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Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction
AIMS: The role of diastolic dysfunction (DD) in prognostic evaluation in heart failure (HF) patients with impaired systolic function remains unclear. We investigated the impact of echocardiography‐defined DD on survival in HF patients with mid‐range (HFmrEF, EF 41–49%) and reduced ejection fraction...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318417/ https://www.ncbi.nlm.nih.gov/pubmed/33932134 http://dx.doi.org/10.1002/ehf2.13352 |
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author | Liu, Dan Hu, Kai Lau, Kolja Kiwitz, Tobias Robitzkat, Katharina Hammel, Clara Lengenfelder, Björn Daniel Ertl, Georg Frantz, Stefan Nordbeck, Peter |
author_facet | Liu, Dan Hu, Kai Lau, Kolja Kiwitz, Tobias Robitzkat, Katharina Hammel, Clara Lengenfelder, Björn Daniel Ertl, Georg Frantz, Stefan Nordbeck, Peter |
author_sort | Liu, Dan |
collection | PubMed |
description | AIMS: The role of diastolic dysfunction (DD) in prognostic evaluation in heart failure (HF) patients with impaired systolic function remains unclear. We investigated the impact of echocardiography‐defined DD on survival in HF patients with mid‐range (HFmrEF, EF 41–49%) and reduced ejection fraction (HFrEF, EF < 40%). METHODS AND RESULTS: A total of 2018 consecutive hospitalized HF patients were retrospectively included and divided in two groups based on baseline EF: HFmrEF group (n = 951, aged 69 ± 13 years, 74.2% male) and HFrEF group (n = 1067, aged 68 ± 13 years, 76.3% male). Clinical data were collected and analysed. All patients completed ≥1 year clinical follow‐up. The primary endpoint was defined as all‐cause death (including heart transplantation) and cardiovascular (CV)‐related death. All‐cause mortality (30.8% vs. 24.9%, P = 0.003) and CV mortality (19.1% vs. 13.5%, P = 0.001) were significantly higher in the HFrEF group than the HFmrEF group during follow‐up [median 24 (13–36) months]. All‐cause mortality increased in proportion to DD severity (mild, moderate, and severe) in either HFmrEF (17.1%, 25.4%, and 37.0%, P < 0.001) or HFrEF (18.9%, 30.3%, and 39.2%, P < 0.001) patients. The risk of all‐cause mortality [hazard ratio (HR) = 1.347, P = 0.015] and CV mortality (HR = 1.508, P = 0.007) was significantly higher in HFrEF patients with severe DD compared with non‐severe DD after adjustment for identified clinical and echocardiographic covariates. For HFmrEF patients, severe DD was independently associated with increased all‐cause mortality (HR = 1.358, P = 0.046) but not with CV mortality (HR = 1.155, P = 0.469). CONCLUSIONS: Echocardiography‐defined severe DD is independently associated with increased all‐cause mortality in patients with HFmrEF and HFrEF. |
format | Online Article Text |
id | pubmed-8318417 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-83184172021-07-31 Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction Liu, Dan Hu, Kai Lau, Kolja Kiwitz, Tobias Robitzkat, Katharina Hammel, Clara Lengenfelder, Björn Daniel Ertl, Georg Frantz, Stefan Nordbeck, Peter ESC Heart Fail Original Research Articles AIMS: The role of diastolic dysfunction (DD) in prognostic evaluation in heart failure (HF) patients with impaired systolic function remains unclear. We investigated the impact of echocardiography‐defined DD on survival in HF patients with mid‐range (HFmrEF, EF 41–49%) and reduced ejection fraction (HFrEF, EF < 40%). METHODS AND RESULTS: A total of 2018 consecutive hospitalized HF patients were retrospectively included and divided in two groups based on baseline EF: HFmrEF group (n = 951, aged 69 ± 13 years, 74.2% male) and HFrEF group (n = 1067, aged 68 ± 13 years, 76.3% male). Clinical data were collected and analysed. All patients completed ≥1 year clinical follow‐up. The primary endpoint was defined as all‐cause death (including heart transplantation) and cardiovascular (CV)‐related death. All‐cause mortality (30.8% vs. 24.9%, P = 0.003) and CV mortality (19.1% vs. 13.5%, P = 0.001) were significantly higher in the HFrEF group than the HFmrEF group during follow‐up [median 24 (13–36) months]. All‐cause mortality increased in proportion to DD severity (mild, moderate, and severe) in either HFmrEF (17.1%, 25.4%, and 37.0%, P < 0.001) or HFrEF (18.9%, 30.3%, and 39.2%, P < 0.001) patients. The risk of all‐cause mortality [hazard ratio (HR) = 1.347, P = 0.015] and CV mortality (HR = 1.508, P = 0.007) was significantly higher in HFrEF patients with severe DD compared with non‐severe DD after adjustment for identified clinical and echocardiographic covariates. For HFmrEF patients, severe DD was independently associated with increased all‐cause mortality (HR = 1.358, P = 0.046) but not with CV mortality (HR = 1.155, P = 0.469). CONCLUSIONS: Echocardiography‐defined severe DD is independently associated with increased all‐cause mortality in patients with HFmrEF and HFrEF. John Wiley and Sons Inc. 2021-05-01 /pmc/articles/PMC8318417/ /pubmed/33932134 http://dx.doi.org/10.1002/ehf2.13352 Text en © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Articles Liu, Dan Hu, Kai Lau, Kolja Kiwitz, Tobias Robitzkat, Katharina Hammel, Clara Lengenfelder, Björn Daniel Ertl, Georg Frantz, Stefan Nordbeck, Peter Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction |
title | Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction |
title_full | Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction |
title_fullStr | Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction |
title_full_unstemmed | Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction |
title_short | Impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction |
title_sort | impact of diastolic dysfunction on outcome in heart failure patients with mid‐range or reduced ejection fraction |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318417/ https://www.ncbi.nlm.nih.gov/pubmed/33932134 http://dx.doi.org/10.1002/ehf2.13352 |
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