Prognostic Factor In Heart Failure Research Articles

Gender differences in the relationship between serum uric acid and the long-term prognosis in heart failure: a nationwide study

BackgroundSerum uric acid (SUA) is an important pathogenetic and prognostic factor for heart failure (HF). Gender differences are apparent in HF. Furthermore, gender differences also exist in the association between SUA and prognosis in various cardiovascular diseases. However, the gender difference for SUA in the prediction of long-term prognosis in HF is still ambiguous.MethodsA total of 1593 HF patients (897 men, 696 women) from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 cycle were enrolled in our final analysis. Participants were categorized according to gender-specific SUA tertile. We assessed the association between SUA and long-term prognosis of HF patients, defined as all-cause mortality and cardiovascular mortality, in different genders via Kaplan–Meier curve analysis, Cox proportional hazard model, and Fine-Gray competing risk model. The restricted cubic spline (RCS) was performed to investigate the dose-response relationship between SUA and outcomes.ResultsGender differences exist in demographic characteristics, clinical parameters, laboratory tests, and medication of HF patients. After a median follow-up of 127 months (95% CI 120–134 months), there were 853 all-cause deaths (493 events in men, 360 events in women) and 361 cardiovascular deaths (206 events in men, 155 events in women). Kaplan-Meier analysis showed that SUA had gender difference in the prediction of cardiovascular mortality (Log-rank p < 0.001, for male, Log-rank p = 0.150, for female), but not in all-cause mortality. Multivariate Cox regression analysis revealed that elevated SUA levels were associated with higher all-cause mortality and cardiovascular mortality in men (HR 1.11, 95% CI 1.05-1.18, p < 0.001, for all-cause death; HR 1.18, 95% CI 1.09-1.28, p < 0.001, for cardiovascular death), but not in women (HR 1.05, 95% CI 0.98-1.12, p = 0.186, for all-cause death; HR 1.01, 95% CI 0.91-1.12, p = 0.902, for cardiovascular death). Even using non-cardiovascular death as a competitive risk, adjusted Fine-Gray model also illustrated that SUA was an independent predictor of cardiovascular death in men (SHR 1.17, 95% CI 1.08-1.27, p < 0.001), but not in women (SHR 0.98, 95% CI 0.87 − 1.10, p = 0.690).ConclusionsGender differences in the association between SUA and long-term prognosis of HF existed. SUA was an independent prognostic predictor for long-term outcomes of HF in men, but not in women.

Peak VO2 and VE/VCO2 exhibit differential prognostic capacity for predicting cardiac events

Abstract Background Cardiopulmonary exercise testing (CPET) are commonly used to assess the functional capacity of patients with heart failure. While both peak oxygen uptake (VO2) and ventilatory efficiency (VE/CO2) are significant prognostic factors in heart failure, their values may not always be concordant. Methods This retrospective study included 688 patients who underwent both CPET and supine bicycle echocardiography (SBE) simultaneously. The primary endpoint of the study was defined as heart failure hospitalization or cardiac death. The patients were categorized into subgroups based on their VO2 and VE/VCO2 slope values. Results After median follow-up of 89 months, 111 (16.4%) patients developed cardiac events. The mean age and ejection fraction were 58 years and 59%. In multivariate analysis, both VO2 and VE/VCO2 remained powerful predictors of cardiac events after adjusting for age, ejection fraction, baseline or exercise E/e’, and peak TR velocity. Subgroup analysis revealed that Group III (VO2 &amp;gt;20 and VE/VCO2 &amp;gt;30) and IV (VO2 &amp;lt;20 and VE/VCO2 &amp;gt;30) had a significantly higher risk of cardiac events, with hazard ratios of 3.38 (CI 1.36-8.40) and 8.40 (CI 3.86-18.34), respectively, compared to Group I (VO2 &amp;gt;20 and VE/VCO2 &amp;lt;30). Group II (VO2 &amp;lt;20 and VE/VCO2 &amp;lt;30) had a non-significantly increased risk of cardiac events with a hazard ratio of 2.04 (CI 0.80-5.21) compared to Group I (Fig). Conclusion Both VO2 and VE/VCO2 slope were found to be excellent predictors of cardiac events in patients who underwent CPET and SBE. However, there is a slight difference between the two parameters, and poorer ventilatory inefficiency was found to be more associated with a worsened prognosis. The study suggests that the risk stratification using the VE/VCO2 slope and peak VO2 values can provide valuable information for clinicians in managing patients with heart failure.

