the fact that it is unicentric, we believe this work holds significance as it highlights the importance of the establishment of different degrees of HF as it can change the prognosis in terms of mortality and progression to kidney replacement therapy in CKD patients. In addition to the established association between reduced EF and mortality, the HFpEF showed to exert a notable influence on outcomes comparing to patients without HF. This emphasizes the importance of not neglecting this entity, as it should treated appropriately.

Efficacy of Angiotensin Receptor-Neprilysin Inhibitor and Its Renal Outcome in Heart Failure Patients: A Systematic Review of Randomized Clinical Trials.

Heart failure (HF) is a major cause of morbidity and mortality and imposes a significant financial burden on healthcare systems globally. Angiotensin receptor-neprilysin inhibitor (ARNI), a novel neuroendocrine inhibitor, is frequently used in treating HF. However, there is still limited understanding regarding how it compares to other neuroendocrine inhibitors, such as angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs). The purpose of this research is to present the most recent data regarding the efficacy and renal impact of ARNIs in the treatment of HF in comparison to ACE inhibitors and ARBs. Several large-scale randomized controlled trials (RCTs) have recently been conducted to evaluate the benefits of this drug in patients with different types of HF, regardless of their renal status. We searched multiple databases, including PubMed, PubMed Central (PMC), and Google Scholar, to find relevant RCTs. The efficacy outcome was a composite of the rate of death from cardiovascular causes, the frequency of HF hospitalizations (HFH), and alterations in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The renal outcome was impairment of renal function. This systematic review analyzed large-scale RCTs involving 17,327 participants, with an average follow-up time of approximately 2.9 years. sacubitril/valsartan showed notable improvements compared to ACEis and ARBs in the following areas: reduction in NT-proBNP levels, prevention of further deterioration in renal function, and decreased hospitalizations for HF. Interestingly, there is no increased risk of mortality from cardiovascular causes with sacubitril or valsartan.

Comparison of Characteristics and Outcomes Between Acute Ischemic Stroke Patients with Different Types of Heart Failure.

Acute ischemic stroke (AIS) can be complicated by heart failure involving preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF), and whether or not the prognosis differs between the 2 types of patients remains unclear. We compared the clinical characteristics and outcomes of the 2 types of patients at 3 months after the stroke.We retrospectively analyzed patients who, between 1 January 2018 and 1 January 2021, experienced AIS that was complicated by HFrEF or HFpEF. All patients had been prospectively registered in the Chengdu Stroke Registry. Poor outcome was defined as a modified Rankin Scale (mRS) score of 2-6 at 3 months. Univariate and binary logistic regression was used to assess whether HFpEF was associated with a significantly worse prognosis than HFrEF.Among the final sample of 108 patients (60.2% men; mean age, 73.08 ± 10.82 years), 75 (69.4%) had HFpEF. Compared to HFrEF patients, those with HFpEF were older (P = 0.002), were more likely to have chronic kidney disease (P = 0.033), and were more likely to experience a poor outcome (P = 0.022). After adjustments, HFpEF was associated with significantly greater risk of poor outcome than HFrEF (OR 4.13, 95%CI 1.20-15.79, P = 0.029). However, rates of hemorrhagic transformation or mortality at 3 months after AIS did not differ significantly between the 2 types of heart failure (all P > 0.05).Patients with AIS involving HFpEF experience worse outcomes than those with HFrEF and therefore may require special monitoring and management. Our findings need to be verified in large prospective studies.

Predictive Value of the Hb/RDW Ratio for the Risk of All-Cause Death in Patients with Heart Failure with Different Ejection Fractions

Introduction: The prognostic value of the ratio of haemoglobin to red cell distribution width (HRR) in different types of heart failure (HF) is not well known. Method and Results: We analysed the long-term prognostic value of HRR in patients with HF using the Cox proportional risk model and Kaplan-Meier method. We reviewed consecutive 972 HF patients. The overall mortality rate was 45.68%. Mortality was 52.22% in the HFrEF group and 40.99% in the HFpEF + HFmrEF group. Cox regression showed that when HRR increased by 1 unit, the risk of all-cause death in all HF patients decreased by 22.8% (HR: 0.772, 95% CI: 0.724, 0.823, p < 0.001), in the HFpEF + HFmrEF group it decreased by 15.5% (HR: 0.845, 95% CI: 0.774, 0.923, p < 0.001), and in the HFrEF group it decreased by 36.1% (HR: 0.639, 95% CI: 0.576, 0.709, p < 0.0001). Subgroup analysis showed that there were interactions between the EF and HRR groups. The group in which HRR best predicted all-cause death from HF was group 1 (EF <40%, HRR <9.45), followed by group 2 (EF <40%, HRR ≥9.45), and group 3 (EF ≥40%, HRR <9.45). HRR had no predictive value in group 4 (EF ≥40%, HRR ≥9.45). Conclusion: HRR is an important predictor of all-cause mortality in patients with HF, especially HFrEF. There is an interaction between HRR group and LVEF group.

