Independent Predictor Of Heart Failure Research Articles

Prognostic impact of right ventricular strain in isolated severe tricuspid regurgitation

Abstract Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with severe tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is challenging. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detecting subclinical RV dysfunction. Purpose This study was aimed to evaluate the prognostic value of RV strain parameters in consecutive stable patients with severe TR. Methods Consecutive patients in stable clinical status with at least severe TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic following a comprehensive clinical protocol were included. Patients with previous episodes of heart failure or scheduled for TV intervention were excluded. RV systolic function was measured with conventional echocardiographic indices (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE], DTI S wave [`S]) and with Speckle-tracking echocardiography (STE) derived automatic peak global and free wall longitudinal strain (RV-GLS and RV-FWLS respectively) using the EPIQ system (Philips Medical Systems, Andover, Massachusetts). A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined. The interobserver variability of RV strain was assessed in 20 randomly selected patients. Results A total of 176 patients were included in this study. Strain parameters detected higher percentage of RV dysfunction compared to conventional indices (figure 1). After a median follow-up of 28 months (IQR: 15–48 months), n=65 patients (37%) reached the combined endpoint. 65 (37%) were admitted for right heart failure and 8% of the population (n=14) died. Cumulative event-free survival was significantly worse in patients with impaired RV-GLS and RV-FWLS. Conventional indices of RV systolic function were not associated with outcomes (p>0.05 for all). In a multivariable analysis (in a model including NYHA class, BNP values, biplane VC, RV end-diastolic area, and RV-FWLS), RV-FWLS was an independent predictors of heart failure and CV mortality (figure 1 and 2; LR χ2: 40.2, p<0.001). Inter-observer agreements for RV strain values were high (intraclass correlation coefficient for RV-GLS and RV-FWLS, r=0.96 and r=0.98 respectively) Conclusion Clinical outcomes demonstrate that RV strain parameters are superior to conventional indices of RV function in patients with isolated ≥ severe TR and absence of previous episodes of heart failure. Among all parameters of RV function, RV-FWLS is the strongest independent predictor of mortality and HF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto Carlos III

Infarction of the papillary muscle is an independent predictor of heart failure, ventricular tachycardia, and consequent mortality

Abstract Background Previous studies have assessed the effect of papillary muscle infarction (papMI) as seen with Late Gadolinium Enhancement (LGE) Cardiac Magnetic Resonance imaging (CMR) after ST-segment elevation myocardial infarction (STEMI) on patient prognosis. As these studies delivered inconclusive results due to limited sample size and follow-up, we set out to assess whether STEMI patients with papMI are at an increased risk of cardiovascular mortality, heart failure, and arrhythmic events. Methods This is a 3-center observational study in n=1,055 consecutive STEMI patients who underwent CMR at a median of 6 (4–9) days, with a mean follow-up of 6.0 years (IQR 3.1–9.1 years). Any presence of papMI, be it supero-lateral, infero-medial, or double, was evaluated visually on the LGE images and checked on the matched cine images. The primary outcomes are time to cardiovascular mortality, heart-failure events defined as heart failure death and hospital admission for heart failure, and arrhythmic events, defined as arrhythmic death and ventricular tachycardia (VT). Results PapMI was diagnosed in 351 patients (33%). PapMI is an independent predictor of cardiovascular mortality after correction for clinically relevant parameters such as infarct size and left ventricular ejection fraction (Multivariate Cox Regression Hazard Ratio (HR)=2.46, 95% confidence interval (CI) 1.23–4.92). Secondly, papMI independently predicts the combined endpoints of heart failure death/heart failure (HR=1.72, 95% CI 1.12–2.63) and arrhythmic death/ VT (HR=4.52, 95% CI 2.18–9.36). Conclusions PapMI predicts cardiovascular mortality, arrhythmic death and heart failure. PapMI should be taken into account, especially when conducting new prognosis studies after STEMI and as a stratification factor in studies for secondary prevention of VT and arrhythmic death. Funding Acknowledgement Type of funding sources: Other.

Predictors of heart failure and all-cause mortality in asymptomatic patients with moderate and severe aortic regurgitation.

