Effect of insulin on readmission for heart failure following a hospitalization for acute heart failure

AIMS: Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and is related with worse outcomes. Insulin treatment is associated with sodium and water retention, weight gain, and hypoglycaemia-all pathophysiological mechanisms related to HF decompensation. This study aimed to evaluate the association between insulin treatment and the risk of 1year readmission for HF in patients discharged for acute HF.; METHODS AND RESULTS: We prospectively included 2895 consecutive patients discharged after an episode of acute HF in a single tertiary hospital. Multivariable Cox regression, adapted for competing events, was used to assess the association between insulin treatment and …

ST2 and left ventricular remodeling after ST-segment elevation myocardial infarction: A cardiac magnetic resonance study.

Background: The association of soluble interleukin-1 receptor-like 1 (ST2) with left ventricular (LV) remodeling is unclear in patients with a first ST-segment elevation myocardial infarction (STEMI). The objective of this work was to assess the relationship between ST2, a marker of inflammation, and cardiac magnetic resonance (CMR) imaging-derived LV remodeling after a first STEMI. Methods: We prospectively evaluated 109 patients with a first STEMI treated with primary percutaneous coronary intervention who had ST2 assessed 24 h post-reperfusion. All patients underwent CMR imaging 1 week and 6 months after STEMI. The independent associations between ST2, LV diastolic and systolic volume in…

Additional file 3: of Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients

Table S3. Cox regression analyses for 1-year HF-related hospitalization. A competing risk strategy using the Gray method was adopted, considering death as the competing risk in both univariate and multivariate Cox regression analyses. (DOCX 27 kb)

Circulating monocyte subsets and heart failure prognosis

Altres ajuts: Fundacio' La MARATO' de TV3 (201502 to ABG, 201516), AdvanceCat with the support of ACCIÓ [Catalonia Trade & Investment, Generalitat de Catalunya], Fundació Bancària La Caixa. Monocytes are a heterogeneous population of effector cells with key roles in tissue integrity restoration and maintenance. Here, we explore the association of monocyte subsets and prognosis in patients with ambulatory heart failure (HF). Monocyte subsets were classified as classical (CD14 ++ /CD16 -), intermediate (CD14 ++ /CD16 +), or non-classical (CD14 + /CD16 ++). Percentage distribution and absolute cell count were assessed in each subset, and multivariable Cox regression analyses were performed wit…

Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: The TRAINING-HF Trial

Introduction and objectives: Despite the prevalence of heart failure with preserved ejection fraction (HFpEF), there is currently no evidence-based effective therapy for this disease. This study sought to evaluate whether inspiratory muscle training (IMT), functional electrical stimulation (FES), or a combination of both (IMT + FES) improves 12- and 24-week exercise capacity as well as left ventricular diastolic function, biomarker profile, and quality of life in HFpEF. Methods: A total of 61 stable symptomatic patients (New York Heart Association II-III) with HFpEF were randomized (1:1:1:1) to receive a 12-week program of IMT, FES, or IMT + FES vs usual care. The primary endpoint of the st…

Additional file 2: of Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients

Table S2. Cox regression analyses for 30-day rehospitalization. A competing risk strategy using the Gray method was adopted, considering death as the competing risk in both univariate and multivariate Cox regression analyses. (DOCX 27 kb)

Advanced interatrial block predicts new-onset atrial fibrillation and ischemic stroke in patients with heart failure: The “Bayes' Syndrome-HF” study

Advanced interatrial block (IAB) is characterized by a prolonged (≥120 ms) and bimodal P wave in the inferior leads. The association between advanced IAB and atrial fibrillation (AF) is known as “Bayes' Syndrome”, and there is scarce information about it in heart failure (HF). We examined the prevalence of IAB and whether advanced IAB could predict new-onset AF and/or stroke in HF patients. Methods and results: The prospective observational “Bayes' Syndrome-HF” study included consecutive outpatients with chronic HF. The primary endpoints were new-onset AF, ischemic stroke, and the composite of both. A secondary endpoint included all-cause death alone or in combination with the primary endpo…

Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

Abstract Background Left ventricular ejection fraction (LVEF) trajectories and functional recovery with current heart failure (HF) management is increasingly recognized. Type 2 diabetes mellitus (T2D) leads to a worse prognosis in HF patients. However, it is unknown whether T2D interferes with LVEF trajectories. The aim of this study was to prospectively assess very long-term (up to 15 years) LVEF trajectories in patients with and without T2D and underlying HF. Methods Ambulatory patients admitted to a multidisciplinary HF clinic were prospectively evaluated by scheduled two-dimensional echocardiography at baseline, 1 year, and then every 2 years afterwards, up to 15 years. Statistical anal…

International Normalized Ratio and Mortality Risk in Acute Heart Failure and Nonvalvular Atrial Fibrillation Patients Receiving Vitamin K Antagonists

Introduction and objectives: Heart failure patients with nonvalvular atrial fibrillation (NVAF) on treatment with vitamin K antagonists (VKA) often have suboptimal international normalized ratio (INR) values. Our aim was to evaluate the association between INR values at admission due to acute heart failure and mortality risk during follow-up. Methods: In this observational study, we retrospectively assessed INR on admission in 1137 consecutive patients with acute heart failure and NVAF who were receiving VKA treatment. INR was categorized into optimal values (INR = 2-3, n = 210), subtherapeutic (INR 3, n = 267). Because INR did not meet the proportional hazards assumption for mortality, res…

Lung ultrasound in outpatients with heart failure: the wet‐to‐dry HF study

The Nancy team is supported by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second 'Investissements d'Avenir' programme (reference: ANR-15-RHUS-0004), by the French PIA project 'Lorraine Université d'Excellence' (reference: ANR-15-IDEX-04-LUE), the ANR FOCUS-MR (reference: ANR-15-CE14-0032-01), ERA-CVD EXPERT (reference: ANR-16-ECVD-0002-02), the Contrat de Plan Etat Lorraine IT2MP, and FEDER Lorraine. Aims: In ambulatory patients with chronic heart failure (HF), congestion and decongestion assessment may be challenging. The aim of this study is to assess the value of lung ultrasound (LUS) in outpatients with HF in characterizing deco…

Pulmonary hypertension and right ventricular dysfunction in heart failure: prognosis and 15‐year prospective longitudinal trajectories in survivors

Aims Systolic pulmonary artery pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), and TAPSE/SPAP ratio trajectories are not fully characterized in chronic heart failure (HF). We assessed very long-term longitudinal SPAP, TAPSE and TAPSE/SPAP trajectories in HF patients, and their dynamic changes in outcomes. Methods and results Prospective, consecutive, observational registry of real-life HF patients, performing echocardiography studies at baseline and according to a prospectively structured schedule after 1 year, and then every 2 years, up to 15 years. Pulmonary hypertension (PH) was defined as SPAP ≥40 mmHg; right ventricular dysfunction (RVD) was defined at TAPSE ≤16 mm…

Circulating neprilysin hypothesis: A new opportunity for sacubitril/valsartan in patients with heart failure and preserved ejection fraction?

BackgroundCirculating Neprilysin (sNEP) has emerged as a potential prognostic biomarker in heart failure (HF). In PARAGON-HF benefit of sacubitril/valsartan was only observed in patients with left ventricular ejection fraction (LVEF) ≤57%. We aimed to assess the prognostic value of sNEP in outpatients with HF and LVEF >57%, in comparison with patients with LVEF ≤57%.MethodsConsecutive HF outpatients were included from May-2006 to February-2016. The primary endpoint was the composite of all-cause death or HF hospitalization and the main secondary endpoint was the composite of cardiovascular death or HF hospitalization. For the later competing risk methods were used.ResultssNEP was measure…

Additional file 3: of Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients

Table S3. Cox regression analyses for 1-year HF-related hospitalization. A competing risk strategy using the Gray method was adopted, considering death as the competing risk in both univariate and multivariate Cox regression analyses. (DOCX 27 kb)

Additional file 2: of Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients

Table S2. Cox regression analyses for 30-day rehospitalization. A competing risk strategy using the Gray method was adopted, considering death as the competing risk in both univariate and multivariate Cox regression analyses. (DOCX 27 kb)

Additional file 2 of Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

Additional file 2: Table S1. Demographic, clinical, and therapeutic characteristics at baseline and treatments during follow-up according to etiology of heart failure and presence of diabetes mellitus. Table S2. Paired wise means data analysis in diabetic patients. Table S3. Causes of death of the studied cohort during the 15-year follow-up, according the presence or absence of diabetes mellitus. Table S4. Multivariable Cox regression analysis for all-cause death and the composite end-point all-cause death or heart failure hospitalization.