Abstract 16064: Prognostication of Cardiopulmonary Exercise Testing in Heart Failure With Reduced Ejection Fraction on Optimized Guideline-Directed Medical Therapy

Introduction: Cardiopulmonary exercise testing (CPET) is a valuable tool for predicting outcomes in patients with heart failure. Peak oxygen consumption (VO2) and minute ventilation/carbon dioxide production (VE/VCO2) are important prognostic factors in heart failure with reduced ejection fraction (HFrEF). However, prior studies have not examined the impact of optimization of guideline-directed medical therapy (GDMT) on the utility of CPET in prognostication. Hypothesis: This study aims to investigate the prognostic value of CPET in a cohort of HFrEF patients who are compliant with all four GDMT components: beta-blockers (BB), ace-inhibitors (ACEi)/angiotensin II-receptor-blockers (ARB)/angiotensin-receptor-neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA), and sodium-glucose cotransporter-2 (SGLT2). This will be compared to patients with HFrEF who are not fully optimized on GDMT to determine variation in the statistical significance of prognostic factors. Methods: We retrospectively analyzed data from 176 HFrEF patients who underwent CPET for prognostication purposes. The patients were followed for one year after. CPET testing was completed between January 2020 to June 2022. LVEF was evaluated by echocardiography, completed within 3 months of the CPET. From the data, 125 participants had an LVEF less than or equal to 40%. Of those, 71 were compliant with all four GDMT components, while 54 were not. Results: After one year, there were 16 events (MSR, transplant, or death) in the GDMT-optimized group comprised of 71 participants. Peak VO2 was higher in the no-event group and was notably the only statistically significant predictor of adverse event (p =0.0162). Similarly, of the 54 participants on less than four GDMT components, 13 adverse events occurred, and the strongest predictor was again peak VO2 (p=0.0027). In addition, VE/VCO2 slope were lower (p= 0.0234) and circulatory power were higher (p=0.0044) in the no-event group. Conclusions: In patients with HFrEF that are optimized on GDMT, peak VO2 is consistently the most robust and only statistically significant prognostication tool on CPET for MCS, transplantation, or death within one year.

Abstract 15158: Prognostic Impact of Right Ventricular-Pulmonary Arterial Coupling Ratio in Patients Undergoing Transcatheter Aortic Valve Replacement

Introduction: Right ventricular (RV) dysfunction is known as an important prognostic factor in heart failure. As reduced RV systolic reserve, RV contractility no longer increases against afterload, resulting in lower ratios of RV function to pulmonary artery (PA) pressure, known as RV-PA coupling ratios. Hypothesis: The assessment of RV-PA coupling ratios provides prognostic information for patients undergoing transcatheter aortic valve replacement (TAVR). Methods and Results: A total of 540 patients with TAVR (age, 84 ± 6 years; 186 men, 354 women) were included in this study. The RV-PA coupling ratio was calculated by dividing the tricuspid annular plane systolic excursion (TAPSE) by the PA systolic pressure (PASP) using transthoracic echocardiography before TAVR. Based on the median TAPSE/PASP (0.584 mm/mmHg), the patients were divided into two groups. Kaplan-Meier analysis demonstrated a higher incidence of adverse cardiac events (cardiac death and heart failure hospitalization) in the group with a low TAPSE/PASP ratio (log-rank test, P &lt;0.001). In multivariate Cox regression analysis, TAPSE/PASP was identified as an independent prognostic parameter (adjusted hazard ratio, 0.259; P = 0.028), whereas neither TAPSE alone nor PASP alone demonstrated any significant prognostic value. Conclusion: The RV-PA coupling ratio serves as a prognostic predictor for adverse cardiac events in patients undergoing TAVR.

Due Diligence of a Diastolic Index as a Prognostic Factor in Heart Failure with Preserved Ejection Fraction.

Of the existing non-invasive diastolic indices, none consider arterial load. This article reveals points of caution for determining the diastolic prognostic index using a novel index of vascular resistance-integrated diastolic function in old, real-world patients with heart failure with preserved ejection fraction (HFpEF) in Japan. This index represents the ratio of left ventricular diastolic elastance (Ed) to arterial elastance (Ea), where Ed/Ea = (E/e')/(0.9 × systolic blood pressure), showing a relative ratio of left atrial filling pressure to left ventricular end-systolic pressure. The role of hemodynamic prognostic factors related to diastolic function, such as Ed/Ea, may differ according to the clinical endpoint, follow-up duration, and sex. In HFpEF patients with heterogenous cardiac structure and function, an assessment using a serial echocardiographic diastolic index in clinical care can provide an accurate prognosis.