Class I indications for aortic valve replacement (AVR) for severe chronic aortic regurgitation (AR) include AR attributable symptoms or left ventricular (LV) ejection fraction <50%. As noninvasive estimates of elevated LV filling pressures (LVFP's) have been noted to predict heart failure (HF) readmission and all-cause mortality (ACM) in HF patients, we hypothesize that elevated LVFP's may also be independent predictors of HF and ACM in chronic AR. We developed a single center patient database of moderate or greater AR diagnoses between 2003 and 2008 and followed each patient through January 2013. We included patients with >30 days follow-up with interpretable Doppler-echocardiograms. We recorded demographic variables, EuroScore II, incident HF and ACM, and Doppler-echo variables of LV size, systolic and diastolic function. Patients with severe AR (105 patients) and moderate AR (201 patients) had similar EuroScore II values and similar incident HF and ACM. For the 180 patients who developed HF, effective arterial elastance (aHR=1.70 (1.01-2.83), p=.041), LV end-diastolic dimension (aHR=1.83, (1.11-3.03), p=.0176), E/e' (aHR=3.04, (1.83-5.05), p<.0001), eccentric hypertrophy (EH) (aHR=2.39, (1.62-5.12), p=.0004), and tricuspid regurgitation (TR) velocity (aHR=5.75, (3.70-10.36), p<.0001) were independent predictors. For the 118 patients with ACM, EH (aHR=1.73, (1.02-3.28), p=.0414), systolic blood pressure (aHR=.58, (.33-.95), p=.0301), left atrial volume index (aHR=1.82, (1.06-3.06), p=.0293), E/e' (aHR=1.83, (1.07-3.08), p=.0280), and TR velocity (aHR=4.14, (2.22-6.49), p<.0001) were independent predictors. Elevated TR velocity and EH were strong markers of HF and ACM in patients with asymptomatic severe AR and in moderate AR.

The Protective Effects of Neurotrophins and MicroRNA in Diabetic Retinopathy, Nephropathy and Heart Failure via Regulating Endothelial Function.

Diabetes mellitus is a common disease affecting more than 537 million adults worldwide. The microvascular complications that occur during the course of the disease are widespread and affect a variety of organ systems in the body. Diabetic retinopathy is one of the most common long-term complications, which include, amongst others, endothelial dysfunction, and thus, alterations in the blood-retinal barrier (BRB). This particularly restrictive physiological barrier is important for maintaining the neuroretina as a privileged site in the body by controlling the inflow and outflow of fluid, nutrients, metabolic end products, ions, and proteins. In addition, people with diabetic retinopathy (DR) have been shown to be at increased risk for systemic vascular complications, including subclinical and clinical stroke, coronary heart disease, heart failure, and nephropathy. DR is, therefore, considered an independent predictor of heart failure. In the present review, the effects of diabetes on the retina, heart, and kidneys are described. In addition, a putative common microRNA signature in diabetic retinopathy, nephropathy, and heart failure is discussed, which may be used in the future as a biomarker to better monitor disease progression. Finally, the use of miRNA, targeted neurotrophin delivery, and nanoparticles as novel therapeutic strategies is highlighted.

Prevalence of Thyroid Dysfunction Among Patients with Heart Failure at a Tertiary Hospital in Mogadishu, Somalia.

IntroductionThyroid disease is an independent predictor of heart failure in patients. This study aimed to investigate the prevalence of thyroid dysfunction among patients with heart failure in Mogadishu, Somalia.MethodsFrom January 2019 to January 2021, a total of 250 patients diagnosed with heart failure admitted to the cardiology outpatient and emergency departments were evaluated retrospectively. The demographic characteristics, the cause of heart failure, and the kind of heart failure were recorded. Patients were categorized into subclinical hypothyroidism, hypothyroidism, low T3 syndrome, subclinical hyperthyroidism, and hyperthyroidism.ResultsA total of 250 heart failure patients. The prevalence of thyroid dysfunction among heart failure patients was 35.6%. The mean age of the patients was 59.8±14 years. Males outnumbered females by 159 (63.2%). The prevalence of thyroid dysfunction was 35.6%. Out of the 250 patients that were examined, most of the patients 30(33.3%) had subclinical hypothyroidism. 23 (25.6%) had overt hypothyroidism, 15 (16.7%) had overt hyperthyroidism, 20 (22.2%) had low T3 syndrome, and two cases had subclinical hyperthyroidism. Regarding the gender status of the thyroid dysfunction, 43(48.3%) were male, and 46(51.7%) were female. Regarding heart failure types among thyroid dysfunction patients, most patients were HFrEF (n=64, 71.9%), and 25(28.1%) were HFpEF. Patients with heart failure and reduced ejection fraction (HFrEF) were more likely to have thyroid dysfunction than those with preserved ejection fraction (p = 0.012). Regarding comorbidities among heart failure patients with thyroid dysfunction, approximately half of the patients had hypertension (40.4%).ConclusionThyroid problems are one of the most prevalent endocrine abnormalities in our practice. Subclinical hypothyroidism was the most common type of thyroid dysfunction among this population. We suggest that thyroid function be evaluated with cardiac function in patients with heart failure and followed up and treated together with heart failure.