Optimal carbohydrate antigen 125 cutpoint for identifying low-risk patients after admission for acute heart failure

Introduction and objectives: Carbohydrate antigen 125 (CA125) has been shown to be useful for risk stratification in patients admitted with acute heart failure (AHF). We sought to determine a CA125 cutpoint for identifying patients at low risk of 1-month death or the composite of death/HF readmission following admission for AHF.Methods: The derivation cohort included 3231 consecutive patients with AHF. CA125 cutoff values with 90% negative predictive value (NPV) and sensitivity up to 85% were identified. The adequacy of these cutpoints and the risk of 1-month death/HF readmission was then tested using the Royston-Parmar method. The best cutpoint was selected and externally validated in a co…

Punto de corte óptimo del antígeno carbohidrato 125 para la identificación de pacientes con bajo riesgo tras un ingreso por insuficiencia cardiaca aguda

Resumen Introduccion y objetivos El antigeno carbohidrato 125 (CA125) se ha mostrado util para la estratificacion del riesgo de los pacientes ingresados por insuficiencia cardiaca aguda (ICA). Se intenta determinar un punto de corte para identificar a los pacientes con bajo riesgo de muerte y muerte/reingreso por insuficiencia cardiaca 1 mes tras el ingreso por ICA. Metodos La cohorte de derivacion incluyo a 3.231 pacientes con ICA consecutivos. Se identificaron valores de corte de CA125 con un valor predictivo negativo (VPN) del 90% y una sensibilidad de hasta el 85%. La idoneidad de estos puntos de corte y el riesgo de muerte/reingreso al mes se evaluaron mediante el metodo de Royston-Par…

Pulmonary vascular resistance versus pulmonary artery pressure for predicting right ventricular remodeling and functional tricuspid regurgitation.

BACKGROUND Pulmonary hypertension (PH) is a common cause of right ventricular (RV) remodeling and functional tricuspid regurgitation (FTR), but incremental pulmonary artery systolic pressure (PASP) does not always correlate with anatomic and functional RV changes. This study aimed to evaluate a noninvasive measure of pulmonary vascular resistance (PVR) for predicting RV dilatation, RV dysfunction, and severity of FTR. METHODS We prospectively analyzed consecutive stable patients with PASP ≥ 35 mm Hg or any degree of RV dilatation or dysfunction secondary to PH. Noninvasive PVR was calculated based on FTR peak velocity and flow in RV outflow tract. RESULTS We included 251 patients, aged 72.1…

Soluble ST2 for Prognosis and Monitoring in Heart Failure

Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality

Background: The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute heart failure admission. Methods: Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling. Res…

Noninvasive Imaging Estimation of Myocardial Iron Repletion Following Administration of Intravenous Iron : The Myocardial- Trial

Background Intravenous ferric carboxymaltose ( FCM ) improves symptoms, functional capacity, and quality of life in heart failure and iron deficiency. The mechanisms underlying these effects are not fully understood. The aim of this study was to examine changes in myocardial iron content after FCM administration in patients with heart failure and iron deficiency using cardiac magnetic resonance. Methods and Results Fifty‐three stable heart failure and iron deficiency patients were randomly assigned 1:1 to receive intravenous FCM or placebo in a multicenter, double‐blind study. T2* and T1 mapping cardiac magnetic resonance sequences, noninvasive surrogates of intramyocardial iron, were eval…

Prognostic Value and Kinetics of Soluble Neprilysin in Acute Heart Failure

Abstract Objectives This study sought to examine the prognostic value of the soluble form of neprilysin (sNEP) in acute heart failure (AHF) and sNEP kinetics during hospital admission. Background sNEP was recently identified in chronic heart failure (HF) and was associated with cardiovascular outcomes. Methods A total of 350 patients (53% women, mean 72.6 ± 10.7 years of age) were included in the study. Primary endpoints were composites of cardiovascular death or HF hospitalizations at short-term (2 months) and long-term (mean: 1.8 ± 1.2 years) follow-up. sNEP was measured using an ad hoc–modified enzyme-linked immunosorbent assay, and its prognostic value was assessed using Cox regression …

