Heart Failure In General Population Research Articles

Prognostic value of growth differentiation factor-15 in heart failure among whole ejection fraction phenotypes.

The utility of growth differentiation factor-15 (GDF-15) in predicting long-term adverse outcomes in heart failure (HF) patients is not well established. This study explored the relationship between GDF-15 levels and adverse outcomes in HF patients across various ejection fraction (EF) phenotypes associated with coronary heart disease (CHD) and evaluated the added prognostic value of incorporating GDF-15 into the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score-based model. This single-centre cohort study included 823 HF patients, categorized into 230 (27.9%) reduced EF (HFrEF), 271 (32.9%) mid-range EF (HFmrEF), and 322 (39.1%) preserved EF (HFpEF) groups. The median age was 68.0years (range: 56.0-77.0), and 245 (29.8%) were females. Compared with the HFrEF and HFmrEF groups, the HFpEF group had a higher GDF-15 concentration (P=0.002) and a higher MAGGIC risk score (P<0.001). We examined the associations between GDF-15 levels and the risks of all-cause mortality and HF rehospitalization using Cox regression models. The C-index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) metrics were employed to assess the incremental prognostic value. During the 9.4year follow-up period, 425 patients died, and 484 were rehospitalized due to HF. Multivariate Cox regression analysis revealed that elevated GDF-15 levels were significantly associated with an increased risk of all-cause mortality [hazard ratio (HR)=1.36, 95% confidence interval (CI): 1.20-1.54; P<0.001] and HF rehospitalization (HR=1.75, 95% CI: 1.57-1.95; P<0.001) across all HF phenotypes. This association remained significant when GDF-15 was treated as a categorical variable (high GDF-15 group: all-cause death: HR=1.73, 95% CI: 1.40-2.14; P<0.001; HF rehospitalization: HR=3.37, 95% CI: 2.73-4.15; P<0.001). Inclusion of GDF-15 in the MAGGIC risk score-based model provided additional prognostic value for all HF patients (Δ C-index=0.021, 95% CI: 0.002-0.041; IDI=0.011, 95% CI: 0.001-0.025; continuous NRI=0.489, 95% CI: 0.174-0.629) and HF rehospitalization (Δ C-index=0.034, 95% CI: 0.005-0.063; IDI=0.021, 95% CI: 0.007-0.032; continuous NRI=0.307, 95% CI: 0.147-0.548), particularly in the HFpEF subgroup. GDF-15 is identified as an independent risk factor for adverse outcomes in HF patients across the entire EF spectrum in the context of CHD. Integrating GDF-15 into the MAGGIC risk score-based model enhances its prognostic capability for adverse outcomes in the general HF population. This incremental prognostic effect was observed specifically in the HFpEF subgroup and not in other subgroups.

Efficacy of remote home telemonitoring (HTM) on congestion control and heart failure (HF) hospitalizations in HF out-patients

Abstract Introduction Heart failure (HF) burden is characterized by high hospitalizations rates, impairing patients survival and quality of life. Yet, early detection and control of congestion with home tele-monitoring (HTM) might help to reduce HF hospitalizations (HFH) (1). Aim To report our experience of congestion management with HTM for HF patients in out-hospital setting. Methods All HF patients followed with the HTM program of our HF clinic between July 2020 and December 2022 were included. For each patient, HTM consisted in daily body weight and symptoms tele-transmission through a connected device. History of HFH were recorded 18 months before and up to 18 months after inclusion in HTM. Alerts were defined as weight gain (WA) (≥ 3 kgs in 2 days or ≥ 2 kgs in 5 days) and/or new symptoms (SA) onset (≥ 3 in 1 day or identical 3 times in 4 days). Relevants HTM alerts were transmitted by the service provider to the local HF team to be managed within 48 hours : phone contact and/or NT-proBNP dosing and/or physical consultation and/or treatment adaptation. Results Among the 147 patients included, mean age was 60±12 years, 110 (75%) were males. Mean left ventricle ejection fraction (LVEF) was 34±11%, and 112 (76%) had HF-rEF, 19 (13%) HF-mrEF and 16 (11%) HF-pEF. Other baselines characteristics are resumed in Table1. Mean HTM duration was 391±250 days and mean device observance was 74±21%. During HTM, 85 (59%) alerts were managed by the HF team in a mean delay of 98±114 days after inclusion : 47 (32%) WA, 34 (23%) SA and 4 (3%) W+SA. After Student-paired test compared to D0 (day of alert transmission), mean weight (kgs) at D2, D5, D10, D21 and D30 were significantly lower (all p&amp;lt;10E-3), respectively 91±17 versus 90±17, 89±17, 89±16, 88±16 and 89±17 kgs (Fig.1A). After Wilcoxon paired-test, the same difference was observed for symptoms (all p&amp;lt;10E-3) : 3±2 (D0) versus 1±1 (D2), 0.7±1 (D5), 0.4±0.8 (D10), 0.5±0.7 (D21) and 0.5±0.9 (D30) (Fig.1B). Patients HFH rates were significantly lower after HTM inclusion : 19 HFH (13%) after HTM versus 70 (48%) before, according to McNemar's X2 test (p&amp;lt;10E-11) (Fig.1C). Notably, post-HTM observed HFH rates (13%) also differed significantly from the 20% expected in a general HF population (2). For the 15 patients (10%) with history of HFH both before and after HTM implementation, mean lengths of stay (LOS) were significantly lower when HFH occurs after HTM inclusion according to Wilcoxon signed rank test : 10±12 vs 22±19 days (-12±17 days, p=0.02) (Fig.1D). Conclusion In our experience, HTM is a efficient to help controling congestion and symptoms of HF patients in out-hospital setting, and can help to reduce HFH, providing that each alerts is being timely and appropriately addressed by the HF team. Prospective studies are needed to confirm these results.Impact of HTM on congestion and HFHTable 1.Patients characteristics.

Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI

BackgroundInsulin is commonly used in type 2 diabetes mellitus (T2DM) to achieve glycemic control. However, recent evidence showed that insulin use is associated with poor outcomes in the context of heart failure (HF). Since heart failure with reduced ejection fraction (HFrEF) accounts for approximately 50% of cases in the general HF population, we aimed to evaluate the effect of insulin treatment on left ventricular (LV) remodeling and contractility abnormalities in a HFrEF cohort and assess whether insulin was a predictor of adverse outcomes in this entity.MethodsA total of 377 HFrEF patients who underwent cardiac MRI were included and divided according to diabetes status and the need for insulin treatment. LV structural and functional indices, as well as systolic strains, were measured. The determinants of impaired myocardial strains were assessed using linear regression analysis. The associated endpoints were determined using a multivariable Cox proportional hazards model.ResultsT2DM patients on insulin displayed a higher indexed LV end-diastolic volume and LV mass than those with T2DM not on insulin or those without T2DM, despite similar LV ejection fractions, accompanied by a higher three-dimensional spherical index (P < 0.01). Worse longitudinal and circumferential peak systolic strain was shown to occur in T2DM patients on insulin (P < 0.01). Insulin treatment was independently associated with impaired magnitudes of systolic strain. The median follow-up duration was 32.4 months (IQR, 15.6–43.2 months). Insulin treatment remained consistently associated with poor outcomes after adjustment for established confounders, with an adjusted hazard ratio of 3.11; (95% CI, 1.45–6.87; P = 0.009) in the overall cohort and 2.16 (95% CI, 1.08–4.59; P = 0.030) in the diabetes cohort.ConclusionsInsulin may further lead to adverse LV remodeling and contractile dysfunction in the context of HFrEF with T2DM. Considerable care should be taken when treating HFrEF patients with insulin.

Association between spirometry pattern, left ventricular diastolic function, and mortality.

Spirometric abnormalities have been related to incident heart failure in general population, who generally have preserved left ventricular ejection fraction (LVEF). We aimed to investigate the association between spirometric indices, cardiac functions and clinical outcomes. Subjects presenting with exertional dyspnoea and received spirometry and echocardiography were eligible for this study. Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1)/FVC ratio were measured to define the spirometry patterns: normal (FEV1/FVC ≥ 70%, FVC ≥ 80%), obstructive (FEV1/FVC < 70%, FVC ≥ 80%), restrictive pattern (FEV1/FVC ≥ 70%, FVC < 80%) and mixed (FEV1/FVC < 70%, FVC < 80%). The diastolic dysfunction index (DDi) was the counts of the indicators, including septal e' velocity <7 cm/s, septal E/e' > 15, pulmonary artery systolic pressure > 35 mmHg and left atrial dimension >40 mm. Among a total of 8669 participants (65.8 ± 16.3 years, 56% men), 3739 (43.1%), 829 (9.6%), 3050 (35.2%) and 1051 (12.1%) had normal, obstructive, restrictive and mixed spirometry pattern, respectively. Subjects with restrictive or mixed spirometry pattern had higher DDi and worse long-term survival than those with obstructive or normal ventilation. FVC but not FEV1/FVC was predictive of 5-year mortality, independent of age, sex, renal function, LVEF, DDi, body mass index, and comorbidities (hazard ratio, 95% confidence intervals: .981, .977-.985). Furthermore, there was an inverse nonlinear relationship between FVC and DDi, suggesting the declined FVC may mediate 43% of the prognostic hazard of left ventricular diastolic dysfunction. The restrictive spirometry pattern or the declined FVC was associated with left ventricular diastolic dysfunction, which aggravated the long-term mortality in the ambulatory dyspnoeic subjects.

