Cargando…
Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction
AIMS: We aimed to examine temporal changes in left ventricular (LV) structures and their prognostic impacts in patients with heart failure (HF) and preserved ejection fraction (HFpEF). METHODS AND RESULTS: In the Chronic Heart Failure Analysis and Registry in the Tohoku District‐2 (CHART‐2) study (n...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons, Ltd.
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891326/ https://www.ncbi.nlm.nih.gov/pubmed/32592517 http://dx.doi.org/10.1002/ejhf.1945 |
_version_ | 1783652674333310976 |
---|---|
author | Yamanaka, Shinsuke Sakata, Yasuhiko Nochioka, Kotaro Miura, Masanobu Kasahara, Shintaro Sato, Masayuki Aoyanagi, Hajime Fujihashi, Takahide Hayashi, Hideka Shiroto, Takashi Sugimura, Koichiro Takahashi, Jun Miyata, Satoshi Shimokawa, Hiroaki |
author_facet | Yamanaka, Shinsuke Sakata, Yasuhiko Nochioka, Kotaro Miura, Masanobu Kasahara, Shintaro Sato, Masayuki Aoyanagi, Hajime Fujihashi, Takahide Hayashi, Hideka Shiroto, Takashi Sugimura, Koichiro Takahashi, Jun Miyata, Satoshi Shimokawa, Hiroaki |
author_sort | Yamanaka, Shinsuke |
collection | PubMed |
description | AIMS: We aimed to examine temporal changes in left ventricular (LV) structures and their prognostic impacts in patients with heart failure (HF) and preserved ejection fraction (HFpEF). METHODS AND RESULTS: In the Chronic Heart Failure Analysis and Registry in the Tohoku District‐2 (CHART‐2) study (n = 10 219), we divided 2698 consecutive HFpEF patients (68.9 ± 12.2 years, 32.1% female) into three groups by LV hypertrophy (LVH) and enlargement (LVE) at baseline: (−)LVH/(−)LVE (n = 989), (+)LVH/(−)LVE (n = 1448), and (+)LVH/(+)LVE (n = 261). We examined temporal changes in LV structures and their prognostic impacts during a median 8.7‐year follow‐up. From (−)LVH/(−)LVE, (+)LVH/(−)LVE to (+)LVH/(+)LVE at baseline, the incidence of the primary outcome, a composite of cardiovascular death or HF admission, significantly increased. Among 1808 patients who underwent echocardiography at both baseline and 1 year, we noted substantial group transitions from baseline to 1 year; the transition rates from (−)LVH/(−)LVE to (+)LVH/(−)LVE, from (+)LVH/(−)LVE to (−)LVH/(−)LVE, from (+)LVH/(−)LVE to (+)LVH/(+)LVE, and from (+)LVH/(+)LVE to (+)LVH/(−)LVE were 27% (182/671), 22% (213/967), 6% (59/967), and 26% (44/170), respectively. In the univariable Cox proportional hazard model, patients who transitioned from (+)LVH/(−)LVE to (+)LVH/(+)LVE or remained in (+)LVH/(+)LVE had the worst subsequent prognosis [hazard ratio (HR) 4.65, 95% confidence interval (CI) 3.09–6.99, P < 0.001; HR 4.01, 95% CI 2.85–5.65, P < 0.001, respectively], as compared with those who remained in (−)LVH/(−)LVE. These results were unchanged after adjustment for the covariates including baseline LV ejection fraction (LVEF) and 1‐year LVEF change. CONCLUSION: In HFpEF patients, LV structures dynamically change over time with significant prognostic impacts, where patients who develop LVE with LVH have the worst prognosis. |
format | Online Article Text |
id | pubmed-7891326 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley & Sons, Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-78913262021-03-02 Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction Yamanaka, Shinsuke Sakata, Yasuhiko Nochioka, Kotaro Miura, Masanobu Kasahara, Shintaro Sato, Masayuki Aoyanagi, Hajime Fujihashi, Takahide Hayashi, Hideka Shiroto, Takashi Sugimura, Koichiro Takahashi, Jun Miyata, Satoshi Shimokawa, Hiroaki Eur J Heart Fail Remodelling AIMS: We aimed to examine temporal changes in left ventricular (LV) structures and their prognostic impacts in patients with heart failure (HF) and preserved ejection fraction (HFpEF). METHODS AND RESULTS: In the Chronic Heart Failure Analysis and Registry in the Tohoku