Entrenamiento de la musculatura inspiratoria y la electroestimulación muscular funcional en el tratamiento de la insuficiencia cardiaca con función sistólica conservada: estudio TRAINING-HF

SEC 2017: Congreso de las Enfermedades Cardiovasculares Introducción y objetivos No se dispone de tratamientos farmacológicos que demuestren reducir la morbimortalidad asociada en pacientes con insuficiencia cardiaca y función sistólica conservada (IC-FEc). El objetivo del presente estudio fue evaluar si en pacientes con IC-FEc, el entrenamiento de la musculatura inspiratoria (EMI), la electroestimulación muscular funcional (EMF) o la combinación de ambas (EMI + EMF) puede mejorar la capacidad funcional, calidad de vida, parámetros de disfunción diastólica o biomarcadores a las 12 y 24 semanas. Métodos Un total de 61 pacientes estables con IC-FEc (clase funcional de la New York Heart Associ…

Razón internacional normalizada y mortalidad de los pacientes con insuficiencia cardiaca y fibrilación auricular tratados con antagonistas de la vitamina K

Resumen Introduccion y objetivos Los pacientes con insuficiencia cardiaca en tratamiento con antagonistas de la vitamina K (AVK) por fibrilacion auricular no valvular (FANV) a menudo presentan valores alterados de la razon internacional normalizada (INR). El objetivo es evaluar la asociacion entre la INR al ingreso por insuficiencia cardiaca y el riesgo de mortalidad en el seguimiento. Metodos Estudio observacional retrospectivo en el que se evaluo la INR al ingreso de 1.137 pacientes consecutivos con insuficiencia cardiaca aguda en tratamiento con AVK por FANV. Esta se categorizo en: INR en rango optimo (INR = 2-3, n = 210), infraterapeutica (INR 3, n = 267). La asociacion independiente en…

Prognostic Value of New-Generation Troponins in ST-Segment-Elevation Myocardial Infarction in the Modern Era: The RUTI-STEMI Study.

Background In ST ‐segment–elevation myocardial infarction ( STEMI ), troponins are not needed for diagnosis: symptoms and ECG data are sufficient to activate percutaneous coronary intervention. This study explored the prognostic value of new‐generation troponins in a real‐life cohort contemporarily treated for STEMI . Methods and Results We studied 1260 consecutive patients with primary STEMI treated with percutaneous coronary intervention between February 22, 2011, and August 31, 2015. We collected data on clinical characteristics and major adverse cardiovascular and cerebrovascular events ( MACCEs ) at 30 days and 1 year. Peak high‐sensitivity troponin T and sensitive‐contemporary tropon…

Destination Therapy with Left Ventricular Assist Devices in Non-transplant Centres: The Time is Right

For almost half a century, cardiac transplant has been the only long-term treatment for patients with end-stage heart failure. Implantable left ventricular assist devices (LVADs) have emerged as a new treatment option for advanced heart failure as destination therapy for patients either too old or not suitable for transplant. A meta-analysis presenting head-to-head comparisons of cardiac transplant versus LVAD as destination therapy (LVAD-DT) found no difference in 1-year mortality rates between LVAD-DT and cardiac transplant (OR 1.49; 95% CI [0.48–4.66]; I2=82.8%). Moreover, a recent subanalysis from the Interagency Registry for Mechanically Assisted Circulatory Support found similar outco…

Rehospitalization burden and morbidity risk in patients with heart failure with mid-range ejection fraction

Aims Heart failure with mid-range ejection fraction (HFmrEF) has been proposed as a distinct HF phenotype, but whether patients on this category fare worse, similarly, or better than those with HF with reduced EF (HFrEF) or preserved EF (HFpEF) in terms of rehospitalization risks over time remains unclear. Methods and results We prospectively included 2961 consecutive patients admitted for acute HF (AHF) in our institution. Of them, 158 patients died during the index admission, leaving the sample size to be 2803 patients. Patients were categorized according to their EF: HFrEF if EF ≤ 40% (n = 908, 32.4%); HFmrEF if EF = 41–49% (n = 449, 16.0%); and HFpEF if EF ≥ 50% (n = 1446, 51.6%). Covar…