Comparative analysis of SGLT2 inhibitors in the treatment of heart failure

Heart failure (HF) remains a significant disease with a high risk of complications and mortality, underscoring the need for effective therapeutic approaches. Sodium-glucose cotransporter 2 inhibitors (SGLT2), such as dapagliflozin, empagliflozin, and canagliflozin, have garnered considerable attention as potential remedies for HF. This review is based on a comparative analysis of these SGLT2 inhibitors and their impact on HF. Preliminary data indicate a positive effect in reducing the risk of HF exacerbation and hospitalizations among patients receiving dapagliflozin and empagliflozin. Interestingly, empagliflozin demonstrates potential in reducing the risk of cardiac death and hospitalizations among patients with preserved ejection fraction. This review underscores the significance of further research to deepen the understanding of the mechanisms of action of each drug and their efficacy in different types of heart failure, potentially contributing to personalized patient treatment.

A meta-analysis investigating the efficacy and adverse events linked to sacubitril-valsartan in various heart failure subtypes.

Sacubitril-valsartan, an inhibitor of the angiotensin receptor neprilysin (ARNi), has been purported to exhibit superiority over angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in individuals diagnosed with heart failure. This paper gives an updated meta-analysis comparing the efficacy and safety of sacubitril-valsartan to that of standard treatment for different types of heart failure. The meta-analysis comprised a total of nine randomized controlled trials (RCTs), incorporating data from a substantial sample size of 15 939 patients. The study observed a decrease in overall mortality and mortality related to cardiovascular causes among patients in the heart failure with reduced ejection fraction (HFrEF) category who were treated with sacubitril-valsartan. However, no statistically significant variation in this outcome was seen among patients with heart failure with preserved ejection fraction and HFmrEF. Patients who were administered sacubitril-valsartan had a notably elevated likelihood of experiencing hypotension. Nevertheless, no significant disparities were observed in terms of other adverse events among the various treatment groups. Current meta-analysis provide support for use of sacubitril-valsartan in decreasing mortality in patients with HFrEF. However, more numbers of studies are required to draw a definite conclusion on other benefits associated with sacubitril-valsartan use over standard treatment of ACE inhibitors and ARBs.

Impact of different types of heart failure on coronavirus disease 2019 infection outcomes