Left Ventricular Global Function Index and Myocardial Contraction Fraction on 2D Echocardiography as Integral Parameters in Patients with Coronary Artery Disease

Patients with coronary artery disease (CAD) form a large group among all patients with cardiovascular diseases. Atherosclerosis, as one of the main pathogenetic mechanisms in adverse cardiovascular events development, is one of the leading causes of disability and mortality. Echocardiography is one of the main imaging techniques in managing cardiovascular patients. In search of a new parameter that would reflect both the morphological and functional LV changes, more and more attention has recently been paid to integrated indicators such as the left ventricular global function index (LVGFI) and myocardial contraction fraction (MCF). These parameters are independent predictors of heart failure and cardiovascular diseases.&#x0D; The aim. To evaluate the prognostic value of left ventricular global index and myocardial contraction fraction based on 2D echocardiography results in patients with CAD.&#x0D; Materials and methods. Patients with CAD confirmed by coronary angiography were included in the prospective clinical study. Thirty patients without CAD were a control group, 35 patients had single vessel lesion, 66 had multivessel CAD. LVGFI and MCF were calculated using 2D echocardiography technique.&#x0D; Results. The groups were comparable with respect to age, body mass index (BMI) and comorbidities. The mean age of the patients in group I was 60.53±1.77 years. In group II, the mean age was the highest, 64.31±1.62 years, and in group III the participants were 63.0±1.14 years old. The data indicate the absence of a significant difference (p = 0.39) in the age structure of the patients. In the control group, women predominated (70%), compared to groups II and III, where the proportion of women was 31.2% and 21.2%, respectively (p = 0.0001). The highest BMI classified as obesity class 1 was observed in the first group: 31.74 ± 1.09 kg/m2. Group III had BMI of 30.71 ± 0.62 kg/m2, which also indicates obesity class 1. Group II had the lowest BMI: 29.76 ± 0.77 kg/m2, but the difference between the groups was insignificant (p = 0.432). LVGFI and MCF differed significantly among groups (р=0.003 and р=0.004, respectively). MCF was the highest in patients with multivessel disease – 35.0% (27.71; 42.0), and the lowest in the group with no vascular lesions – 42.29% (36.35; 52.21). LVGFI also was different among the groups. It was the lowest in group III (24.91% [19.22; 30.48]), and the highest in group I (30.85% [25.46; 37.13]).&#x0D; Conclusions. MCF and LVGFI are closely related to the degree of coronary artery involvement. These integral parameters may be used as non-invasive markers of more significant coronary arteries involvement.

Model Embraced Electromechanical Coupling Time for Estimation of Heart Failure in Patients With Hypertrophic Cardiomyopathy.

ObjectiveThis study aimed to establish a model embraced electromechanical coupling time (EMC-T) and assess the value of the model for the prediction of heart failure (HF) in patients with hypertrophic cardiomyopathy (HCM).Materials and MethodsData on 82 patients with HCM at Shaanxi Provincial People’s Hospital between February 2019 and November 2021 were collected and then formed the training dataset (n = 82). Data were used to screen predictors of HF using univariate and multivariate analyses. Predictors were implemented to discover the optimal cut-off value, were incorporated into a model, and shown as a nomogram. The cumulative HF curve was calculated using the Kaplan–Meier method. Additionally, patients with HCM at other hospitals collected from March 2019 to March 2021 formed the validation dataset. The model’s performance was confirmed both in training and validation sets.ResultsDuring a median of 22.91 months, 19 (13.38%) patients experienced HF. Cox analysis showed that EMC-T courses in the lateral wall, myoglobin, PR interval, and left atrial volume index were independent predictors of HF in patients with HCM. Five factors were incorporated into the model and shown as a nomogram. Stratification of patients into two risk subgroups by applying risk score (<230.65, ≥230.65) allowed significant distinction between Kaplan–Meier curves for cumulative incidence of HF events. In training dataset, the model had an AUC of 0.948 (95% CI: 0.885–1.000, p < 0.001) and achieved a good C-index of 0.918 (95% CI: 0.867–0.969). In validation dataset, the model had an AUC of 0.991 (95% CI: 0.848–1.000, p < 0.001) and achieved a strong C-index of 0.941 (95% CI: 0.923–1.000). Calibration plots showed high agreement between predicted and observed outcomes in both two datasets.ConclusionWe established and validated a novel model incorporating electromechanical coupling time courses for predicting HF in patients with HCM.

Role of depressive symptoms in the prognosis of heart failure and its potential clinical predictors.