Role of PCSK9 in the course of ejection fraction change after ST-segment elevation myocardial infarction: a pilot study

Altres ajuts: Conselleria d'Educació, Investigació, Cultura i Esport GV/2018/116 Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low-density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure-related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging-derived left ventricular ejection fraction (LVEF) after a first ST-segment elevation myocardial infarction (STEMI). We prospectively evaluated 40…

A bio-clinical approach for prediction of sudden cardiac death in outpatients with heart failure: The ST2-SCD score

Sudden cardiac death (SCD) is one of the main modes of death in heart failure (HF) patients and its prediction remains a real challenge. Our aim was to assess the incidence of SCD at 5 years HF contemporary managed outpatients, and to find a simple prediction model for SCD.SCD was considered any unexpected death, witnessed or not, occurring in a previously stable patient with no evidence of worsening HF or any other cause of death. A competing risk strategy was adopted using the Fine-Gray method of Cox regressions analyses that considered other causes of death as the competing event.The derivation cohort included 744 consecutive outpatients (72% men, age 67.9 ± 12.2 years, left ventricular …

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

Right ventricular dysfunction (RVD) parameters are increasingly important features in heart failure with preserved ejection fraction (HFpEF). We sought to evaluate the prognostic impact of a progressive RVD staging system by combining the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (TAPSE/PASP) ratio with functional tricuspid regurgitation (TR) severity. We prospectively included 1355 consecutive HFpEF patients discharged for acute heart failure (HF). Of them, in 471 (34.7%) patients, PASP could not be accurately measured, leaving the final sample size to be 884 patients. Patients were categorized as Stage 1: TAPSE/PASP &ge

Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients.

Background Heart failure (HF) is associated with a high rate of readmissions within 30 days post-discharge and in the following year, especially in frail elderly patients. Biomarker data are scarce in this high-risk population. This study assessed the value of early post-discharge circulating levels of ST2, NT-proBNP, CA125, and hs-TnI for predicting 30-day and 1-year outcomes in comorbid frail elderly patients with HF with mainly preserved ejection fraction (HFpEF). Methods Blood samples were obtained at the first visit shortly after discharge (4.9 ± 2 days). The primary endpoint was the composite of all-cause mortality or HF-related rehospitalization at 30 days and at 1 year. All-cause mo…

Heart failure with mid-range ejection fraction: a transition phenotype?

Usefulness of Right Ventricular to Pulmonary Circulation Coupling as an Indicator of Risk for Recurrent Admissions in Heart Failure With Preserved Ejection Fraction.

In recent years, the study of right ventricular (RV) to pulmonary circulation (PC) coupling in heart failure with preserved ejection fraction (HFpEF) has been a matter of special interest. Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio has emerged as a reliable noninvasive index of RV to PC coupling. Thus, we hypothesized that TAPSE/PASP would be a predictor of readmission burden in HFpEF. One thousand one hundred and twenty seven consecutive HFpEF patients discharged for acute HF were included. In 367 patients (32.6%), PASP could not be accurately measured by echocardiography, leaving the final sample size to be 760 patients. Negative …

Additional file 1: of Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients

Table S1. Correlations between studied biomarkers. Correlation between the different studied biomarkers was performed using Pearson correlation test of log-transformed values of each biomarker. (DOCX 25 kb)

Additional file 1: of Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients

Table S1. Correlations between studied biomarkers. Correlation between the different studied biomarkers was performed using Pearson correlation test of log-transformed values of each biomarker. (DOCX 25 kb)

Neprilysin inhibition, endorphin dynamics, and early symptomatic improvement in heart failure: a pilot study

Altres ajuts: This work was supported in part by Fundació La Marató de TV3 (201516-10, 201502-30), Societat Catalana de Cardiologia, "la Caixa" Banking Foundation. Altres ajuts: PERIS/SLT002-16-00234 Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor developed for the treatment of heart failure with reduced ejection fraction. Its benefits are achieved through the inhibition of neprilysin (NEP) and the specific blockade of the angiotensin receptor AT1. The many peptides metabolized by NEP suggest multifaceted potential consequences of its inhibition. We sought to evaluate the short-term changes in serum endorphin (EP) values and their relation with patients' p…

CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-gui…

Head-to-head comparison of contemporary heart failure risk scores.

