Ola Vedin1, Carolyn S P Lam2, Angela S Koh2, Lina Benson2, Tiew Hwa Katherine Teng2, Wan Ting Tay2, Oscar Ö Braun2, Gianluigi Savarese2, Ulf Dahlström2, Lars H Lund2. 1. From the Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Sweden (O.V.); National Heart Centre Singapore (C.S.P.L., A.S.K., T.H.K.T., W.T.T.); Duke-NUS Medical School, Singapore (C.S.P.L., A.S.K.); Regional Cancer Centre Stockholm Gotland, Sweden (L.B.); School of Population Health, University of Western Australia, Perth (T.H.K.T.); Department of Cardiology, Skåne University Hospital, Lund University, Sweden (O.Ö.B.); Department of Medicine, Karolinska Institutet, Stockholm, Sweden (G.S., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (G.S., L.H.L.); and Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden. ola.vedin@ucr.uu.se. 2. From the Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Sweden (O.V.); National Heart Centre Singapore (C.S.P.L., A.S.K., T.H.K.T., W.T.T.); Duke-NUS Medical School, Singapore (C.S.P.L., A.S.K.); Regional Cancer Centre Stockholm Gotland, Sweden (L.B.); School of Population Health, University of Western Australia, Perth (T.H.K.T.); Department of Cardiology, Skåne University Hospital, Lund University, Sweden (O.Ö.B.); Department of Medicine, Karolinska Institutet, Stockholm, Sweden (G.S., L.H.L.); Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (G.S., L.H.L.); and Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden.
Abstract
BACKGROUND: The pathogenic role of ischemic heart disease (IHD) in heart failure (HF) with reduced ejection fraction (HFrEF; EF <40%) is well established, but its pathogenic and prognostic significance in HF with midrange (HFmrEF; EF 40%-50%) and preserved EF (HFpEF; EF ≥50%) has been much less explored. METHODS AND RESULTS: We evaluated 42 987 patients from the Swedish Heart Failure Registry with respect to baseline IHD, outcomes (IHD, HF, cardiovascular events, and all-cause death), and EF change during a median follow-up of 2.2 years. Overall, 23% had HFpEF (52% IHD), 21% had HFmrEF (61% IHD), and 55% had HFrEF (60% IHD). After multivariable adjustment, associations with baseline IHD were similar for HFmrEF and HFrEF and lower in HFpEF (risk ratio, 0.91 [0.89-0.93] versus HFmrEF and risk ratio, 0.90 [0.88-0.92] versus HFrEF). The adjusted risk of IHD events was similar for HFmrEF versus HFrEF and lower in HFpEF (hazard ratio, 0.89 [0.84-0.95] versus HFmrEF and hazard ratio, 0.84 [0.80-0.90] versus HFrEF). After adjustment, prevalent IHD was associated with increased risk of IHD events and all other outcomes in all EF categories except all-cause mortality in HFpEF. Those with IHD, particularly new IHD events, were also more likely to change to a lower EF category and less likely to change to a higher EF category over time. CONCLUSIONS: HFmrEF resembled HFrEF rather than HFpEF with regard to both a higher prevalence of IHD and a greater risk of new IHD events. Established IHD was an important prognostic factor across all HF types.
BACKGROUND: The pathogenic role of ischemic heart disease (IHD) in heart failure (HF) with reduced ejection fraction (HFrEF; EF <40%) is well established, but its pathogenic and prognostic significance in HF with midrange (HFmrEF; EF 40%-50%) and preserved EF (HFpEF; EF ≥50%) has been much less explored. METHODS AND RESULTS: We evaluated 42 987 patients from the Swedish Heart Failure Registry with respect to baseline IHD, outcomes (IHD, HF, cardiovascular events, and all-cause death), and EF change during a median follow-up of 2.2 years. Overall, 23% had HFpEF (52% IHD), 21% had HFmrEF (61% IHD), and 55% had HFrEF (60% IHD). After multivariable adjustment, associations with baseline IHD were similar for HFmrEF and HFrEF and lower in HFpEF (risk ratio, 0.91 [0.89-0.93] versus HFmrEF and risk ratio, 0.90 [0.88-0.92] versus HFrEF). The adjusted risk of IHD events was similar for HFmrEF versus HFrEF and lower in HFpEF (hazard ratio, 0.89 [0.84-0.95] versus HFmrEF and hazard ratio, 0.84 [0.80-0.90] versus HFrEF). After adjustment, prevalent IHD was associated with increased risk of IHD events and all other outcomes in all EF categories except all-cause mortality in HFpEF. Those with IHD, particularly new IHD events, were also more likely to change to a lower EF category and less likely to change to a higher EF category over time. CONCLUSIONS: HFmrEF resembled HFrEF rather than HFpEF with regard to both a higher prevalence of IHD and a greater risk of new IHD events. Established IHD was an important prognostic factor across all HF types.
Authors: Sicong Huang; Tianrun Cai; Brittany N Weber; Zeling He; Kumar P Dahal; Chuan Hong; Jue Hou; Thany Seyok; Andrew Cagan; Marcelo F DiCarli; Jacob Joseph; Seoyoung C Kim; Daniel H Solomon; Tianxi Cai; Katherine P Liao Journal: Arthritis Care Res (Hoboken) Date: 2021-10-08 Impact factor: 4.794