District‐2 (CHART‐2) study (n = 10 219), we divided 2698 consecutive HFpEF patients (68.9 ± 12.2 years, 32.1% female) into three groups by LV hypertrophy (LVH) and enlargement (LVE) at baseline: (−)LVH/(−)LVE (n = 989), (+)LVH/(−)LVE (n = 1448), and (+)LVH/(+)LVE (n = 261). We examined temporal changes in LV structures and their prognostic impacts during a median 8.7‐year follow‐up. From (−)LVH/(−)LVE, (+)LVH/(−)LVE to (+)LVH/(+)LVE at baseline, the incidence of the primary outcome, a composite of cardiovascular death or HF admission, significantly increased. Among 1808 patients who underwent echocardiography at both baseline and 1 year, we noted substantial group transitions from baseline to 1 year; the transition rates from (−)LVH/(−)LVE to (+)LVH/(−)LVE, from (+)LVH/(−)LVE to (−)LVH/(−)LVE, from (+)LVH/(−)LVE to (+)LVH/(+)LVE, and from (+)LVH/(+)LVE to (+)LVH/(−)LVE were 27% (182/671), 22% (213/967), 6% (59/967), and 26% (44/170), respectively. In the univariable Cox proportional hazard model, patients who transitioned from (+)LVH/(−)LVE to (+)LVH/(+)LVE or remained in (+)LVH/(+)LVE had the worst subsequent prognosis [hazard ratio (HR) 4.65, 95% confidence interval (CI) 3.09–6.99, P < 0.001; HR 4.01, 95% CI 2.85–5.65, P < 0.001, respectively], as compared with those who remained in (−)LVH/(−)LVE. These results were unchanged after adjustment for the covariates including baseline LV ejection fraction (LVEF) and 1‐year LVEF change. CONCLUSION: In HFpEF patients, LV structures dynamically change over time with significant prognostic impacts, where patients who develop LVE with LVH have the worst prognosis. John Wiley & Sons, Ltd. 2020-08-09 2020-12 /pmc/articles/PMC7891326/ /pubmed/32592517 http://dx.doi.org/10.1002/ejhf.1945 Text en © 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Remodelling Yamanaka, Shinsuke Sakata, Yasuhiko Nochioka, Kotaro Miura, Masanobu Kasahara, Shintaro Sato, Masayuki Aoyanagi, Hajime Fujihashi, Takahide Hayashi, Hideka Shiroto, Takashi Sugimura, Koichiro Takahashi, Jun Miyata, Satoshi Shimokawa, Hiroaki Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction |
title | Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction |
title_full | Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction |
title_fullStr | Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction |
title_full_unstemmed | Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction |
title_short | Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction |
title_sort | prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction |
topic | Remodelling |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891326/ https://www.ncbi.nlm.nih.gov/pubmed/32592517 http://dx.doi.org/10.1002/ejhf.1945 |
work_keys_str_mv | AT yamanakashinsuke prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT sakatayasuhiko prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT nochiokakotaro prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT miuramasanobu prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT kasaharashintaro prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT satomasayuki prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT aoyanagihajime prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT fujihashitakahide prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT hayashihideka prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT shirototakashi prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT sugimurakoichiro prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT takahashijun prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT miyatasatoshi prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT shimokawahiroaki prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction AT prognosticimpactsofdynamiccardiacstructuralchangesinheartfailurepatientswithpreservedleftventricularejectionfraction |