COVID-19 as an Aggravator of Cardiovascular Diseases: Increasing Immunoglobulin G, a Valuable Prognostic Factor for Heart Failure

Background: COVID-19 might worsen preexisting cardiac conditions and cause new heart failure (HF). To appropriately triage and treat patients, an early diagnosis is necessary. Objectives: This study assessed the levels of antibodies immunoglobulin G (IgG) and immunoglobulin M (IgM) required for the coronavirus spike S protein in the serum of individuals with cardiovascular disease (CVD) who developed HF complications from COVID-19. Methods: A total of 104 hospitalized patients with confirmed COVID-19 were equally divided into severe COVID-19 cases with new HF evidence and controls. The levels of IgG and IgM antibodies vs SARS-CoV-2 were measured. The possible correlation of antibody levels with underlying cardiac risk factors was also investigated. Results: It was found that 86% of HF patients and 5% of controls had an IgG level greater than 100 AU/mL (P &lt; 0.05). Ischemic heart disease (IHD) was the most common disease in the patient group, and the highest level of antibodies was also found in this group. Conclusions: Increasing IgG during COVID-19 can be one of the signs of worsening heart disease, which is more prevalent in patients with an underlying IHD and hypertension.

PCr/ATP ratios and mitochondrial function in the heart. A comparative study in humans

Cardiac energy status, measured as phosphocreatine (PCr)/adenosine triphosphate (ATP) ratio with 31P-Magnetic Resonance Spectroscopy (31P-MRS) in vivo, is a prognostic factor in heart failure and is lowered in cardiometabolic disease. It has been suggested that, as oxidative phosphorylation is the major contributor to ATP synthesis, PCr/ATP ratio might be a reflection of cardiac mitochondrial function. The objective of the study was to investigate whether PCr/ATP ratios can be used as in vivo marker for cardiac mitochondrial function. We enrolled thirty-eight patients scheduled for open-heart surgery in this study. Cardiac 31P-MRS was performed before surgery. Tissue from the right atrial appendage was obtained during surgery for high-resolution respirometry for the assessment of mitochondrial function. There was no correlation between the PCr/ATP ratio and ADP-stimulated respiration rates (octanoylcarnitine R2 < 0.005, p = 0.74; pyruvate R2 < 0.025, p = 0.41) nor with maximally uncoupled respiration (octanoylcarnitine R2 = 0.005, p = 0.71; pyruvate R2 = 0.040, p = 0.26). PCr/ATP ratio did correlate with indexed LV end systolic mass. As no direct correlation between cardiac energy status (PCr/ATP) and mitochondrial function in the heart was found, the study suggests that mitochondrial function might not the only determinant of cardiac energy status. Interpretation should be done in the right context in cardiac metabolic studies.

Deep learning approach for analyzing chest x-rays to predict cardiac events in heart failure.

A deep learning (DL) model based on a chest x-ray was reported to predict elevated pulmonary artery wedge pressure (PAWP) as heart failure (HF). The aim of this study was to (1) investigate the role of probability of elevated PAWP for the prediction of clinical outcomes in association with other parameters, and (2) to evaluate whether probability of elevated PAWP based on DL added prognostic information to other conventional clinical prognostic factors in HF. We evaluated 192 patients hospitalized with HF. We used a previously developed AI model to predict HF and calculated probability of elevated PAWP. Readmission following HF and cardiac mortality were the primary endpoints. Probability of elevated PAWP was associated with diastolic function by echocardiography. During a median follow-up period of 58 months, 57 individuals either died or were readmitted. Probability of elevated PAWP appeared to be associated with worse clinical outcomes. After adjustment for readmission score and laboratory data in a Cox proportional-hazards model, probability of elevated PAWP at pre-discharge was associated with event free survival, independent of elevated left atrial pressure (LAP) based on echocardiographic guidelines (p < 0.001). In sequential Cox models, a model based on clinical data was improved by elevated LAP (p = 0.005), and increased further by probability of elevated PAWP (p < 0.001). In contrast, the addition of pulmonary congestion interpreted by a doctor did not statistically improve the ability of a model containing clinical variables (compared p = 0.086). This study showed the potential of using a DL model on a chest x-ray to predict PAWP and its ability to add prognostic information to other conventional clinical prognostic factors in HF. The results may help to enhance the accuracy of prediction models used to evaluate the risk of clinical outcomes in HF, potentially resulting in more informed clinical decision-making and better care for patients.

Health-Related Quality of Life and Its Association With Outcomes in Adults With Congenital Heart Disease and Heart Failure: Insight From FRESH-ACHD Registry.