AimsThis study aims to analyse the factors associated with prognosis in hospitalized patients with heart failure, particularly the role of depressive symptoms, and to develop a prediction model for depressive symptoms based on clinical characteristics in hospitalized patients with heart failure.Methods and resultsBaseline information was collected at admission, and patients were followed up after discharge. The endpoint events were being hospitalized for heart failure or all‐cause death. Depressive symptoms were evaluated and defined via the Patient Health Questionnaire (PHQ)‐2 and PHQ‐9. The bidirectional elimination was used to screen independent predictors of heart failure with depression symptoms. The least absolute shrinkage and selection operator (LASSO) optimized the predictor variables, and the prediction model was constructed. The model was internally validated by the bootstrap sampling method (Bootstrap), and its performance was assessed by discrimination and calibration. The mean age of patients with heart failure was 69.43 ± 12.15 years, and the proportion of males was 66.67%. The prevalence of depressive symptoms in hospitalized patients with heart failure was 46.83%, and the prevalence of moderate/severe depressive symptoms was 11.62%. Eighty cases (30.30%) were readmitted for heart failure, and 13 cases (4.92%) were all‐cause deaths. Depressive symptoms (HR = 2.43, 95% CI: 1.55–3.80) and the PHQ‐9 score (HR = 1.11, 95% CI: 1.06–1.16) were both independent risk factors for endpoint events (P < 0.001). For heart failure patients combined with depressive symptoms, obesity (OR = 0.27, 95% CI: 0.09–0.77, P = 0.015), N‐terminal brain natriuretic peptide precursor (NT‐proBNP) level (lnNT‐proBNP: OR = 1.55, 95% CI: 1.20–2.01, P < 0.001) and red blood cell distribution width (RDW) (OR = 1.26, 95% CI: 1.08–1.47, P = 0.004) were the independent factors. Six variables, including cardiovascular disease hospitalization history, obesity, renal insufficiency, NT‐proBNP level, neutrophil ratio and RDW, were included to construct the prediction model. The area under the curve (AUC) was 0.730 in the original data, and the calibration curve was approximately distributed along the reference line in Bootstrap (500 resamplings), indicating the high level of discrimination and calibration of this model.ConclusionsDepressive symptoms and the PHQ‐9 score are both independent risk factors for the prognosis of hospitalized patients with heart failure. In hospitalized patients with heart failure, the risk prediction model developed in this study has good predictive power for depressive symptoms.

Abstract EP35: Longitudinal Lipidomic Profiling Of Left Ventricular Mass In American Indians: The Strong Heart Study

Background: Dyslipidemia is a major risk factor for CVD. Left ventricular mass (LVM) is an independent predictor of heart failure and other cardiovascular events. It is unclear whether and how altered plasma lipidome (all lipids in a plasma sample) affects LVM. The relationship between longitudinal change in plasma lipidome and change in LVM is also unstudied in any racial/ethnic group. Objective: To identify molecular lipid species associated with LVM, independent of traditional risk factors. Methods: Using an untargeted LC-MS, we repeatedly measured 1,542 lipids in 3,162 fasting plasma samples collected at two time points (2001-2003, 2006-2009, mean 5.5 years apart) from 1,581 American Indians in the Strong Heart Family Study. All participants were free of overt CVD at both time points. LVM was measured by M-mode echocardiography and LVM index (LVMI) was calculated as LVM/height 2.7 . Lipids associated with LVMI were identified by generalized estimating equation (GEE) models, adjusting for age, sex, center, BMI, smoking, blood pressure, renal function, LDL-c, and diabetes. We first conducted the analysis at each time point, separately, and then combined the results by meta-analysis. The longitudinal association between change in lipids and change in LVMI was examined by GEE, adjusting for the same covariates plus baseline lipids and LVMI. Multiple testing was controlled by false discovery rate at 0.05. Results: The mean age of participants was 39.8 years (62.5% women) at baseline and 45.1 years at follow-up. We identified 325 lipids (125 known), largely fatty acyls, sterol lipids, sphingolipids, glycerolipids, and glycerophospholipids, significantly associated with LVMI at both time points. Longitudinal changes in 17 lipids, including glycerolipids, glycerophospholipids, and sphingolipids, were either positively (ORs: 1.09 -1.95) or negatively (ORs: 0.50 - 0.69) associated with change in LVMI over 5 years of follow-up. Changes in lipids explain up to 1.58% of the variability in the change of LVMI during follow-up. Additional adjustments for use of anti-hypertensive and lipid-lowering drugs did not change the results. Conclusion: Altered fasting plasma lipidome and its longitudinal change over time were significantly associated with LVMI beyond clinical factors and baseline lipids. Our results shed light on the mechanisms through which dyslipidemia may affect LV remodeling, thereby contributing to heart failure or other cardiovascular events.