S1237 Association of Liver Biopsy Pathology on Outcome of Patients Undergoing Heart Transplantation

Introduction: Patients with advanced heart failure needing heart transplant (HT) commonly have some degree of liver dysfunction. Liver biopsies are the gold-standard for evaluating the severity of liver disease and are commonly performed prior to listing a patient for HT. However, there is limited data on the impact of liver fibrosis on outcomes for HT candidates. The objective of this study was to determine the relationship between liver fibrosis severity and mortality rates for patients on the HT waitlist and post-HT. Methods: A retrospective cohort study of adults listed for HT who underwent a liver biopsy for evaluation of liver fibrosis from 08/12/2004-02/16/2022 at a large heart transplant center was performed. Degree of fibrosis was categorized as either early (only fibrosis expansion of portal areas with or without short fibrous septa or no fibrosis) or advanced (evidence of portal-to-portal bridging or cirrhosis). Trend analysis was performed on clinical, laboratory and mortality data using Cox proportional hazard model, controlling for MELD-XI. At-risk period starts at the time of waitlist and extends into the post-transplant phase. The end of the follow-up period was defined as mortality on the waitlist, mortality post-HT, or administrative censoring at the end of the study period. Results: Of 42 patients with liver biopsies, 14 (33%) had advanced fibrosis, 28 (67%) had early fibrosis, and 2 (5%) patients had cirrhosis. There was no significant difference in the survival of patients with advanced fibrosis and early fibrosis over time (HR 1.37, CI 0.47- 3.98, p = 0.56). Fifteen waitlisted patients did not eventually receive transplants, and there was no significant difference in survival within group (HR 0.65, CI 0.18-2.32, p = 0.51); 9 of these 15 patients died on the waitlist. Twenty-seven patients did eventually receive transplants, and there was no significant difference in survival within this group (HR 1.00, CI 0.09-11.43, p = 1.00). (Figure) Conclusion: There was no significant difference in the survival rates between HT candidates with and without advanced fibrosis on the waitlist and post-HT, suggesting that patients on the transplant waitlist may not need liver biopsy for heart transplant workup. However, our sample population was derived from patients who were already on the transplant waitlist. Therefore, our results cannot be extrapolated to the general advanced heart failure population undergoing HT evaluation, many of whom are not waitlisted due to cirrhosis (Table). Table 1. - Predicted survival percentages for transplanted patients, non-transplanted patients, and both groups combined at 30 days, 1 year and 5 years with early liver fibrosis or advanced liver fibrosis from time of listing Transplanted Patients (% [CI]) Non-transplanted Patients (% [CI]) Transplanted and Non-transplanted Patients (% [CI]) Early Liver Fibrosis 30 Days 100 (0-100) 84.6 (66.0-100) 95.8 (90.0-100) 1 Year 96.2 (88.8-100) 53.5 (29.2-97.9) 84.5 (73.2-97.4) 5 Years 88.1 (74.6-100) 17.3 (3.6-84.0) 68.2 (52.4-88.9) Advanced Liver Fibrosis 30 Days 100 (0-100) 89.7 (75.7-100) 94.3 (86.1-100) 1 Year 96.2 (86.6-100) 66.6 (42.4-100) 79.3 (63.0-99.9) 5 Years 88.2 (67.4-100) 32.1 (9.8-100) 59.2 (37.6-93.1) CI = confidence interval. Figure 1.: (1) Survival curve of waitlisted patients with and without advanced liver fibrosis, including patients who received and did not receive transplants. Time 0 is the time of listing. Fibrosis score 0 = early liver fibrosis. Fibrosis score 1 = advanced liver fibrosis. (2). Survival curve of only those patients who did not receive transplants. Time 0 is the time of listing. Fibrosis score 0 = early liver fibrosis. Fibrosis score 1 = advanced liver fibrosis. (3) Survival curve of only those patients who received transplants. Time 0 is the time of listing. Fibrosis score 0 = early liver fibrosis. Fibrosis score 1 = advanced liver fibrosis.