Background Quality of Life (QoL) is a prognostic factor in heart failure (HF) of patients with acquired cardiac disease. The aim of this study was to determine the predictive value of QoL on outcomes in adults with congenital heart disease (ACHD) and HF. Methods and Results Quality of life of 196 adults with congenital heart disease with clinical heart failure (HF) (mean age: 44.3±13.8 years; 51% male; 56% with complex congenital heart disease; 47% New York Heart Association class III/IV) included in the prospective multicentric registry FRESH-ACHD (French Survey on Heart Failure-AdultwithCongenitalHeartDisease)was assessed using the 36-Item Short Form Survey (SF-36), a patient-reported survey. The primary end point was defined by all-cause death, HF-related hospitalization, heart transplantation, and mechanical circulatory support. At 12 months, 28 (14%) patients reached the combined end point. Patients with low quality of life experienced major adverse events more frequently (logrank P=0.013). On univariate analysis, lower score at physical functioning (hazard ratio [HR], 0.98 [95% CI, 0.97-0.99]; P=0.008), role limitations related to physical health (HR, 0.98 [95% CI, 0.97-0.99]; P=0.008), and general health dimensions of the SF-36 (HR, 0.97 [95% CI, 0.95-0.99]; P=0.002) were significantly predictive of cardiovascular events. However, after multivariable analysis, SF-36 dimensions were no longer significantly associated with the primary end point. Conclusions Patients with congenital heart disease with HF and poor quality of life experience severe events more frequently, making quality of life assessment and rehabilitation programs essential to alter their trajectory.

Relationships of Whole-Heart Myocardial Mechanics and Cardiac Morphometrics by Transthoracic Echocardiography with Main Prognostic Factors of Heart Failure in Non-Ischemic Dilated Cardiomyopathy.

there are many prognostic factors of heart failure (HF) based on their evaluation from imaging, to laboratory tests. In clinical practice, it is crucial to use widely available, cheap, and easy-to-use prognostic factors, such as left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, 6 min walk test (6MWT), B-type natriuretic peptide (BNP), etc. We sought to evaluate the relationships between whole-heart myocardial mechanics and cardiac morphometrics with the main commonly used prognostic factors of HF in patients with non-ischemic dilated cardiomyopathy (NIDCM). two-dimensional (2D) echocardiography for myocardial mechanics (global longitudinal, radial, and circumferential strains of the left ventricle; right ventricular longitudinal strain; strain values of reservoir, conduit, and contraction function of both atria) and cardiac morphometric (diameters and volumes of both atria and ventricles) parameters were performed, and the HF main traditional prognostic factors were identified. We assessed 109 patients (68.8% male; 49.7 ± 10.5 years) with newly diagnosed NIDCM. Myocardial mechanics and morphometrics were weakly correlated with the patient's age, gender, and smoking (R = 0.2, p < 0.05). Stronger relationships were observed with NYHA class, 6MWT, and BNP (the strongest correlations were with LVEF: R = -0.499, R 0.462, R = -0.461, p < 0.001, respectively). There were moderately strong correlations with LVEF and other whole-heart myocardial mechanics or morphometrics. Moreover, LVEF with global regurgitation volume (GRV) and right ventricle free wall longitudinal strain (RVFWLS) were the most usually detected parameters in multivariate analysis to be associated with changes in HF prognostic factors. in NIDCM patients, the main prognostic factors of HF are correlated with whole-heart myocardial mechanics and morphometrics. However, LVEF, GRV, and RVFWLS are the most usually found 2D echocardiographic factors associated with changes in HF prognostic factors.

Health-related quality of life and its association with outcomes in adults with congenital heart disease and heart failure: Insight from FRESH-ACHD registry

QoL is an important prognostic factor in Heart Failure (HF) of patients with acquired cardiac disease. The aim of this study was to determine the predictive value of Quality of Life (QoL) on outcomes in adults with congenital heart disease (ACHD) and HF. QoL of 196 ACHD patients with clinical HF (mean age: 44.3 ± 13.8 years; 51% male, 56% with complex CHD; 47% NYHA III/IV) included in the prospective multicentric registry FRESH-ACHD were assessed using SF-36 auto-questionnaire. The primary endpoint was defined by all-cause death, HF-related hospitalisation, heart transplantation or mechanical circulatory support. During a median follow-up of 12 months IQR [11.7–12], 28 (14%) patients reached the combined endpoint. Patients with low QoL experienced more frequently major adverse events (Fig. 1 [ML1], Logrank P = 0.013). On univariate analysis, lower score at physical functioning (HR = 0.98; 95% CI 0.97–0.99, P = 0.008), role limitations related to physical health (HR = 0.98; 95% CI 0.97–0.99, P = 0.008) and general health dimensions of the SF-36 (HR = 0.97 95% CI 0.95–0.99, P = 0.002) were significantly predictive of cardiovascular events (Fig. 1). Physical and general components of QoL were associated with worse outcomes in ACHD patients with HF, making QoL evaluation and rehabilitation programs essential to change this trajectory.