Prognostic value of left atrioventricular coupling index (LACI) in pre- and post-menopausal women : from the multi-ethnic study of atherosclerosis (MESA)

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Although endogenous sex hormones influence both left atrial (LA) and left ventricular (LV) structure in peri-menopausal women, no study has ever evaluated the interaction between sex hormones levels and the left atrioventricular coupling. PURPOSE This study aimed to assess the prognostic value of a left atrioventricular coupling index (LACI) in pre- and post-menopausal women without history of CVD at baseline. METHODS In all women participating in the Multi-Ethnic Study of Atherosclerosis (MESA) with baseline cardiovascular magnetic resonance (CMR) study, LACI was measured as the ratio of the LA end-diastolic volume divided by the LV end-diastolic volume. Cox proportional hazard models were used to assess the association between LACI and the outcomes of atrial fibrillation (AF), heart failure (HF), coronary heart disease (CHD) death, and hard CVD defined by myocardial infarction, resuscitated cardiac arrest, stroke, or CHD death. In multivariable analyses, the associations between LACI and the time-to-event were evaluated, adjusting for demographics, traditional cardiovascular risk factors, menopausal status and sex hormone levels. RESULTS Among the 2,087 women (61.2 ± 10.1 years), 485 cardiovascular events were observed during mean follow-up period of 13.2 ± 3.3 years. Greater LACI was independently associated with AF (HR 1.70; 95% CI [1.51-1.90]), HF (HR 1.62; 95% CI [1.33-1.97]), CHD death (HR 1.36; 95% CI [1.10-1.68]), and hard CVD (1.30; 95% CI [1.13-1.51], all p &amp;lt; 0.001). Adjusted models with LACI showed significant improvement in model discrimination and reclassification compared to currently used standard models to predict the incidences of AF (C-statistic: 0.82 vs. 0.79; NRI = 0.325; IDI = 0.036), HF (C-statistic: 0.84 vs. 0.81; NRI = 0.571; IDI = 0.023), CHD death (C-statistic: 0.87 vs. 0.85; NRI = 0.506; IDI = 0.012), and hard CVD (C-statistic: 0.78 vs. 0.76; NRI = 0.229; IDI = 0.012). The prognostic value of LACI was homogeneous in both pre- and post-menopausal women with a better discrimination and reclassification compared to individual LA or LV parameters. CONCLUSIONS In a multi-ethnic population of pre- and post-menopausal women, LACI is an independent predictor of HF, AF, CHD death and hard CVD. In both pre- and post-menopausal women, LACI has an incremental prognostic value to predict cardiovascular events over traditional risk factors and sex hormone levels. ClinicalTrials.gov Identifier: NCT00005487 Abstract Figure. Kaplan-Meier curves by LACI terciles Abstract Figure. Kaplan-Meier curves by LACI and Menop.

Left ventricular diastolic dysfunction, including an impaired myocardial relaxation pattern, predicts long-term cardiovascular and non-cardiovascular mortality in the community

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Prior studies have demonstrated abnormalities of diastolic function are independent predictors of heart failure and all-cause mortality. The optimal way to classify diastolic function has continued to evolve over time, particularly in those with preserved left ventricular ejection fraction. A notable change in the 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines is that individuals with impaired myocardial relaxation and normal filling pressure can be classified as normal diastolic function. Purpose To determine whether the association of diastolic dysfunction with increased risk of all-cause mortality is driven by cardiovascular or non-cardiovascular death. Second, to evaluate if the presence of an impaired myocardial relaxation inflow pattern without other diastolic abnormalities conveys a marker of increased risk. Methods This study utilized the Olmsted County Heart Function Study (OCHFS), a well characterized prospective adult community cohort with comprehensive echocardiography between 2001 and 2004 and long-term follow-up. Only individuals with measurable diastolic function were included (n = 1,104). Those with reduced left ventricular ejection fraction, more than moderate valve disease, or a clinical diagnosis of heart failure (n = 52); or indeterminate diastolic function (n = 47) were excluded. Diastolic function was assessed by the current Mayo Clinic diagnostic algorithm (Figure). Results A total of 695 individuals were classified as normal, 265 with impaired myocardial relaxation or grade 1 diastolic dysfunction, and 45 with grade 2-3 diastolic dysfunction. Those with diastolic dysfunction were older and had more comorbidities including diabetes, hypertension and coronary disease (Table). There were 264 deaths in the median follow up period of 15.2 years (IQR 14.4 – 18.0), including 173 non-cardiovascular and 81 cardiovascular deaths. Both cardiovascular and non-cardiovascular mortality were associated with the presence and grade of diastolic dysfunction (Table 1). Individuals classified as normal by 2016 ASE/EACVI criteria, but grade 1 by the Mayo algorithm had an increased risk of all-cause mortality after univariate analysis (HR 4.35, 95% CI (3.35, 5.65), p &amp;lt; 0.0001) compared to normal subjects and remained associated after adjustment for age (HR 1.55, 95% CI (1.15, 2.09), p &amp;lt; 0.0001. Subjects with a grade 1 pattern had a higher rate of cardiovascular mortality (ꭕ2 70.1, p &amp;lt; 0.0001). Conclusions Individuals with diastolic dysfunction, including those with an impaired relaxation mitral inflow, were at increased risk of mortality, particularly cardiovascular mortality. This study highlights the importance of separating grade 1 diastolic dysfunction from normal in the assessment of diastolic function as it represents a clinically significant risk marker of myocardial disease. Abstract Figure. Abstract Figure.