Abstract Background Pre-existing cardiovascular disease has been associated with increased mortality in patients with coronavirus disease 2019 (COVID-19). However, the impact of different types of heart failure in unvaccinated patients with COVID-19 infection has been understudied. Purpose In this study, we compare the in-hospital outcomes of patients with COVID-19 and chronic heart failure with reduced ejection fraction (HFrEF) against patients with COVID-19 and chronic heart failure with preserved ejection fraction (HFpEF). Methods This was a retrospective cohort study done by utilizing the 2020 National Inpatient Sample database. We identified patients admitted to the hospital with a principal diagnosis of COVID-19 infection and a secondary diagnosis of either chronic HFrEF or HFpEF. We conducted propensity score matching using a greedy nearest neighbor 1:1 model. Multivariable logistic regression, adjusted for age, sex, hospital characteristics (bed size, location, region), health insurance and comorbidities was used to compare mortality. The comorbidities adjusted for included atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease, coronary artery disease, hypertension, obesity, prior myocardial infarction and type 2 diabetes mellitus. The categorical and continuous variables were analyzed by Pearson’s chi-squared and Student t-test respectively. Results 12,518 patients met our inclusion criteria. Patients with COVID-19 infection and chronic HFrEF had 1.11 times higher odds of suffering in-hospital mortality compared to patients with COVID-19 infection and chronic HFpEF (aOR 1.11, 95% CI: 1.01-1.21; p = 0.03). When separated by race, there was no difference in mortality between our two cohorts (Figure 1). Patients with COVID-19 infection and chronic HFrEF were more likely to have acute hepatic failure (1.2% vs 0.6%, p &amp;lt; 0.001), ventricular tachycardia (6.7% vs 3.1%, p &amp;lt; 0.001) and ventricular fibrillation (0.6% vs 0.2%, p &amp;lt; 0.001), but less likely to have acute respiratory distress syndrome (5.0% vs 6.6%, p &amp;lt; 0.001, Table 1). In terms of comorbidities, patients with both COVID-19 and chronic HFrEF were more likely to have atrial fibrillation (22.8% vs 21.3%, p = 0.03) coronary artery disease (39.5% vs 35.1%, p &amp;lt; 0.001) and prior myocardial infarction (8.8% vs 6.4%, p &amp;lt; 0.001, Table 1). These patients also had shorter hospital stays (8.4 days vs 9.0 days, p &amp;lt; 0.001), but there was no difference in mean total hospital charges ($87,975.84 vs $88,715.96, p = 0.75, Table 1). Conclusion Patients with COVID-19 and chronic HFrEF had higher odds of suffering in-hospital mortality compared to patients with COVID-19 and chronic HFpEF. These patients were also more likely to have acute hepatic failure, ventricular tachycardia and ventricular fibrillation. Further studies should investigate how COVID-19 vaccination status influences the outcomes of this vulnerable population.

Meteorin-like plasma levels as a novel biomarker for heart failure

Abstract Introduction Meteorin-like (metrnl), a new adipokine with insulin-sensitizing and anti-inflammatory action, has recently drawn much attention due to its protective effects in the cardiovascular system. Metrnl promotes heart repair after insults like ischemia/reperfusion, cardiotoxicity, or diabetic cardiomyopathy in mice, and its circulating levels in patients have been associated with the presence and severity of coronary artery disease and heart failure, although in the latter with contradictory results. Purpose Our aim was to study the correlation between plasma metrnl levels and biochemical and echocardiographic parameters in patients hospitalized with de novo heart failure (HF) to determine whether this adipokine could be a useful biomarker/therapeutic target for HF. Methods Blood samples of 400 patients hospitalized with de novo HF were collected in a multicenter clinical study. Plasma levels of metrnl were measured by enzyme-linked immunosorbent assay. Results In de novo HF patients, metrnl plasma levels were positively correlated with age (r = 0.322, P &amp;lt; 0.0001), NT-proBNP (r = 0.293, P &amp;lt; 0.0001), troponin (r = 0.192, P &amp;lt; 0.001), creatinine (r = 0.353, P &amp;lt; 0.0001) and urea (r = 0.322, P &amp;lt; 0.0001), while negatively correlated with albumin (r = -0.308, P &amp;lt; 0.0001) and alanine aminotransferase (r = -0.183, P &amp;lt; 0.0001). Metrnl plasma levels were also positively correlated with echocardiographic data of cardiac morphology as intraventricular septum thickness (r = 0.197, P &amp;lt; 0.0001) and left ventricular posterior wall thickness (r = 0.150, P &amp;lt; 0.004). On the other hand, Cox regression analysis suggested that higher plasma metrnl was associated with increased cardiovascular mortality (HR, 1.004, P &amp;lt; 0.004)) and rate of readmission for HF (HR, 1.002, P &amp;lt; 0.008). Regarding the different types of HF, we found that metrnl plasma levels were lower in HF with reduced ejection fraction (HFrEF) in comparison those with preserved ejection fraction (HFpEF) [408.06 (354.05 - 537.71) pg/mL vs. 486.06 (391.94 – 607.80), median (interquartile range), respectively; P &amp;lt; 0.0001]. Conclusion Metrnl plasma levels were associated with markers of cardiac (troponin), renal (creatinine and urea) and hepatic (alanine aminotransferase and albumin) damage. The HF marker NT-proBNP and the echocardiographic parameters intraventricular septum thickness and left ventricular posterior wall thickness are also linked to metrnl plasma levels. Moreover, metrnl levels were found to be independent predictors of cardiovascular mortality and readmission for heart failure. And finally, metrnl plasma levels in patients hospitalized with de novo HF were increased in patients with HFpEF vs. HFrEF. Our results reinforce the relevance of the adipokine metrnl in the pathophysiology and diagnosis of HF, and supports its possible use in the future as biomarker/therapeutic target for HF.