Development and Validation of a Prognostic Model Based on Clinical Biomarkers for Heart Failure in Adult Patients Following Allogeneic Hematopoietic Stem Cell Transplantation

Introduction: Heart failure (HF) is an uncommon but one of the most serious types of cardiovascular complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the prognostic factors of HF after allo-HSCT remain unknown, and there is currently no prognostic model for HF after allo-HSCT. In this study, we investigated the clinical features and prognosis of patients with HF after allo-HSCT. A prognostic model based on clinical biomarkers, which combined variables that are readily available in clinical practice, that is capable of predicting 2-month mortality of HF patients after allo-HSCT was developed and validated. Methods: In our retrospective study, 154 patients with HF after allo-HSCT from 2008 to 2021 were identified. One hundred patients were assigned to the derivation cohort and the remaining 54 patients were assigned to the external validation cohort according to the time of transplantation. We first calculated the univariable association of each variable with 2-month mortality in the derivation cohort. Second, the variables with p values less than 0.1 in the univariate analysis were further included as candidate predictors in the multivariate analysis using a backward stepwise logistic regression model. The variables that remained in the final model based on the outcomes of the multivariate analysis in the derivation cohort were identified as independent prognostic factors. A scoring system to predict the prognosis of HF after allo-HSCT was also established, and scores were assigned to the prognostic factors based on the regression coefficient. Results: Using multivariable logistic regression methods with stepwise variable selection, four highly significant independent prognostic factors for the two-month mortality of HF were identified: pulmonary infection (p=0.005; odds ratio [OR], 6.89; 95% confidence interval [CI], 1.93-29.13), Grades III to IV acute graft-versus-host disease (severe aGVHD) (p=0.033; odds ratio [OR], 3.62; 95% confidence interval [CI], 1.15-12.69), lactate dehydrogenase (LDH)>426 U/L (p=0.049; odds ratio [OR], 3.02; 95% confidence interval [CI], 1.00-9.32) and brain natriuretic peptide (BNP)>1799 pg/ml (p=0.026; odds ratio [OR], 3.44; 95% confidence interval [CI], 1.16-10.56). We also included cardiac troponin I (cTNI) (p=0.069; odds ratio [OR], 2.93, 95% confidence interval [CI], 0.94-29.13) in our final 5-predictor prognostic model. A risk grading model termed the BLIPS score (BNP, LDH, cardiac troponin I, pulmonary infection, severe aGVHD) was constructed according to the regression coefficients. BNP level>1799 pg/mL, LDH level>426 U/L, cTNI level>100 pg/ml, and severe aGVHD were each assigned one point, and pulmonary infection was assigned two points. The points scored for each of these five factors were added to yield the overall risk score, which ranged from zero to six. Patients were stratified into a low-risk group (0-2 points), an intermediate-risk group (3-4 points) and a high-risk group (5-6 points). The validated internal c-statistic was 0.870 (95% CI, 0.798-0.942), and the external c-statistic was 0.882 (95% CI, 0.791-0.973). According to the calibration plots, the model-predicted probabilities showed a good correlation with the actual observed frequencies. Decision curve analysis indicated that the clinical implementation of the prognostic model could benefit HF patients. The Kaplan‒Meier estimations of overall survival revealed good separation between these risk groups. We generated a risk heatmap for the BLIPS model to visualize the risk estimates derived from the individual prognostic factor profile. Conclusions: Patients who develop HF after allo-HSCT have a poor prognosis. An integrated prognostic model based on clinical biomarkers (BLIPS) was developed and externally validated, and this is the first straightforward scoring model that incorporates clinical and laboratory risk factors to evaluate the 2-month mortality of patients with HF after receiving allo-HSCT to treat hematological malignancies. This model can be effectively utilized to help improve the survival and prognosis of HF patients by accelerating the early identification of patients at a high risk of mortality and contributing to the appropriate implementation of urgent medical support. Disclosures: No relevant conflicts of interest to declare.

