Satit Janwanishstaporn1,2, Siting Feng1,3, John Teerlink4, Marco Metra5, Gad Cotter6, Beth A Davison6, G Michael Felker7, Gerasimos Filippatos8, Peter Pang9, Piotr Ponikowski10, Thomas Severin11, Claudio Gimpelewicz11, Thomas Holbro11, Chien Wei Chen11, Iziah Sama12, Adriaan A Voors12, Barry H Greenberg1. 1. Division of Cardiology, University of California, San Diego, CA, USA. 2. Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 3. Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 4. Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, CA, USA. 5. Cardiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy. 6. Momentum Research, Durham, NC, USA. 7. Division of Cardiology, Duke University School of Medicine, Durham, NC, USA. 8. School of Medicine, University of Cyprus, Nicosia, Cyprus. 9. Department of Emergency Medicine, Indiana University School of Medicine, and the Regenstrief Institute, Indianapolis, IN, USA. 10. Department of Heart Diseases, Medical University, Military Hospital, Wrocław, Poland. 11. Novartis Pharma, Basel, Switzerland. 12. Department of Cardiology, University of Groningen, Groningen, The Netherlands.
Abstract
AIMS: Although left ventricular ejection fraction (LVEF) is routinely used to categorize patients with heart failure (HF), whether it predicts outcomes after hospitalization for acute heart failure (AHF) is uncertain. Consequently, we assessed the relationship between LVEF and cardiovascular (CV) outcomes in a large, well characterized cohort of patients hospitalized for AHF. METHODS AND RESULTS: The 6128 patients from the RELAX-AHF-2 trial who had LVEF measured during AHF hospitalization were separated into LVEF quartiles and the relationship between LVEF and a composite of CV mortality and rehospitalization for HF or renal failure through 180 days was assessed. We found progressively lower risk for this composite outcome as LVEF increased (hazard ratio 0.95, 95% confidence interval 0.93-0.98 per 5% LVEF increase, P < 0.001) that was driven predominantly by decreased risk for rehospitalization. The smoothed spline curve depicting risk remained stable as LVEF decreased until reaching approximately 40%, at which point risk increased progressively with further reductions in LVEF. Significant differences between LVEF quartiles for post-discharge CV risk were seen in patients with an ischaemic aetiology or with a history of HF preceding index hospitalization, but were less robust in patients with non-ischaemic aetiology and absent in those with de novo HF. CONCLUSION: In patients hospitalized with AHF, CV events over 180 days were more frequent in patients with lower LVEF. This was due predominantly to a significant increase in risk for HF/renal failure rehospitalization but not in either CV or all-cause mortality. LVEF had greater prognostic value in patients with ischaemic aetiology or pre-existing HF.
AIMS: Although left ventricular ejection fraction (LVEF) is routinely used to categorize patients with heart failure (HF), whether it predicts outcomes after hospitalization for acute heart failure (AHF) is uncertain. Consequently, we assessed the relationship between LVEF and cardiovascular (CV) outcomes in a large, well characterized cohort of patients hospitalized for AHF. METHODS AND RESULTS: The 6128 patients from the RELAX-AHF-2 trial who had LVEF measured during AHF hospitalization were separated into LVEF quartiles and the relationship between LVEF and a composite of CV mortality and rehospitalization for HF or renal failure through 180 days was assessed. We found progressively lower risk for this composite outcome as LVEF increased (hazard ratio 0.95, 95% confidence interval 0.93-0.98 per 5% LVEF increase, P < 0.001) that was driven predominantly by decreased risk for rehospitalization. The smoothed spline curve depicting risk remained stable as LVEF decreased until reaching approximately 40%, at which point risk increased progressively with further reductions in LVEF. Significant differences between LVEF quartiles for post-discharge CV risk were seen in patients with an ischaemic aetiology or with a history of HF preceding index hospitalization, but were less robust in patients with non-ischaemic aetiology and absent in those with de novo HF. CONCLUSION: In patients hospitalized with AHF, CV events over 180 days were more frequent in patients with lower LVEF. This was due predominantly to a significant increase in risk for HF/renal failure rehospitalization but not in either CV or all-cause mortality. LVEF had greater prognostic value in patients with ischaemic aetiology or pre-existing HF.
Authors: Johanna E Emmens; Jozine M Ter Maaten; Yuya Matsue; Sylwia M Figarska; Iziah E Sama; Gad Cotter; John G F Cleland; Beth A Davison; G Michael Felker; Michael M Givertz; Barry Greenberg; Peter S Pang; Thomas Severin; Claudio Gimpelewicz; Marco Metra; Adriaan A Voors; John R Teerlink Journal: Eur J Heart Fail Date: 2021-12-02 Impact factor: 17.349