Activities of Daily Living and Outcomes in Patients with Advanced Heart Failure

BackgroundFunctional debility is associated with worse outcomes in the general heart failure population, but the prevalence of difficulty with activities of daily living and clinical significance once patients develop advanced heart failure requires further examination. MethodsThis was a population-based, retrospective cohort study of Olmsted County, Minnesota adults with advanced heart failure from 2007-2018. Difficulty with 9 activities of daily living was assessed by questionnaire. Predictors of difficulty were assessed by a proportional odds model. Associations of difficulty with activities of daily living with mortality and hospitalization were examined using Cox and Andersen-Gill models. ResultsAmong 765 patients with advanced heart failure, 565 (73.9%) reported difficulty with activities of daily living at diagnosis. Of those, 257 (45%) had moderate and 148 (26%) had severe difficulty. Independent predictors of difficulty included female sex (odds ratio [OR] 1.73; 95% confidence interval [CI], 1.26-2.36; P = .001), older age (OR per 10-year increase 1.17; 95% CI, 1.05-1.31; P = .005), dementia (OR 1.85; 95% CI, 1.06-3.24; P = .031), depression (OR 1.75; 95% CI, 1.28-2.40; P = .001), and morbid obesity (OR 1.49; 95% CI, 1.04-2.13; P = .031). Estimated 2-year mortality was 61.5%, 64.2%, and 67.6% in patients with no/minimal, moderate, and severe difficulty, respectively. The adjusted hazard ratios (95% CI) for death were 1.08 (0.90-1.28) and 1.17 (0.95-1.43) for moderate and severe difficulty, respectively, vs no/minimal difficulty (P = .33). There were no statistically significant associations of difficulty with activities of daily living and hospitalization risks. ConclusionsMost patients with advanced heart failure have difficulty completing activities of daily living and are at high risk of mortality regardless of impairment in activities of daily living.

Atrial fibrillation in cardiac resynchronization therapy.

Patients with atrial fibrillation (AF) were largely excluded from the major clinical trials of cardiac resynchronization therapy (CRT), despite the presence of AF in up to 40% of patients receiving CRT in clinical practice. AF appears to attenuate the response to CRT, by the combination of a reduction in biventricular pacing and the loss of atrioventricular synchrony. In addition, remodeling secondary to CRT may influence the progression of AF. Management options for patients with AF and CRT include rate control, with drugs or atrioventricular node ablation, or rhythm control, with electrical cardioversion and antiarrhythmic therapy, or AF catheter ablation. The evidence for these therapies in patients with CRT is largely limited to observational studies or inferred from randomized studies in the general heart failure population. In this review, we explore the complex interaction between AF, heart failure, and CRT and discuss the evidence for the treatment options in this difficult patient cohort.

Abstract 14249: Response to Cardiac Resynchronization Therapy in Cancer Patients With Heart Failure

Introduction: Heart failure is associated with poor clinical outcomes in cancer patients. Cardiac resynchronization therapy (CRT) provides a therapeutic avenue to improve left ventricular function and decrease symptoms. Historically, CRT has been underutilized in cancer patients. We assessed the hypothesis that cancer patients have a similar response to cardiac resynchronization therapy as the general heart failure population. Methods: This study included 37 patients with cancer who underwent CRT implantation between 2012 and 2020. The primary endpoints were response to CRT as measured by an improvement in left ventricular ejection fraction (LVEF) by &gt;=10% or decrease in left ventricular end systolic volume index (LVESVi) by &gt;=15% over 3 to 24 months. Secondary endpoints were change in LVEF, LVESVi, and New York Heart Association (NYHA) class. Results: Of 37 patients, primary and secondary endpoints were available for 34 patients (mean [SD] age, 68 [9] years; 24 men (71%); 26 nonischemic cardiomyopathy (76%), 8 ischemic (24%); mean QRSd 152 ms; 10 patients with NYHA II symptoms (29%), 24 NYHA III (71%)). 20 patients met the primary endpoint (65% [46%-80%]). This response rate is not significantly different than published response rates to CRT of 70% in the general heart failure population. The average improvement in LVEF was 12.9% ([9.4%-16.4%], p&lt;0.001). The average decrease in LVESVi was 25.4% ([17.2%-33.5%], p&lt;0.001). 23 of 34 patients had an improvement in NYHA classification (20 by one class, 3 by two), whereas 9 patients had no improvement and 2 patients had worsening symptoms (mean improvement 0.7 [0.46-0.96], p&lt;0.001). 2 of 37 patients had a complication (one late device infection, one right atrial lead dislodgment requiring reimplantation). 4 of 37 patients (10.8%) died within 12 months of primary oncologic cause. 4 of 34 (11.7%) CRT-D patients had received appropriate therapies on device interrogation at time of submission. Conclusions: CRT improves left ventricular function, reverses left ventricular remodeling, and improves exertional dyspnea in patients with cancer. Response rate is similar to that of a general heart failure population. Oncologic prognoses of over 12 months life expectancy at time of implant were reasonably accurate.

