BACKGROUND: Heart failure (HF) is a leading cause of adult hospitalization, morbidity, and mortality. We evaluated the influence of myocardial ischemia and left ventricular ejection fraction (LVEF) on outcomes in patients who were hospitalized with new onset HF. METHODS: We prospectively recruited 201 consecutive patients hospitalized for a first episode of HF from 17 medical centers across Europe and North America. All patients received gated single-photon emission computed tomographic testing with standardized study interpretations by trained core laboratory investigators. Predefined data from routine care were collected and aggregated. Computerized scoring was performed at the core laboratory and participants with a summed difference score ≥4 were defined as having myocardial ischemia. Participants were categorized as having systolic heart failure (SHF) (LVEF<40%) or nonsystolic heart failure (NS-HF) (LVEF≥40%). A proportional hazards model was used to assess the impact of clinical predictors on the outcomes of mortality, cardiac rehospitalization and a combined outcome within 2 years of study enrollment. RESULTS: 180 patients (mean age was 65.5 ± 14.6 years and 57.2% male) fulfilled study criteria and were included. Myocardial ischemia was present in 45 (41.2%) patients with SHF and 19 (27.5%) patients with NS-HF (p <0.01). During the follow-up period, 11.1% (n=20) died and 42.2% (n=76) experienced a recurrent hospitalization. Patients with NS-HF and ischemia had the highest (73.7%) event rate compared with the other cohorts (multivariate OR=3.29, 95% CI 1.69-6.42, p=0.001). CONCLUSIONS: In new-onset HF, those with NS-HF and myocardial ischemia are at the highest risk for poor outcomes.
BACKGROUND:Heart failure (HF) is a leading cause of adult hospitalization, morbidity, and mortality. We evaluated the influence of myocardial ischemia and left ventricular ejection fraction (LVEF) on outcomes in patients who were hospitalized with new onset HF. METHODS: We prospectively recruited 201 consecutive patients hospitalized for a first episode of HF from 17 medical centers across Europe and North America. All patients received gated single-photon emission computed tomographic testing with standardized study interpretations by trained core laboratory investigators. Predefined data from routine care were collected and aggregated. Computerized scoring was performed at the core laboratory and participants with a summed difference score ≥4 were defined as having myocardial ischemia. Participants were categorized as having systolic heart failure (SHF) (LVEF<40%) or nonsystolic heart failure (NS-HF) (LVEF≥40%). A proportional hazards model was used to assess the impact of clinical predictors on the outcomes of mortality, cardiac rehospitalization and a combined outcome within 2 years of study enrollment. RESULTS: 180 patients (mean age was 65.5 ± 14.6 years and 57.2% male) fulfilled study criteria and were included. Myocardial ischemia was present in 45 (41.2%) patients with SHF and 19 (27.5%) patients with NS-HF (p <0.01). During the follow-up period, 11.1% (n=20) died and 42.2% (n=76) experienced a recurrent hospitalization. Patients with NS-HF and ischemia had the highest (73.7%) event rate compared with the other cohorts (multivariate OR=3.29, 95% CI 1.69-6.42, p=0.001). CONCLUSIONS: In new-onset HF, those with NS-HF and myocardial ischemia are at the highest risk for poor outcomes.
Authors: Sharon Ann Hunt; William T Abraham; Marshall H Chin; Arthur M Feldman; Gary S Francis; Theodore G Ganiats; Mariell Jessup; Marvin A Konstam; Donna M Mancini; Keith Michl; John A Oates; Peter S Rahko; Marc A Silver; Lynne Warner Stevenson; Clyde W Yancy Journal: J Am Coll Cardiol Date: 2009-04-14 Impact factor: 24.094
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Authors: K F Fox; M R Cowie; D A Wood; A J Coats; J S Gibbs; S R Underwood; R M Turner; P A Poole-Wilson; S W Davies; G C Sutton Journal: Eur Heart J Date: 2001-02 Impact factor: 29.983
Authors: E P Bounous; D B Mark; B G Pollock; M A Hlatky; F E Harrell; K L Lee; J S Rankin; A S Wechsler; D B Pryor; R M Califf Journal: Circulation Date: 1988-09 Impact factor: 29.690
Authors: Kenneth Dickstein; Alain Cohen-Solal; Gerasimos Filippatos; John J V McMurray; Piotr Ponikowski; Philip Alexander Poole-Wilson; Anna Strömberg; Dirk J van Veldhuisen; Dan Atar; Arno W Hoes; Andre Keren; Alexandre Mebazaa; Markku Nieminen; Silvia Giuliana Priori; Karl Swedberg Journal: Eur Heart J Date: 2008-09-17 Impact factor: 29.983
Authors: Gregg C Fonarow; Wendy Gattis Stough; William T Abraham; Nancy M Albert; Mihai Gheorghiade; Barry H Greenberg; Christopher M O'Connor; Jie Lena Sun; Clyde W Yancy; James B Young Journal: J Am Coll Cardiol Date: 2007-08-06 Impact factor: 24.094
Authors: Prem Soman; Avijit Lahiri; Jennifer H Mieres; Dennis A Calnon; David Wolinsky; George A Beller; Tina Sias; Kenneth Burnham; Laurence Conway; Peter A McCullough; Edouard Daher; Mary N Walsh; Joseph Wight; Gary V Heller; James E Udelson Journal: J Nucl Cardiol Date: 2009-01-20 Impact factor: 5.952