Erwan Donal1,2, Lars H Lund3, Emmanuel Oger4, Camilla Hage3, Hans Persson5, Amélie Reynaud2, Pierre-Vladimir Ennezat6, Fabrice Bauer7, Elodie Drouet8, Cecilia Linde3, Claude Daubert1,2. 1. Cardiology department & CIC-IT U 804, Hôpital Pontchaillou-CHU Rennes, Rennes University Health Centre, rue Henri Le Guillou, 35000, Rennes, France. 2. LTSI, Rennes 1 University, INSERM 1099, Rennes, France. 3. Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. 4. Clinical Investigation Center INSERM CIC-1414, CHU Rennes, France. 5. Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden. 6. Cardiology Department, Lille University Health Centre, Lille, France. 7. Cardiology Department, Rouen University Health Centre, Rouen, France. 8. French Society of Cardiology, Paris, France.
Abstract
OBJECTIVES: To identify electrocardiographic and echocardiographic predictors of mortality and hospitalizations for heart failure (HF) in the KaRen study. BACKGROUND: KaRen is a prospective, observational study of the long-term outcomes of patients presenting with heart failure and a preserved ejection fraction (HFpEF). METHOD: We identified 538 patients who presented with acute cardiac decompensation, a >100 pg/mL serum b-type natriuretic peptide (BNP) or >300 pg/mL N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration and a left ventricular ejection fraction (LVEF) >45%. After 4-8 weeks of standard treatment, 413 patients (mean age = 76 ± 9 years, 55.9% women) returned for analyses of their clinical status, laboratory screen, and detailed electrocardiographic and Doppler echocardiographic recordings. They were followed for a mean of 28 months thereafter. The primary study endpoint was time to death from all causes or first hospitalization for heart failure. RESULTS: Mean LVEF was 62.4 ± 6.9% and median NT-proBNP 1410 pmol/L. PR interval >200 ms was present in 11.2% of patients and 14.9% had a >120 ms QRS duration, with left bundle branch block in only 6.3%. Over a mean follow-up of 28 months, 177 patients (42.9%) reached a primary study endpoint, including 61 deaths and 116 hospitalizations for heart failure. After adjustment for age, gender, New York Heart Association class, atrial fibrillation history, creatinine, sodium, BNP, ejection fraction, and right ventricular fractional shortening, only E/e' remained as a predictor, with a hazard ratio = 1.49 and P = 0.0012. CONCLUSION: The incidence of hospitalizations for HF and deaths in KaRen was high and E/e' predicted adverse clinical outcomes. These observations should help in the risk stratification and therapy of HFpEF.
OBJECTIVES: To identify electrocardiographic and echocardiographic predictors of mortality and hospitalizations for heart failure (HF) in the KaRen study. BACKGROUND: KaRen is a prospective, observational study of the long-term outcomes of patients presenting with heart failure and a preserved ejection fraction (HFpEF). METHOD: We identified 538 patients who presented with acute cardiac decompensation, a >100 pg/mL serum b-type natriuretic peptide (BNP) or >300 pg/mL N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration and a left ventricular ejection fraction (LVEF) >45%. After 4-8 weeks of standard treatment, 413 patients (mean age = 76 ± 9 years, 55.9% women) returned for analyses of their clinical status, laboratory screen, and detailed electrocardiographic and Doppler echocardiographic recordings. They were followed for a mean of 28 months thereafter. The primary study endpoint was time to death from all causes or first hospitalization for heart failure. RESULTS: Mean LVEF was 62.4 ± 6.9% and median NT-proBNP 1410 pmol/L. PR interval >200 ms was present in 11.2% of patients and 14.9% had a >120 ms QRS duration, with left bundle branch block in only 6.3%. Over a mean follow-up of 28 months, 177 patients (42.9%) reached a primary study endpoint, including 61 deaths and 116 hospitalizations for heart failure. After adjustment for age, gender, New York Heart Association class, atrial fibrillation history, creatinine, sodium, BNP, ejection fraction, and right ventricular fractional shortening, only E/e' remained as a predictor, with a hazard ratio = 1.49 and P = 0.0012. CONCLUSION: The incidence of hospitalizations for HF and deaths in KaRen was high and E/e' predicted adverse clinical outcomes. These observations should help in the risk stratification and therapy of HFpEF.
Authors: Tor Biering-Sørensen; Sanjiv J Shah; Inder Anand; Nancy Sweitzer; Brian Claggett; Li Liu; Bertram Pitt; Marc A Pfeffer; Scott D Solomon; Amil M Shah Journal: Eur J Heart Fail Date: 2017-03-21 Impact factor: 15.534
Authors: Benedikt Koell; Caroline Zotter-Tufaro; Franz Duca; Andreas A Kammerlander; Stefan Aschauer; Daniel Dalos; Marlies Antlanger; Manfred Hecking; Marcus Säemann; Julia Mascherbauer; Diana Bonderman Journal: Int J Cardiol Date: 2016-12-21 Impact factor: 4.164
Authors: Olivier Huttin; Alan G Fraser; Lars H Lund; Erwan Donal; Cecilia Linde; Masatake Kobayashi; Tamas Erdei; Jean-Loup Machu; Kevin Duarte; Patrick Rossignol; Walter Paulus; Faiez Zannad; Nicolas Girerd Journal: ESC Heart Fail Date: 2021-03-03