Diagnostic Value of Serum Concentration of Galectin-3 in Patients With Heart Failure With Preserved Ejection Fraction.

BackgroundAlthough the predictive value of galectin-3 for heart failure with preserved ejection fraction has been demonstrated, the diagnostic value remains unclear. The present study was performed to address this issue.HypothesisGalectin-3 has diagnostic value for heart failure with preserved ejection fraction.MethodsThis is a diagnostic experiment. We conducted an observational study of 223 patients with combined symptoms of heart failure and diseases that can lead to heart failure with preserved ejection fraction. Patients were grouped into the heart failure group and control group in accordance with the 2016 European Society of Cardiology heart failure guidelines for heart failure with preserved ejection fraction. Baseline information and serum galectin-3 concentration were assessed within 24 h after admission.ResultsSerum galectin-3 concentration was significantly higher in the heart failure group compared with the control group. Binary logistic regression analysis showed that higher galectin-3 concentration was associated with the occurrence of heart failure with preserved ejection fraction. The area under the curve of galectin-3 was 0.763, indicating that galectin-3 has moderate diagnostic value for heart failure with preserved ejection fraction. Galectin-3 >15.974 ng/mL identified heart failure with preserved ejection fraction with 76.0% sensitivity and 71.9% specificity.ConclusionsThere was a correlation between galectin-3 and heart failure with preserved ejection fraction, and galectin-3 was an independent predictor of heart failure with preserved ejection fraction. The diagnostic value of galectin-3 for heart failure with preserved ejection fraction was moderate (AUC: 0.763, 95% CI: 0.696–0.821, P < 0.01, and the sensitivity is 76.0% while the specificity is 71.9% at the threshold 15.974 ng/mL) and was higher than that of interventricular septal thickness or E/A ratio.

Clinical prognostic role of bioimpedance phase angle in diabetic and non-diabetic hemodialysis patients.

Bioelectrical-impedance analysis (BIA) is frequently used to estimate dry weight in hemodialysis (HD) patients. However, the clinical prognostic significance of BIA indicators is unclear. As a nutritional index, low phase angle (PA) might be an independent risk factor for predicting death in multiple chronic diseases. We performed this study to find relative influence factors of PA and other clinical prognostic significance. The study involved 87 HD patients, 33 of whom were diabetic and 54 of whom were not. We measured body composition index, body water index and nutritional indicators and collected biochemical criteria. Then, we statistically analyzed the associations of these indices. After 1 year of follow- up, we recorded death, heart failure, hospitalization, cerebrovascular and cardiovascular events and other clinical outcomes. We found a significant difference between the two groups in visceral-fat area, extracellular water/total body water (ECW/TBW) ratio and PA value. Two factors were negatively associated with PA: ECW/TBW ratio and HCO3- before HD. At 1 year, we noted that PA was associated with events such as heart failure or hospitalization. By further stratification and multivariate analysis adjusting for age, sex and months of dialysis, we found that low PA was an independent predictor of heart failure for diabetic HD patients. PA value was lower in Diabetic nephropathy (DN) HD patients, than that in non-DN HD patients. PA was mainly negatively associated with ECW/TBW ratio. It is a useful index for predicting heart failure in diabetic HD patients.

Established Tumour Biomarkers Predict Cardiovascular Events and Mortality in the General Population.