Abstract 13532: Long-Term Survival of Different Heart Failure Categories in Patients Discharged Owing to Coronary Artery Disease With/Without Acute Coronary Syndrome

Background: Heart failure (HF) has been classified into distinct phenotypes based on left ventricular ejection fraction (LVEF). We conducted this retrospective cohort study to explore the long-term survival prognosis of different types of HF especially the HF with improved ejection fraction (HFimpEF) group. Methods: We collected patients who had ever been hospitalized owing to coronary artery disease or acute coronary syndrome between July 2006 and June 2017 at National Taiwan University Hospital (NTUH) and NTUH Hsin-Chu Branch. Patients were classified as (1) HF with reduced ejection fraction (HFrEF); (2) HFimpEF; (3) HF with mildly reduced ejection fraction (HFmrEF); (4) HF with preserved ejection fraction (HFpEF); according to echocardiography-derived LVEF during or after the index hospitalization. The date of the first echocardiography during or after the index hospitalization was defined as the index date. All patients were followed from their index date until death or the end of the study (December 31 2017), whichever occurred first. Results: Totally, 11549 patients were categorized into 4 groups (HFrEF group, n = 986; HFimpEF group, n = 461; HFmrEF group, n = 1454; and HFpEF group, n = 8648). The crude mortality rate during follow-up in HFrEF group, HFimpEF group, HFmrEF group, and HFpEF group was 60.4%, 28.0%, 36.6%, and 18.3%, respectively. Patients in HFimpEF group, HFmrEF group, and HFpEF group all possessed a significantly reduced risk of all-cause mortality compared with HFrEF group (adjusted hazard ratio [HR] 0.241, 95% confidence interval [CI] 0.199-0.292 for HFimpEF group; 0.443, 95% CI 0.393-0.500 for HFmrEF group; and 0.292, 95% CI 0.262-0.324 for HFpEF group). Using the time-varying Cox regression model to deal with the immortal time bias, we found a persistent lower risk of all-cause mortality in patients in HFimpEF group compared with patients in HFrEF group (adjusted HR 0.579, 95% CI 0.467-0.718). Conclusion: Patients in HFrEF group had the worst long-term survival prognosis and patient in HFpEF group had the best long-term survival prognosis. Patients in HFimpEF group represented a distinctive population with good survival prognosis than HFrEF group and HFmrEF group.

Integrative Proteomic Analysis Reveals the Cytoskeleton Regulation and Mitophagy Difference Between Ischemic Cardiomyopathy and Dilated Cardiomyopathy

Ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM) are the two primary etiologies of end-stage heart failure. However, there remains a dearth of comprehensive understanding the global perspective and the dynamics of the proteome and phosphoproteome in ICM and DCM, which hinders the profound comprehension of pivotal biological characteristics as well as differences in signal transduction activation mechanisms between these two major types of heart failure. We conducted high-throughput quantification proteomics and phosphoproteomics analysis of clinical heart tissues with ICM or DCM, which provided us the system-wide molecular insights into pathogenesis of clinical heart failure in both ICM and DCM. Both protein and phosphorylation expression levels exhibit distinct separation between heart failure and normal control heart tissues, highlighting the prominent characteristics of ICM and DCM. By integrating with omics results, Western blots, phosphosite-specific mutation, chemical intervention, and immunofluorescence validation, we found a significant activation of the PRKACA–GSK3β signaling pathway in ICM. This signaling pathway influenced remolding of the microtubule network and regulated the critical actin filaments in cardiac construction. Additionally, DCM exhibited significantly elevated mitochondria energy supply injury compared to ICM, which induced the ROCK1–vimentin signaling pathway activation and promoted mitophagy. Our study not only delineated the major distinguishing features between ICM and DCM but also revealed the crucial discrepancy in the mechanisms between ICM and DCM. This study facilitates a more profound comprehension of pathophysiologic heterogeneity between ICM and DCM and provides a novel perspective to assist in the discovery of potential therapeutic targets for different types of heart failure.

Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society.