Frontal QRS/T angle can predict mortality in COVID-19 patients

Abstract Aims fQRS-T angle was investigated from general population including healthy people to patients who has hearth failure. It can predict mortality of myocarditis, ischemic cardiomyopathy, non-ischemic cardiomyopathy, idiopathic dilated cardiomyopathy and chronic heart failure in general population. There is no study in the literature that has been investigated for COVID-19 patients. The purpose of this retrospective multi-center study is to evaluate fQRS angle of COVID-19 patients for in-hospital mortality and need mechanical ventilation. Methods and results ECG was enrolled in 327 COVID-19 patients during admission and the fQRS angle calculated. Mechanical ventilation was needed for 119 patients and 110 of them died in hospital. Patients were divided into two groups according to their fQRS angle as fQRs&amp;gt;90° and fQRS≤90°. Percentages of mortality and need of MV according to fQRS angle were found 67.8% and 66.1% respectively in fQRs&amp;gt;90° group and 26.1%, 29.9% in fQRS≤90°group. Heart rate, SO2, fQRS, eGFR and CRP only were predictors for mortality in multivariable analysis. Mortality risk was increased 2.9-fold in univariate analysis and 1.6-fold in multivariate analysis for fQRS&amp;gt;90 patient group in respect to fQRS≤90 group. Conclusion In conclusion, a wide fQRS angle (&amp;gt;90°) was found as a predictor for mortality in-hospital and associated with the need for mechanical ventilation in COVID-19 patients. Funding Acknowledgement Type of funding sources: None. Mortality, need mechanical ventilationUnivariable and multivariable predictors

Outcomes and healthcare resource utilization in adult congenital heart disease patients with heart failure.

AimsWhile heart failure (HF) is a leading cause of death in adults with congenital heart disease (ACHD), few studies report contemporary outcomes after the first HF hospitalization. We examined outcomes of ACHD patients newly admitted for HF compared with ACHD patients without HF and the general HF population without ACHD.Methods and resultsUsing population databases from a single‐payer health system from 1994 to 2018, ACHD patients newly admitted for HF were matched 1:1 to ACHD patients without HF (n = 4030 matched pairs). Similarly, ACHD patients newly admitted for HF were matched 1:1 to HF patients without ACHD (n = 4336 matched pairs). Patients with ACHD and HF (median age 68 years, 45% women) experienced higher mortality in short‐term [30 day adjusted hazard ratio (HR) 4.68, 95% confidence interval (CI) 4.06, 5.43, P < 0.001], near‐term (1 year HR 3.87, 95% CI 3.77, 4.92, P < 0.001), and long‐term (24 year HR 1.59, 95% CI 1.13, 2.36, P = 0.008) follow‐up. Patients with ACHD and HF had fewer baseline cardiovascular comorbidities than non‐ACHD HF but demonstrated higher 30 day (HR 1.56, 95% CI 1.41, 1.73, P < 0.001), 1 year (HR 1.30, 95% CI 1.20, 1.40, P < 0.001), and 24 year (HR 2.40, 95% CI 1.73, 3.38, P < 0.001) mortality. Those with ACHD and HF also exhibited higher cardiovascular readmission rates at 30 days with HRs 9.15 (95% CI; 8.00, 10.48, P < 0.001) vs. ACHD without HF, and 1.71 (95% CI; 1.54, 1.85, P < 0.001) vs. HF without ACHD, and the higher readmission risk extended to 10 year follow‐up.ConclusionsAdults with congenital heart disease patients with new HF have high risks of death and cardiovascular hospitalization, and preventative strategies to improve outcomes are urgently needed.