Introduction: Several lines of evidence reveal that cardiovascular disease (CVD) and cancer share similar common pathological milieus. The prevalence of the two diseases is growing as the population ages and the burden of shared risk factors increases. In this respect, we hypothesise that tumour biomarkers can be potential predictors of CVD outcomes in the general population.Methods: We measured six tumour biomarkers (AFP, CA125, CA15-3, CA19-9, CEA and CYFRA 21-1) and determined their predictive value for CVD in the Prevention of Renal and Vascular End-stage Disease (PREVEND) study. A total of 8,592 subjects were enrolled in the study.Results: The levels of CEA significantly predicted CV morbidity and mortality, with hazard ratios (HRs) of HR 1.28 (95% CI 1.08–1.53), respectively. Two biomarkers (CA15-3 and CEA) showed statistical significance in predicting all-cause mortality, with HRs 1.58 (95% CI 1.18–2.12) and HR 1.60 (95% CI 1.30–1.96), when adjusted for shared risk factors and prevalent CVD. Furthermore, biomarkers seem to be sex specific. CYFRA 21-1 presented as an independent predictor of CV morbidity and mortality in female, but not in male gender, with HR 1.82 (95% CI 1.40–2.35). When it comes to all-cause mortality, both CYFRA and CEA show statistical significance in male gender, with HR 1.64 (95% CI 1.28–3.12) and HR 1.55 (95% CI 1.18–2.02), while only CEA showed statistical significance in female gender, with HR 1.64 (95% CI 1.20–2.24). Lastly, CA15-3 and CEA strongly predicted CV mortality with HR 3.01 (95% CI 1.70–5.32) and HR 1.82 (95% CI 1.30–2.56). On another hand, CA 15-3 also presented as an independent predictor of heart failure (HF) with HR 1.67 (95% CI 1.15–2.42).Conclusion: Several tumour biomarkers demonstrated independent prognostic value for CV events and all-cause mortality in a large cohort from the general population. These findings support the notion that CVD and cancer are associated with similar pathological milieus.

Total Serum Protein as an Independent Predictor of Heart Failure with Preserved Ejection Fraction in Obese Pediatric Population

Objectives: We aimed to clarify the prognostic role of Total Serum Protein (TSP) in obese children with HFpEF and its using as an effective and noninvasive approach for screening of target population. Methods: In total, 587 patients who enrolled in our unique program aimed for children’s obesity treatment were referred. Among these patients, we identified and retrospectively studied 64 patients who met our criteria and compared them with 24 lean healthy subjects. Baseline examination, routine blood testing and transthoracic echocardiography were obtained. Results: We revealed that obese patients had higher TSP levels compared to them with normal weight. They also had worse echocardiographic results including a lower Left Ventricular Ejection Fraction (LVEF) and E/A ratio. Positive correlations between TSP and Pulmonary Artery Systolic Pressure (PASP), Left Atrial Volume Index (LAVI), and Interventricular Septal Systolic/Diastolic Dimension (IVSs, IVSd) and negative TSP correlations with LVEF and E/A ratio were found, too. Compared to the commonly used Albumin-to-Globulin Ratio (AGR), the TSP was a better metabolic predictor. There were more significant correlations in obese subgroup with HFpEF than to those without HFpEF. Conclusions: We first indicated that higher TSP levels are positively associated with obesity and HFpEF in children and could be used as a more easily available biomarker which provides a more-accurate HFpEF risk evaluation of obese pediatric population group than other objective indices, possibly allowing early implementation of appropriate intervention in daily practice and leads to better outcomes and early prevention in patients with higher HF risk.

Prevalence and predictors of heart failure among patients on maintenance hemodialysis therapy at Muhimbili National Hospital in Tanzania: a cross-sectional study

BackgroundHeart failure among patients on hemodialysis therapy portends poor outcomes. Traditional risk factors like aging, hypertension and diabetes mellitus are relatively common in these patients and may not accurately predict the occurrence of heart failure. Such patients may have other factors that contribute to heart failure. This study aimed to investigate the prevalence and predictors of heart failure among patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania.ResultsAmong 160 patients on maintenance hemodialysis, 49 (30.6%) were female. The mean age of patients was 52.2 ± 13.3 years. Almost all patients had hypertension and 69 (43.1%) had diabetes mellitus. Heart failure was prevalent in 17 (10.6%) patients. On multivariate analysis, presence of angina, intradialytic hypertension, and anemia were independent predictors of heart failure. Patients with heart failure had significantly higher malnutrition inflammation scores and erythropoietin resistance indexes.ConclusionsHeart failure among hemodialysis patients correlates with the presence of angina, intradialytic hypertension, and anemia. Patients with heart failure had a greater degree of malnutrition–inflammation complex, and erythropoietin resistance. Patients with these conditions require a thorough cardiac evaluation and appropriate treatment.

Usefulness of Global Longitudinal Strain to Predict Heart Failure Progression in Patients With Nonobstructive Hypertrophic Cardiomyopathy