Abstract 14409: Deep Learning Approach for Analyzing Chest X-rays to Predict Cardiac Events in Heart Failure

Introduction: A deep learning (DL) model based on a chest X-ray (CXR) was reported to predict elevated pulmonary artery wedge pressure (PAWP) as congestive heart failure (HF). Hypothesis: We hypothesize that a previously developed application of a CXR-based DL algorithm could also be used to predict re-hospitalized HF in patients with HF. This study aimed to 1) investigate the role of probability of elevated PAWP to predict clinical outcomes in association with other parameters, and 2) to evaluate whether probability of elevated PAWP based on DL added prognostic information to other conventional clinical prognostic factors in HF. Methods: We evaluated 192 patients hospitalized with HF. We used a previously developed AI model to predict HF and calculated probability of elevated PAWP in the study cohort. The primary endpoint was readmission following HF and cardiac death. Results: Probability of elevated PAWP was associated with echocardiographic parameters including left atrial size, filling pressure, and pulmonary artery pressure. During a median follow-up period of 58 months, 57 patients were either readmitted or died. Probability of elevated PAWP appeared to be associated with worse clinical outcomes. After adjustment for readmission score and laboratory data in a Cox proportional-hazards model, probability of elevated PAWP at pre-discharge (per 1SD) was associated with event free survival, independent of elevated left atrial pressure (LAP) by echocardiography (hazard ratio:1.39, 95%CI:1.17-1.65, p&lt;0.001). In sequential Cox models, a model based on clinical data (χ2, 16.8) was improved by elevated LAP (χ2,24.4; p =0.005), and increased further by probability of elevated PAWP (χ2,41.1; p &lt;0.001). Conclusions: This study suggests that probability of elevated PAWP provides important incremental prognostic value for predicting readmission and cardiac mortality risk assessment in patients with HF.

Triglyceride Glucose Index Was a Predictor of 6-Month Readmission Caused by Pulmonary Infection of Heart Failure Patients.

Objectives Insulin resistance is associated with the prognosis of heart failure (HF) patients. The triglyceride glucose (TyG) index is a simple marker of insulin resistance. However, it remains unclear whether the TyG index is associated with the incidence of readmission in patients with HF. Methods We enrolled 901 patients with completed records on serum triglyceride and glucose in our study. The TyG index was calculated as log (fasting triglycerides (mg/dL) x fasting glucose (mg/dL)/2). There were 310 cases of readmission and the average TyG index was 7.8 ± 0.7. Restricted cubic spline was fitted to explore the linearity of TyG index associating with 6-month readmission of HF patients. Logistic regression analysis was performed to explore the association between TyG index quartile and the incidence of 6-month readmission. Results Only the 6-month readmission was significantly different among TyG quartiles, and it was the highest (41.9%) in the lowest quartile (ranging 6.17∼7.36). the TyG index was nonlinearly associated with 6-month readmission (p for nonlinearity = 0.009), with the lower level of TyG index increasing the risk of 6-month readmission. Besides, multivariable logistic analysis showed that the lowest TyG quartile was associated with a higher incidence of 6-month readmission in the unadjusted model (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.18–2.57; p=0.005), partially adjusted model (OR 1.82, 95%CI 1.22–2.72; p=0.004), and fully-adjusted model (OR 1.65, 95%CI 1.09–2.45; p=0.024). The association was consistent across gender and diabetes group. Conclusion A lower TyG index independently increased the risk of 6-month readmission in HF patients, which could be a prognostic factor in heart failure.

Long-term clinical course and prognostic factors of heart failure with reduced ejection fraction (HFrEF) patients underwent primary prophylactic implantable cardioverter defibrillator (ICD)

Abstract Background For decades, ICD is a well-established therapy for improving prognosis of structural heart disease with severe cardiac dysfunction, and ICD for primary prophylaxis against sudden cardiac death were routinely provided. However, long-term prognosis and clinical course are different in each individual patient with an ICD, and it is moreover unclear what kind of factors might have influences on their clinical outcomes. Purpose The aim of this study is to clarify long-term prognosis and predictors of future major adverse cardiac events (MACEs) in HFrEF patients with an ICD as primary prophylaxis in Japanese population. Methods We retrospectively analyzed our ICD database. Patients underwent primary prophylactic ICD implantation from 2006 to 2020 at our institute and met the criteria of ICD recommendation of the latest Japanese guideline. Its requirements are receiving optimal medication therapy, symptomatic heart failure (New York Heart Association classification II or greater), and severe cardiac dysfunction (left ventricular ejection fraction (LVEF) is 35% or less). Additionally, prior NSVT is considered Class I ICD recommendation. In the case of ischemic cardiomyopathy (ICM), ICD implantation was done at least 40 days after myocardial infarction and at least 90 days after revascularization. MACEs were defined as composite outcome of cardiovascular death, heart failure hospitalization, and appropriate ICD therapies. Results A total of 148 consecutive patients were enrolled (male, 120 (81%); age, 62.1±11.8 years; LVEF, 23.0±5.86%; left ventricular end-diastolic diameter (LVDd), 67.6±9.26mm; paroxysmal or persistent atrial fibrillation (AF), 38 (26%); NSVT, 113 (76%); use of class III antiarrhythmic drugs, 48 (32%); ICM, 49 (33%); cardiac resynchronization therapy (CRT), 63 (43%)). One hundred twenty patients (81%) were programmed with a shock-only zone over 200 beats per minute. The median follow-up duration was 58.5 months. Among those 148 patients, MACEs were occurred to 60 patients (41%). As a result of dividing all patients into two groups by the occurrence of MACE, LVEF and LVDd were worse in MACE(+) group, whereas, MACE(−) had greater number of co morbidities. The results of cox-regression analysis showed LVDd (HR: 1.07, 95% CI: 1.03–1.12, p&amp;lt;0.001), AF (HR: 2.88, 95% CI: 1.56–5.31, p&amp;lt;0.001) and ICM (HR: 1.78, 95% CI: 1.00–3.16, p=0.049) were the independent predictors of MACEs (Table). However, initial ICD programming was not related to the occurrence of MACE. Conclusions The incidence of MACEs in patients with an ICD and severe HFrEF was substantially high in this Japanese population. Etiology of ICM, left ventricle size, and AF were the potential risk factors for future MACEs. Funding Acknowledgement Type of funding sources: None.

Tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio as a predictor of in-hospital mortality for acute heart failure

BackgroundRight ventricular (RV) function is an important prognostic factor in heart failure. Patients with impaired right ventricular function have a poorer prognosis. The ratio between a tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) is a simple non-invasive parameter that has shown a good correlation with invasively estimated right ventricle (RV)-pulmonary artery (PA) coupling. The current study aimed to determine the value of the non-invasive evaluation of RV-PA coupling using the TAPSE/PASP ratio in predicting in-hospital mortality in patients with acute heart failure.MethodsWe included 200 patients with (heart failure and reduced ejection fraction) HFrEF presented by acute heart failure. Echocardiographic evaluation for left ventricle systolic and diastolic function was performed at the time of admission. RV functions were evaluated by calculating the following (TAPSE, PSAP, TAPSE/PASP ratio). Data were analyzed to find the predictors of in-hospital mortality.ResultsThe study cohort included two hundred consecutive patients who were hospitalized for a diagnosis of acute decompensation of chronic heart failure. The in-hospital mortality rate was 12%. TAPSE/PASP was an independent predictor for in-hospital mortality (odd ratio = 3.470; 95% confidence interval, 1.240–9.705, p-value = 0.018) and (odd ratio = 18.813; 95% confidence interval, 1.974–179.275, p-value = 0.011) in univariate and multivariable logistic regression analyses respectively. In ROC curve analysis, TAPSE/PASP with a cut-off value < 0.4 mm/mmHg had a sensitivity of 79.17, a specificity of 47.73, and an area under ROC curve = 0.666 for predicting in-hospital mortality.ConclusionsThe non-invasive TAPSE/PASP ratio could be an independent predictor of mortality in HErEF patients presenting with acute heart failure.

Discriminative Value of Serum Irisin in Prediction of Heart Failure with Different Phenotypes among Patients with Type 2 Diabetes Mellitus.

Recent studies have shown that circulating levels of irisin are prognostic factors in heart failure (HF), but no data are available on the predictive role of irisin in patients with type 2 diabetes mellitus (T2DM) and different phenotypes of HF. The aim of the study was to investigate whether serum levels of irisin predict HF in T2DM patients. We prospectively included 183 participants with T2DM aged 41 to 62 years (30 non-HF patients and 153 HF patients) and 25 healthy volunteers in the study and evaluated clinical data, hemodynamics and biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP) and irisin). Serum levels of irisin < 8.30 ng/mL were found to be a better indicator of HF with reduced ejection fraction (HFrEF) than irisin ≥ 8.30 ng/mL, but the predictive cut-off point for NT-proBNP remained the same as for HF with mildly reduced ejection fraction (HFmrEF). Serum levels of irisin < 10.4 ng/mL significantly improved the predictive ability of NT-proBNP for HF with preserved ejection fraction (HFpEF). In conclusion, we found that decreased serum levels of irisin significantly predicted HFpEF, rather than HFmrEF and HFrEF, in T2DM patients. This finding may open a new approach to HF risk stratification in T2DM patients.