Prognosis and outcome determinants after heart failure diagnosis in patients who underwent aortic valvular intervention.

AimsTo study clinical phenotype, prognosis for all‐cause and cardiovascular (CV) mortality and predictive factors in patients with incident heart failure (HF) after aortic valvular intervention (AVI) for aortic stenosis (AS).Methods and resultsIn this retrospective, observational study we included patients from the Swedish Heart Failure Registry (SwedeHF) recorded 2003–2016, with AS diagnosis and AVI before HF diagnosis. The AS diagnosis was established according to International Classification of Diseases 10th revision (ICD‐10) codes, thus without information concerning clinical or echocardiographical data on the aortic valve disease. The patients were divided into two subgroups: left ventricular ejection fraction (LVEF) ≥ 50% (AS‐HFpEF) and <50% (AS‐HFrEF). We individually matched three controls with HF from the SwedeHF without AS (control group) for each patient. Baseline characteristics, co‐morbidities, survival status and outcomes were obtained by linking the SwedeHF with two other Swedish registries. We used Kaplan–Meier curves to present time to all‐cause mortality, cumulative incidence function for time to CV mortality and Cox proportional hazards model to evaluate the relative difference between AS‐HFrEF and AS‐HFpEF and AS‐HF and controls. The crude all‐cause mortality was 49.0%, CV mortality 27.9% in AS‐HF patients, respectively 44.7% and 26.6% in matched controls. The adjusted risk for all‐cause mortality and CV mortality was similar in HF, regardless of LVEF vs. controls. No significant difference in factors predicting higher all‐cause mortality was observed in AS‐HFrEF vs. AS‐HFpEF, except for diabetes (only in AS‐HFrEF), with statistically significant interaction predicting death between the two groups.ConclusionsIn this nationwide SwedeHF study, we characterized incident HF population after AVI. We found no significant differences in all‐cause and CV mortality compared with general HF population. They had virtually the same predictors for mortality, regardless of LVEF.

Position of Patients with Mid-Range Ejection Fraction in the General Chronic Heart Failure Population

The European society of cardiology guideline for the diagnosis and treatment of acute and chronic heart failure (CHF) in 2016 identified a new group of patients with mid-range left ventricular ejection fraction (LVEF) with reference interval in the range of 40-49 %. This review highlights the issues of epidemiology and etiology of CHF, outlines the echocardiographic portrait, biomarker profile and patients` dynamic phenotypes, considers the guidelines of their managements and the prognosis of the disease determiner’s factors. Special attention is paid to the peculiarities of the formation of this heterogeneous cohort of patients and the feasibility of expanding the existing CHF classification by introducing two transitional phenotypes.

The protocol and rationale for the efficacy aNd ToleRability of sacUbitril-valSarTan in adult congenital heart disease patients with heart failure (ENTRUST ACHD HF) registry

BackgroundHeart failure within the adult congenital heart disease (ACHD) population is a significant source of morbidity and mortality. Optimal medical therapy (OMT) remains the mainstay of management for ACHD heart failure patients. Sacubitril/Valsartan is an angiotensin-receptor neprilysin inhibitor (ARNI) which is a relatively novel addition to the pantheon of heart failure therapies with a significant evidence base to support its reduction in heart failure rehospitalisation, improvement in ventricular reverse remodelling and reduction in mortality in the general heart failure population. Its use in the ACHD population is limited to small case series. ObjectivesThe Efficacy aNd ToleRability of sacUbitril-valSarTan in Adult Congenital Heart Disease patients with Heart Failure (ENTRUST ACHD HF) registry has been developed to address the tolerability and efficacy of an ARNI in the OMT of ACHD HF patients by quantifying its structural, functional and symptomatic outcomes. MethodsENTRUST ACHD HF is an international multi-centre, open label, prospective, observational cohort registry designed to include ACHD HF patients with NYHA class II-IV symptoms and systemic ventricular ejection fractions <40% or ≥ moderate systolic dysfunction. The registry will seek to recruit 1000 patients over a 5 year period and document clinical, biochemical, functional and echocardiographic data over a 60 month follow-up window. Safety monitoring will be paramount to the registry design and follow-up process. ConclusionsENTRUST ACHD HF seeks to provide robust evidence regarding the tolerability and efficacy of Sacubitril/Valsartan in the largest cohort of ACHD HF patients to date through a registry design.

Mechanical Circulatory Support for the Failing Sub-Aortic Right Ventricle in Adults.