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021-2022 in relation to Polish health care conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include: drugs blocking the renin-angiotensin-aldosterone system (preferably angiotensin receptor antagonist/neprilisin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect - options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers - carvedilol and nebivolol), mineralocorticoid receptor antagonist and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness of the above-mentioned has been confirmed in numerous prospective, randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent, additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or presence of arrhythmia. The manuscript emphasizes cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction. We propose practical guidelines for the use of medicines, the profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation or antiplatelet and anticoagulant therapy were also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF were discussed.

Framework for precision phenotyping of heart failure patients using clinical data at rest and exercise

Precision phenotyping of mechanistic differences between and within different types of heart failure is a valuable tool not only to understand the range of underlying cardiovascular dysfunction but to identify patients who could benefit from a targeted treatment or procedure. Our group previously has used standard clinical hemodynamic measures at rest coupled with a computational model of the cardiovascular system to identify differences between patients diagnosed with heart failure with preserved ejection fraction (HFpEF). Even though this effort has proven fruitful, many patients with HFpEF exhibit symptoms only during exercise. We hypothesize that incorporating exercise metrics into our approach will improve discrimination between HFpEF phenotypes. In this study we have expanded the pool of clinical data to include cardiopulmonary exercise testing (CPET) data and added to the complexity of our cardiovascular system model to simulate exercise. Data were collected prospectively from both Peking University Third Hospital and the University of Michigan and include measures from right heart catheterization (RHC) at rest and at exercise along with transthoracic echocardiography (TTE) at rest. The measures for each patient are used to identify our expanded cardiovascular systems model which now can inform parameters related to the strength of sarcomeric contraction in the left, septal and right ventricular walls, left and right atrial elastance in addition to predicting left ventricular and right ventricular cardiac power at rest and exercise. Based on the preliminary data acquired, we present a framework that can quantify underlying differences between HFpEF patients using unsupervised machine learning to find distinct HFpEF phenogroups, using clinical data both at rest and during exercise. Michigan Medicine/Peking University Health Science Center Joint Institute for Translational and Clinical Research This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

All-Cause and Cardiovascular-Related Mortality in CKD Patients With and Without Heart Failure: A Population-Based Cohort Study in Kaiser Permanente Southern California

Heart failure and chronic kidney disease (CKD) frequently coexist reflective of the strong interplay between these organ systems. A better understanding of the prevalence of different types of heart failure (preserved and reduced ejection fraction) and their subsequent mortality risks among advanced CKD patients would provide important epidemiologic insights and may pave the way for more focused and proactive management strategies. Retrospective cohort study. Patients aged≥18 years with incident CKD (estimated glomerular filtration rate≤45mL/min/1.73m2) with and without heart failure in a large integrated health care system in Southern California. Heart failure, heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF). All-cause and cardiovascular-related mortality within one year of CKD identification. HRs were estimated using Cox proportional-hazards model for risk of all-cause mortality and Fine-Gray subdistribution hazard model for risk of cardiovascular-related mortality within 1 year. The study cohort included 76,688 patients with incident CKD between 2007 and 2017, of which 14,249 (18.6%) had prevalent heart failure. Among these patients, 8,436 (59.2%) had HFpEF and 3,328 (23.3%) had HFrEF. Compared with patients without heart failure, the HR for 1-year all-cause mortality was 1.70 (95% CI, 1.60-1.80) among patients with heart failure. The HRs were 1.59 (95% CI, 1.48-1.70) for patients with HFpEF and 2.43 (95% CI, 2.23-2.65) for patients with HFrEF. Compared with patients without heart failure, the 1-year cardiovascular-related mortality HR for patients with heart failure was 6.69 (95% CI, 5.93-7.54). Cardiovascular-related mortality HR was even higher among those with HFrEF (HR, 11.47; 95% CI, 9.90-13.28). Retrospective design with a short 1-year follow-up period. Additional variables including medication adherence, medication changes, and time-varying variables were not accounted for in this intention-to-treat analysis. Among patients with incident CKD, heart failure was highly prevalent with HFpEF accounting for over 70% among patients with known ejection fraction. Although the presence of heart failure was associated with higher 1-year all-cause and cardiovascular-related mortality, patients with HFrEF were the most vulnerable.

Association Between Anemia Status and the Risk of Different Types of Heart Failure: A RCSCD-TCM Study in China.

