Time-sensitive Prognostic Performance of an Afterload-integrated Diastolic Index in Heart Failure with Preserved Ejection Fraction: a Prospective Multicentre Observational Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2022 Aug 10

PMID 35948381

Authors

Shiro Hoshida

Shungo Hikoso

Yukinori Shinoda

Koichi Tachibana

Tomoko Minamisaka

Tamaki Shunsuke

Masamichi Yano

Takaharu Hayashi

Akito Nakagawa

Yusuke Nakagawa

Takahisa Yamada

Yoshio Yasumura

Daisaku Nakatani

Yasushi Sakata

Affiliations

Soon will be listed here.

Abstract

Objectives: The prognostic significance of an afterload-integrated diastolic index, the ratio of diastolic elastance (Ed) to arterial elastance (Ea) (Ed/Ea=[E/e']/[0.9×systolic blood pressure]), is valid for 1 year after discharge in older patients with heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the association with changes in Ed/Ea from enrolment to 1 year and prognosis thereafter in patients with HFpEF.

Setting: A prospective, multicentre observational registry of collaborating hospitals in Osaka, Japan.

Participants: We enrolled 659 patients with HFpEF hospitalised for acute decompensated heart failure (men/women: 296/363). Blood tests and transthoracic echocardiography were performed before discharge and at 1 year after.

Primary Outcome Measures: All-cause mortality and/or re-admission for heart failure were evaluated after discharge.

Results: High Ed/Ea assessed before discharge was a significant prognostic factor during the first, but not the second, year after discharge in all-cause mortality or all-cause mortality and/or re-admission for heart failure. When re-analysis was performed using the value of Ed/Ea at 1 year after discharge, high Ed/Ea was significant for the prognosis during the second year for both end points (p=0.012 and p=0.033, respectively). The poorest mortality during 1‒2 years after enrolment was observed in those who showed a worsening Ed/Ea during the first year associated with larger left ventricular mass index and reduced left ventricular ejection fraction. In all-cause mortality and/or re-admission for heart failure, the event rate during 1‒2 years was highest in those with persistently high Ed/Ea even after 1 year.

Conclusions: Time-sensitive prognostic performance of Ed/Ea, an afterload-integrated diastolic index, was observed in older patients with HFpEF.

Trial Registration Number: UMIN000021831.

Citing Articles

Due Diligence of a Diastolic Index as a Prognostic Factor in Heart Failure with Preserved Ejection Fraction.

Hoshida S J Clin Med. 2023; 12(20).

PMID: 37892830 PMC: 10607873. DOI: 10.3390/jcm12206692.

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