Patients with ccTGA or d-TGA managed via atrial switch (Mustard or Senning operations) have biventricular circulations with a sub-aortic right ventricle (2V-RV). Other than in a tiny percentage of ccTGA patients, premature heart failure (HF) is common, driven by chronic RV dilatation and dysfunction and/or tricuspid regurgitation. These patients are different from the general HF population in that they are younger, more heterogeneous, are predisposed to pulmonary hypertension and present unique and complex surgical challenges. Despite their young age, they experience disproportionately poor access to advanced therapies and are often disqualified for transplant by pulmonary hypertension, HLA sensitization, program risk-tolerance and psychosocial issues. Mechanical support of the subaortic RV with ventricular assist device (subaortic RVAD, also known as SVAD), although technically challenging, can be an effective alternative to palliative care and offers high likelihood of bridging patients to heart transplant candidacy. In addition, temporary trans-catheter SVAD Impella support has been advantageous for stabilization of decompensated 2V-RV patients or as bridge to durable SVAD support. Improved awareness of and access to specialist ACHD-HF teams offering mechanical support (and transplantation) for 2V-RV patients is increasingly urgent for this aging population, and will improve options and outcomes for these patients as HF emerges.

Prognostic accuracy of common heart failure scales in patients with dilated cardiomyopathy

Abstract Introduction The reliable identification of patients with heart failure (HF) and high mortality risk is crucial for treatment optimalization and prognostication, especially in younger population in dilated cardiomyopathy (DCM). However, the profile of DCM patients significantly differs from the general HF population. Therefore, the applicability of commonly used HF prognostic scales may be sub-optimal in DCM. Purpose Comparison of the prognostic accuracy of common HF prognostic scales in DCM. Methods Between 2010 and 2018 we analysed 406 DCM in- and outpatients (aged 54±14 years, 76% male, NYHA: 2.5±0.9, symptoms duration: 40±58 months, EF: 26±9%, LVEDd: 66±10mm, NT-proBNP: 3662±7617pg/ml, 10% had ICD, 3.5% had CRT). The mortality risk was assessed by 8 most popular HF prognostic scores. In 2019 information on patients status were gathered after 48±32months. Results During first month 4 patients (1.0%) died, after 1 year – 19 (6%), 2 years – 32 (11%), 3 years – 42 (18%), 4 years – 52 (27%), 5 years – 59 (40%). BCN and SHFM calculators had the best prognostic ability for 1–5 years mortality (Table 1). Conclusions Mortality risk of DCM patients during 5 years is high and reaches 40%. BCN and SHFM calculators had the best prognostic ability for 1–5 years mortality. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Department of Scientific Research and Structural Funds of Medical College, Jagiellonian University

Safety of compression therapy for venous ulcer disease in the setting of congestive heart failure.

Compression therapy is the mainstay of treatment for patients with venous ulcer disease. There exists a lack of certainty as to the safety of compression therapy in patients with congestive heart failure. A retrospective review of 95 patients with the diagnosis of congestive heart failure (systolic, diastolic, or combined), who underwent compression therapy at the wound care center of a large teaching hospital between January 2013 and June 2019, was performed. Patient outcomes including mortality, weight gain, admission for heart failure decompensation, and requirement for diuretic dose increase were compared to the general congestive heart failure population as well as to the registry data. In the compression cohort, with a mean compression period of 310 days, seven patients (7.3%) were admitted for congestive heart failure exacerbation and six (6.3%) underwent diuretic dosage increase. Two patients (2.1%) died during the compression period. These endpoints were not significantly higher than within the general congestive heart failure population. Compression therapy appears safe amongst patients with stable congestive heart failure.

Echocardiographic Assessment of Right Ventriculo-arterial Coupling: Clinical Correlates and Prognostic Impact in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy.

BACKGROUNDRight ventriculo-arterial coupling (RV-PA) can be estimated by echocardiography using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) and it has prognostic value in the general heart failure (HF) population. We aimed to study the clinical correlates and prognostic value of RV-PA in HF patients undergoing cardiac resynchronization therapy (CRT).METHODSWe retrospectively studied 70 HF patients undergoing CRT implantation.RESULTSRV-PA coupling was estimated by TAPSE/PASP ratio using baseline echocardiography. Non-response to CRT was defined as improvement of left ventricular ejection fraction < 5% in a follow-up echo 6-12 months after CRT. Those with lower TAPSE/PASP ratios (worse RV-PA coupling) had higher NT-proBNP concentrations and increased E/e′ ratio. TAPSE/PASP ratio and PASP, but not TAPSE, predicted nonresponse to CRT with TAPSE/PASP ratio showing the best discriminative ability with a sensitivity of 76% and specificity of 71%. Among these parameters, PASP independently predicted all-cause mortality.CONCLUSIONSRV-PA coupling estimated by TAPSE/PASP ratio was associated with established prognostic markers in HF. It numerically outperformed PASP and TAPSE in predicting the response to CRT. Our data suggest that this simple and widely available echocardiographic parameter conveys significant pathophysiological and prognostic meaning in HF patients undergoing CRT.