We investigated the association between anemia status and the risk of heart failure (HF) in patients with coronary heart disease (CHD) based on a multi-center, large-sample and retrospective cross-sectional study including 89,207 patients. Heart failure was categorized as HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and HF with mid-range ejection fraction (HFmrEF). In multi-adjusted models, compared with patients without anemia, mild anemia (odds ratio [OR] 1.71; 95% confidence interval [CI] 1.53-1.91; P < .001), moderate anemia (OR 3.68; 95% CI, 3.25-4.17; P < .001), and severe anemia (OR 8.02; 95% CI, 6.50-9.88; P < .001) were associated with the risk of HF among CHD patients. Men aged <65years were more likely to develop HF. In subgroup analyses, the multi-adjusted ORs and 95% CI of HFpEF, HFrEF, and HFmrEF related to anemia were 3.24 (95% CI 1.43-7.33), 2.22 (95% CI 1.28-3.84), and 2.55 (95% CI 2.24-2.89), respectively. These findings suggest that anemia might be associated with increased risk of different types of HF, especially HFpEF.

Abstract P583: Cardiac Sarcoidosis is an Under-Recognized Cause of Heart Failure Admissions in the United States: A Population Based Epidemiologic Study

Background: Progressive heart failure is the cause of mortality for almost 25% of patients with cardiac sarcoidosis (CA). However, there are limited studies on the impact of heart failure (HF) on mortality, hospital length of stay (LOS), and total hospital charges for patients with cardiac sarcoidosis. Methods: Data were extracted from the National Inpatient Sample (NIS) 2016-2019 Database. The NIS was searched for hospitalizations for adult patients with cardiac sarcoidosis as the principal discharge diagnosis with and without different types of heart failure as secondary diagnosis using ICD-10 codes. Multivariate analysis via STATA was used to adjust for confounders. Results: 6,560 patients were identified with a diagnosis of cardiac sarcoidosis. Only 0.08% of patients with heart failure were identified with a diagnosis of cardiac sarcoidosis, of which 15.8% had systolic HF, 3.7% diastolic had HF, and 14% had combined systolic and diastolic HF. There were more males than females (60.0% vs. 40.0 %, p&lt;0.01). Mortality was increased for combined systolic and diastolic HF (OR 1.98, p&lt;0.04). LOS was increased for patients with any type of HF(+2.48 days, &lt;0.001), systolic heart failure (+2.14 days, p&lt;0.017), combined systolic and diastolic HF (+1.96 days, p&lt;0.010). Total hospital charges were increased with any type of HF ($44,214.43, p&lt;0.004), and systolic heart failure ($58,298.90, p&lt;0.015). Interestingly, patients with cardiac sarcoidosis did not have increased mortality with all types of HF(OR 1.04, p=0.928), systolic HF (OR 0.98, p=0.973), diastolic HF (OR 0.35, p=0.179), and combined systolic and diastolic HF (OR 1.34 experienced a 51% increased odds of mortality (OR 1.51, 95%CI 1.41-1.62, p&lt;0.01), a longer LOS with a mean difference of 1.4 days (95%CI, 1.16-1.57, p&lt;0.01), and a more costly overall hospitalization with a mean difference of $12,841 (95%CI $9,705-$15,976, p&lt;0.01). Conclusion: Cardiac sarcoidosis remains a widely under-recognized cause of HF hospitalizations in the United States.

The cardiovascular effects of SGLT2 inhibitors, RAS inhibitors, and ARN inhibitors in heart failure.