Health-related quality of life and its association with outcomes in adults with congenital heart disease and heart failure: Insight from FRESH-ACHD registry

QoL is an important prognostic factor in Heart Failure (HF) of patients with acquired cardiac disease. The aim of this study was to determine the predictive value of Quality of Life (QoL) on outcomes in adults with congenital heart disease (ACHD) and HF. QoL of 196 ACHD patients with clinical HF (mean age: 44.3 ± 13.8 years; 51% male, 56% with complex CHD; 47% NYHA III/IV) included in the prospective multicentric registry FRESH-ACHD was assessed using SF-36 auto-questionnaire. The primary endpoint was defined by all-cause death, HF-related hospitalisation, heart transplantation or mechanical circulatory support. During a median follow-up of 12 months IQR [11.7–12], 28 (14%) patients reached the combined endpoint. Patients with low QoL experienced more frequently major adverse events ( Fig. 1 [ML1], Logrank P = 0.013). On univariate analysis, lower score at physical functioning (HR = 0.98; 95% CI 0.97–0.99, P = 0.008), role limitations related to physical health (HR = 0.98; 95% CI 0.97–0.99, P = 0.008) and general health dimensions of the SF-36 (HR = 0.97 95% CI 0.95–0.99, P = 0.002) were significantly predictive of cardiovascular events. Physical and general components of QoL were associated with worse outcomes in ACHD patients with HF, making QoL evaluation and rehabilitation programs essential to change this trajectory.

Peak Circulatory Power Is A Strong Prognostic Factor In Heart Failure With Preserved Ejection Fraction

<h3>Objectives</h3> Cardiopulmonary exercise testing (CPET) is the gold standard for assessing functional capacity and estimating prognosis in chronic heart failure (CHF). Peak circulatory power (CP) defined as the product of peak oxygen uptake (VO₂ peak) and peak exercise systolic blood pressure (SBP) was originally introduced by Cohen-Solal et al (2002) and eventually evaluated as a prognostic index in systolic CHF, congenital heart disease and idiopathic pulmonary arterial hypertension. The aim of this study was to confirm prognostic value of peak CP in HF with preserved ejection fraction (HFpEF). <h3>Methods</h3> We retrospectively analyzed the subgroup of 50 patients with HFpEF, NYHA classes II-III (17 female, mean age 64,8±11,6 years) previously enrolled in the prospective observational study. All patients received optimal medical treatment. At baseline the patients underwent comprehensive investigation including CPET. Peak CP was assessed as the product of VO₂ peak and peak SBP. Average follow-up period amounted 35 months. Cardiovascular mortality was considered the primary end-point. <h3>Results</h3> Cardiovascular mortality amounted 32% (n=16). ROC-analysis demonstrated significant independent predictive value of peak CP for cardiovascular mortality (AUC=0,741; 95% CI=0,597 to 0,854; p=0,0025). According to Youden index (J = sensitivity + specificity - 1) the patients were subsequently dichotomized by peak CP of 1600 as a cut-off point (sensitivity = 56%, specificity=91%). Kaplan-Meier analysis confirmed unfavorable prognosis in patients with peak CP ≤ 1600 (Log rank chi square = 8,3; p = 0,004). <h3>Conclusion</h3> Peak circulatory power (CP) combining VO₂ peak and peak exercise systolic blood pressure demonstrates significant prognostic value in HFpEF. Low peak CP reflecting poor cardiac power indicates unfavorable prognosis in terms of cardiovascular mortality and may be used as an independent non-invasive marker for long-term risk stratification in HFpEF patients.

M2. Cardiorenal anaemia syndrome vs left ventricular ejection fraction: which is a better mortality prognostic factor for heart failure? A systematic review and meta-analysis

Abstract Aim Cardiorenal anaemia syndrome (CRAS) involves a vicious interaction between heart failure (HF), chronic kidney disease, and anaemia. CRAS is associated with higher morbidity, mortality, and health care cost. This study investigated CRAS as a predicting factor of all-cause mortality compared to left ventricular ejection fraction (LVEF) in HF patients as one of the established classifications being linked to prognosis in HF. Methods and Results A systematic review based on PRISMA guidelines was performed on 6 scientific databases (PubMed, ProQuest, Scopus, ScienceDirect, Springer) with search terms related to left ventricular ejection fraction, heart failure, and cardiorenal anaemia syndrome. Original English case-control and cohort studies in heart failure participants which analyzed hazard ratio (HR) of all-cause mortality were considered eligible. The quality assessment was evaluated with New Castle Ottawa Scale (NOS). A total of 17 studies comprising 90,092 participants from more than 14 countries were included in the qualitative analysis with eleven subjected to meta-analysis. The presence of CRAS aligns with a significantly higher mortality rate (HR 1.64 [95% CI 1.44 – 1.87]) as compared to current classification based on ejection fraction obtained insignificant clinical outcomes of reduced ejection fraction HF (HFrEF) (HR 1.06 [95% CI 0.98 – 1.15]) in the pooled analysis. Conclusion CRAS is a significant death prognosticator and indicates a worse prognosis in HF patients as compared to HF patients with reduced ejection fraction. CRAS is a potential alternative prognostic factor for heart failure patients to predict mortality outcomes.