Another Obesity Paradox: In Cardiac AL Amyloid a Higher BMI Is Associated with a Lower Rate of Cardiac Response

Background:Light-chain amyloidosis (AL) is a clonal plasma cell disorder in which Ig light chains cause organ-specific disease due to toxic misfolded light-chain aggregates and extracellular deposition of amyloid fibrils derived from light chain proteins. The majority of amyloid patients present in various stages of heart failure and survival is largely driven by the extent of cardiac involvement. In the general heart failure population, overweight and mild/moderate obesity is associated with lower mortality, termed the obesity survival paradox. Conversely for patients with multiple myeloma, a disease similar in pathophysiology to AL, obesity is a risk factor for hematological progression. Hypothesis:We hypothesized that patients with cardiac amyloidosis would exhibit an obesity survival paradox and sought to determine the impact of BMI on hematological and cardiac responses to anti-plasma cell treatment. Methods:We conducted a single tertiary center retrospective study of consecutive patients with cardiac AL amyloidosis, referred between 1/1/2009 and 09/30/2018. We collected demographics and BMI prior to treatment. We recorded the date of diagnosis and subsequent dates of hematological and/or cardiac response, mortality or end of follow-up. We constructed a Cox proportional hazards model examining the association between BMI and mortality with a restricted cubic spline function curve. Three logistic regression models were constructed to examine the association between high BMI (&gt;/=25 kg/m2) and cardiac or hematological response, and mortality. Models were adjusted for age, sex and cardiac stage at the time of diagnosis. Results:Of 79 patients, 17 patients had BMI of 17-22.5, 19 a BMI of 22.6-25, 23 a BMI of 25.1-29.7, and 20 a BMI of &gt;/=30 kg/m2. Crude mortality was 31/79 (39%). There was no relationship between BMI as a continuous variable and mortality (HR 0.98, 95% CI 0.91-1.06, p=0.625, adjusted for age and sex), although a survival paradox trend was suggested by the spline curve. While there was no relationship between high BMI and hematological response (adjusted OR 1.00, 0.37-2.75, p=0.996), there was a relationship between high BMI and lower likelihood of achieving cardiac response (adjusted OR 0.23, 0.07-0.71, p=0.011). Conclusions:In this small cohort of patients with AL cardiac amyloidosis, there was no significant relationship between BMI and mortality. Hematological response was unrelated to BMI, but patients with a higher BMI were significantly less likely to achieve a cardiac response. These findings suggest that obesity might be associated with poorer cardiac outcomes in AL amyloidosis, highlighting the importance of a multidisciplinary approach involving oncologists, cardiologists, and nutritionists in the treatment of this complex multi-organ disease. Disclosures Comenzo: Caelum: Consultancy, Membership on an entity's Board of Directors or advisory committees; Prothena Biosciences: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi-Aventis: Membership on an entity's Board of Directors or advisory committees; Takeda: Research Funding; Unum: Membership on an entity's Board of Directors or advisory committees, Research Funding; Myself: Patents &amp; Royalties: Patent 9593332, Pending 20170008966; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Karyopharm: Research Funding.

Intravenous Versus Oral Iron Replacement in Patients with a Continuous-Flow Left Ventricular Assist Device.

Intravenous Versus Oral Iron Replacement in Patients with a Continuous-Flow Left Ventricular Assist Device.

In Cardiac AL Amyloid a Higher BMI is Associated with a Lower Rate of Cardiac Response

Light-chain amyloidosis (AL) is a clonal plasma cell disorder in which Ig light chains cause organ-specific disease due to toxic misfolded light-chain aggregates and extracellular deposition of amyloid fibrils derived from light chain proteins. Approximately half of AL amyloid patients present with cardiac involvement and survival is largely driven by the extent of heart failure. In the general heart failure population, overweight and mild/moderate obesity is associated with lower mortality, termed the obesity survival paradox.