No studies have comprehensively compared the efficacy of sodium-glucose cotransporter-2 (SGLT2) inhibitors, renin-angiotensin system (RAS) inhibitors, and angiotensin receptor neprilysin (ARN) inhibitors based on different type of heart failure, including heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). The aim of this network meta-analysis was to evaluate the relative efficacy of SGLT2 inhibitor (SGLT2i), RAS inhibitor (RASi) and ARN inhibitor (ARNI) in different types of heart failure. A systemic literature search was performed from inception to 19 November 2022 for randomized control trials assessing the risk of cardiovascular (CV) death or hospitalization for heart failure (HHF) of these drugs in HF. A network meta-analysis was performed. Risk ratio (RR) with 95% confidence intervals (CI) were synthesized. Seventeen studies were selected with a total of 61 489 patients. In patients with HFrEF, ARNI led to a reduced risk of a composite outcome of CV death or HHF when compared with placebo (RR=0.83, 95% CI 0.77-0.89). Similar trends were observed when focusing on the outcome of CV death or HHF alone. In patients with HFpEF, SGLT2i showed the beneficial effects on the CV death or HHF events when compared with placebo and RASi (RR=0.82, 95% CI 0.74-0.92; RR=1.16, 95% CI 1.02-1.31). For CV death, all these three drugs could not show beneficial effects in HFpEF. For the incidence of HHF in HFpEF, both SGLT2i and ARNI demonstrated the beneficial effects but SGLT2i was superior to ARNI. There were no differences in the events of discontinuation under these drugs when compared with placebo or each other in either HFrEF or HFpEF patients. SGLT2i showed the least renal injury among these interventions in HFrEF and there were no differences in the incidence of renal injury of these interventions in HFpEF. Among these drugs, ARNI showed the greatest ability to lower the incidence of CV death or HHF and SGLT2i exerted the least renal injury in patients with HFrEF. In patients with HFpEF, SGLT2i was associated with a reduction in the risk of CV death or HHF. There were no differences in the incidence of renal injury of these interventions in HFpEF. The intolerance of these drugs were comparable in both HFrEF and HFpEF.

Effectiveness and safety of transcatheter aortic valve replacement in elderly people with severe aortic stenosis with different types of heart failure

BackgroundImpaired left ventricular function is an independent predictor of adverse clinical outcomes in patients with aortic stenosis. The aim of this study is to evaluate the short-term changes of echocardiographic parameters, New York Heart Association (NYHA) class and B-type natriuretic peptide (BNP) level and adverse events amongst patients with heart failure (HF) after transcatheter aortic valve replacement (TAVR) procedure.MethodsThis was a retrospective cohort study conducted at affiliated Yantai Yuhuangding Hospital of Qingdao University between September 2017 and September 2022. TAVR cases were stratified into three groups [heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), heart failure with preserved ejection fraction (HFpEF)] by left ventricular ejection fraction (LVEF). Baseline characteristics, changes in echocardiographic parameters (1 week and 1 month), BNP (1 month), and NYHA class (6 months) post-TAVR were compared across the three groups. Meanwhile, we observed the adverse events of the patients after TAVR.ResultsA total of 96 patients were included, of whom 15 (15.6%) had HFrEF, 15 (15.6%) had HFmrEF, and 66 (68.8%) had HFpEF. Compared to the HFpEF subgroup, patients in the HFrEF subgroup were younger (p < 0.05), and with a higher BNP (p < 0.05). The left ventricular end-diastolic dimension (LVEDD) in HFrEF group decreased significantly after TAVR. HFmrEF and HFrEF patients showed significant improvements in LVEF after TAVR. The pulmonary artery systolic pressure (PASP), aortic valve peak gradient (AVPG) and aortic valve peak gradient (Vmax) decreased significantly 1 month after TAVR in all three groups compared to the baseline (all p < 0.05). BNP significantly reduced in HFrEF group compared to HFpEF patients after TAVR (p < 0.05). The majority of patients experienced an improvement at least one NYHA class in all three groups 6 months post-TAVR. There is no significant increase in the risk of adverse events in the HFrEF group.ConclusionsPatients who underwent TAVR achieved significant improvements in BNP, NYHA class, LVEDD, LVEF, and PASP across the three HF classes, with a more rapid and pronounced improvement in the HFrEF and HFmrEF groups. Complication rates were low in the different HF groups. There is no significant increase in the risk of periprocedural complications in the HFrEF and HFmrEF groups.