While predicting prognosis to anticipate adverse disease course has long been an aspiration in hypertrophic cardiomyopathy (HC), reliable markers of progressive and unrelenting heart failure symptoms in the absence of obstruction are not well characterized. We sought to evaluate markers of systolic function, including the role of global longitudinal strain (GLS), to identify nonobstructive HC patients at risk for future heart failure. A cohort of 296 consecutive nonobstructive HC patients (42 ± 18years; 75% male) with NYHA class I/II symptoms and preserved systolic function at study entry (EF: 65 ± 6%), were followed for progressive heart failure symptoms (increase in ≥ 1 NYHA functional class) and/or development of systolic dysfunction (EF < 50%). Over median follow-up of 4 ± 3 years, 35 study patients (10%) experienced new heart failure events, including 31 with progressive symptoms and 4 who developed systolic dysfunction. Abnormal GLS < 16% was associated with a 5-fold increase in risk for heart failure compared to GLS > 18% (p < 0.001). GLS remained an independent predictor of heart failure even after adjustment for other relevant disease variables including EF (OR 1.23, p = 0.005). However, notably, when GLS and EF were combined, the prediction of heart failure for individual patients was enhanced (net reclassification improvement 0.55; p = 0.002). Together, GLS < 16% and EF 50% to 59% were associated with a 12.5-fold greater risk for heart failure versus patients with GLS > 18% and EF ≥ 60%, who were at the lowest risk. In conclusion, in nonobstructive HC with no or mild symptoms and preserved EF, abnormal GLS is a strong independent predictor for subsequent development of progressive heart failure symptoms and/or systolic dysfunction. Furthermore, the greatest power in predicting outcome in nonobstructive HC is achieved by combining GLS with EF to identify HC patients at the highest risk for heart failure progression and systolic dysfunction.

New Heart Failure After Myocardial Infarction (From the National Cardiovascular Data Registries [NCDR] Linked With All-Payer Claims)

Heart failure (HF) is common in patients presenting with acute myocardial infarction (MI), but incidence and predictors of new onset HF after hospitalization for MI are less well characterized. We evaluated patients hospitalized for acute MI without preceding or concurrent HF in the National Cardiovascular Data Registry (NCDR) CathPCI and Chest Pain-MI registries linked with claims data between April 2010 and March 2017. Cumulative incidence and independent predictors of HF after discharge were determined, and a simplified risk score was developed to predict incident HF following MI. In 337,274 patients with acute MI and no history of HF, 8.0% developed incident HF within 1 year after discharge and 18.8% developed HF within 5 years. Significant predictors of HF after MI included advanced chronic kidney disease (CKD) (HR 2.34, 95% confidence interval [CI] 2.23-2.46 for Stage IV vs Stage I, and HR 2.18, 95% CI 2.07-2.29 for Stage V vs. Stage I), recurrent MI following index MI (HR 2.24, 95% CI 2.19-2.28), African-American race (HR 1.44, 95% CI 1.40-1.48), and diabetes (HR 1.39, 95% CI 1.37-1.42). A risk score of 8 variables predicted HF with modest discrimination (optimism-corrected c-statistic 0.64) and good calibration. In conclusion, nearly 1 in 5 patients in a large nationally representative cohort without preceding or concurrent heart failure at time of MI developed incident HF within 5 years after discharge. Advanced CKD and recurrent MI were the strongest predictors of future HF. Increased recognition of specific risk factors for HF may help inform care strategies following MI.

Association of Mean and Variability of HbA1c with Heart Failure in Patients with Type 2 Diabetes.

Heart failure (HF) is a common presentation in patients with type 2 diabetes mellitus (T2DM). Previous studies revealed that the HbA1c level is significantly associated with HF. However, little is known about the association between HbA1c variability and HF. We aimed to evaluate the association of mean and variability of HbA1c with HF in patients with T2DM. Using Diabetes Share Care Program data, patients with T2DM who had mean HbA1c (HbA1c-Mean), and HbA1c variability (tertiles of HbA1c-SD and HbA1c-adjSD) within 12–24 months during 2001–2008 were included. The cutoffs of HbA1c-Mean were set at <7%, 7–7.9%, and ≥8%. Hazard ratios (HRs) for HF during 2008–2018 were estimated using Cox proportional hazard models. A total of 3824 patients were included, of whom 315 patients developed HF during the observation period of 11.72 years. The associated risk of HF increased with tertiles of HbA1c variability and cutoffs of HbA1c-Mean. In mutually adjusted models, HbA1c-Mean showed a consistent dose-response association with HF, while the association of HbA1c variability with HF disappeared. Among patients with HbA1c-Mean <7%, the associated risk of HF in patients with HbA1c variability in tertile 3 was comparable to patients with HbA1c-Mean ≥8%. In conclusion, mean HbA1c was an independent predictor of HF and not explained by HbA1c variability. In addition to absolute HbA1c level, targeting on stability of HbA1c in patients with good glycemic control was also important for the development of HF in patients with T2DM.

Incidence, predictors and mortality risk of new heart failure in patients hospitalised with atrial fibrillation

ObjectiveTo determine the incidence, risk predictors and relative mortality risk of incident heart failure (HF) in patients following atrial fibrillation (AF) hospitalisation.MethodsThe Western Australian Hospitalisation Morbidity Data Collection was used...