Impact of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure

Objective: To investigate the effects of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure. Methods: The patients with renal insufficiency [baseline estimated glomerular filtration rate < 60 ml·min-1·(1.73 m2)-1] and heart failure followed-up for more than 2 years and hospitalized in Beijing Anzhen Hospital, Capital Medical University from January 1, 2018 to June 30, 2019 were enrolled in this retrospective cohort study. The patients were divided into three groups based on the baseline left ventricular ejection fraction (LVEF): heart failure with reduced ejection fraction (HFrEF, LVEF < 40%) group, heart failure with mildly reduced ejection fraction (HFmrEF, 40% ≤ LVEF < 50%) group, and heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%) group. Clinical data were collected and endpoint events (adverse renal outcome: the composite outcome of all-cause death or worsening renal function) were recorded through the electronic medical record system. Kaplan-Meier survival curve was used to analyze the incidence of endpoint events of different heart failure subgroups. Cox regression model was performed to analyze the risk factors of endpoint events. Results: A total of 228 patients with renal insufficiency complicated with heart failure were included, with age of (68.14±14.21) years old and 138 males (60.5%). There were 85 patients (37.3%) in the HFrEF group, 40 patients (17.5%) in the HFmrEF group, and 103 patients (45.2%) in the HFpEF group. There were statistically significant differences in age, proportion of age > 65 years old, sex distribution, systolic blood pressure, pulmonary artery pressure, serum sodium, serum calcium, hemoglobin, serum cholesterol, low-density lipoprotein cholesterol, serum uric acid, troponin I, hypersensitive C-reactive protein, LVEF, ventricular septal thickness, left ventricular end-diastolic diameter, B-type natriuretic peptide, estimated glomerular filtration rate, and proportions of using beta blockers, using spirolactone, myocardial infarction, hypertension, cardiomyopathy and atrial fibrillation (all P < 0.05). During the median follow-up of 36.0 (28.0, 46.0) months, 73 patients (32.0%) had adverse renal outcomes. The total incidences of adverse renal outcomes were 32.9% (28/85) in the HFrEF group, 35.0% (14/40) in the HFmrEF group, and 30.1% (31/103) in the HFpEF group. Kaplan-Meier survival curve showed that there was no significant difference in the incidence of endpoint events among the three groups (log-rank test χ2=0.17, P=0.680). Multivariate Cox regression analysis showed that HFpEF (HFrEF as reference, HR=2.430, 95% CI 1.055-5.596, P=0.037) was an independent influencing factor of endpoint events. Conclusions: The long-term renal prognosis of patients with renal insufficiency and heart failure is poor. Compared with HFrEF, HFpEF is an independent risk factor of poor long-term renal prognosis in renal insufficiency patients with heart failure.

Smernice za dijagnostiku i tretman srčane insuficijencije - pregled noviteta

Heart failure (HF) is a global health problem nowadays, with a high prevalence and incidence rate, as like as a high mortality rate. Quality of life is also very important for patients and their families, and it is often affected in HF. This article is not only about a definition and different types of HF, it is more about modern diagnostic and therapeutic approaches to HF patients according to the latest ESC guidelines for the diagnosis and treatment of acute and chronic HF. There are many different factors contributing to poor quality of life in HF. The last ESC HF guidelines have recognized the importance of multidiciplinar approach to HF patients, such as treatment of cardiovascular and non-cardiovascular comorbidities.

Abstract 12075: Extracellular Vesicle Cargo Long-Noncoding RNAs Are Dynamic Biomarkers in Acute Decompensated Heart Failure

Introduction: Acute decompensation is associated with increased long-term mortality in patients with heart failure (HF). Biomarkers of acute HF that are dynamic during decongestion may provide physiologic insight for this observation. We hypothesized that long-noncoding RNAs (lncRNAs) and mRNAs in extracellular vesicles (EVs) not only mark different types of HF, but also may be dynamically altered with decongestion across physiologically important pathways. Methods: RNA sequencing was performed on plasma-derived EVs in acute HF patients (7 HFpEF; 7 HFrEF) at hospital admission (V1) and at discharge (V2) along with 9 controls without HF. Differential expression analysis was performed using DESeq2 across groups and time-points. Transcripts were prioritized by fold change (±1.5) and statistical significance (&lt;5% FDR). We subsequently validated targets in EVs from 182 additional patients (24 control; 86 HFpEF; 72 HFrEF). Results: Between HF and control patients, 138 lncRNAs and 147 mRNAs were different (Fig a,b). LncRNAs were confirmed to be exclusively present in EVs. Of 13 targets investigated in our validation cohort, 5 lncRNAs and 6 mRNAs were significantly different between control and HF (age, sex-adjusted; Fig c). Pairwise comparisons between EV RNAs at hospital admission versus decongestion revealed a significant change in 4 lncRNAs (Fig d,e ) that was independent of weight change during hospitalization. Notably, distinct fragments derived from these transcripts were noted in HF versus control groups. Conclusions: The plasma EV transcriptome is significantly altered in patients with acute HF. Plasma EV-derived lncRNA fragments demarcate congestion and decongestion better than mRNAs, may be markers for pathophysiologically relevant pathways independent of volume status, and may provide additional prognostic information.