Altres ajuts: acords transformatius de la UAB Aims: Several heart failure (HF) web-based risk scores are currently used in clinical practice. Currently, we lack head-to-head comparison of the accuracy of risk scores. This study aimed to assess correlation and mortality prediction performance of Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC-HF) risk score, which includes clinical variables + medications; Seattle Heart Failure Model (SHFM), which includes clinical variables + treatments + analytes; PARADIGM Risk of Events and Death in the Contemporary Treatment of Heart Failure (PREDICT-HF) and Barcelona Bio-Heart Failure (BCN-Bio-HF) risk calculator, which also include biomarke…

Trends in modes of death in heart failure over the last two decades: less sudden death but cancer deaths on the rise.

AIMS Better management of heart failure (HF) over the past two decades has improved survival, mainly by reducing the incidence of death due to cardiovascular (CV) causes. Deaths due to non-CV causes, particularly cancer, may be increasing. This study explored the modes of death of consecutive patients who attended a HF clinic over 17 years. METHODS AND RESULTS A total of 935 deaths were ascertained from 2002 to 2018 among 1876 patients (mean age 65.8 ± 12.5 years, 75% men, left ventricular ejection fraction < 50%) admitted to our HF clinic. Median follow-up was 4.2 years [1.9-7.8]. Mode of death was curated from patient health records and verified by the Catalan and Spanish health system da…

Bio-profiling and bio-prognostication of chronic heart failure with mid-range ejection fraction.

Abstract Background Recent ESC guidelines on heart failure (HF) have introduced a new phenotype based on left ventricular ejection fraction (LVEF), called the mid-range (HFmrEF). This phenotype falls between the classical reduced (HFrEF) and preserved (HFpEF) HF phenotypes. We aimed to characterize the HFmrEF biomarker profile and outcomes. Methods 1069 consecutive ambulatory patients were included in the study (age 66.2 ± 12.8 years); 800 with HFrEF (74.8%), 134 with HFmrEF (12.5%), and 135 with HFpEF (12.5%). We measured serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), soluble suppression of tumorigenicity (ST2), galectin-…

Serum neprilysin and recurrent hospitalizations after acute heart failure

Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach.

International audience; To better understand heart failure with preserved ejection fraction (HFpEF), we need to better characterize the transition from asymptomatic pre-HFpEF to symptomatic HFpEF. The current emphasis on left ventricular diastolic dysfunction must be redirected to microvascular inflammation and endothelial dysfunction that leads to cardiomyocyte remodeling and enhanced interstitial collagen deposition. A pre-HFpEF patient lacks signs or symptoms of heart failure (HF), has preserved left ventricular ejection fraction (LVEF) with incipient structural changes similar to HFpEF, and possesses elevated biomarkers of cardiac dysfunction. The transition from pre-HFpEF to symptomati…

Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction.

Objective: To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area. Patients and Methods: Consecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older A…

Heart failure with preserved ejection fraction infrequently evolves toward a reduced phenotype in long-term survivors: a long-term prospective longitudinal study

Background: Long-term trajectories of left ventricular ejection fraction (LVEF) in heart failure (HF) patients with preserved EF (HFpEF) remain unclear. Our objective was to assess long-term longitudinal trajectories in consecutive HFpEF patients and the prognostic impact of LVEF dynamic changes over time. Methods and Results: Consecutive ambulatory HFpEF patients admitted to a multidisciplinary HF Unit were prospectively evaluated by 2-dimensional echocardiography at baseline and at 1, 3, 5, 7, 9, and 11 years of follow-up. Exclusion criteria were patients having a previous known LVEF &lt;50%, patients undergoing only 1 echocardiogram study, and those with a diagnosis of dilated, noncompa…

Serum Neprilysin and Recurrent Admissions in Patients With Heart Failure

Background Our aim was to evaluate the association between the soluble form of neprilysin ( sNEP ) levels and long‐term all‐cause, cardiovascular, and acute heart failure ( AHF ) recurrent admissions in an ambulatory cohort of patients with heart failure. sNEP has emerged as a new biomarker with promising implications for prognosis and therapy in patients with heart failure. Reducing the recurrent admission rate of heart failure patients has become an important target of public health planning strategies. Methods and Results We measured sNEP levels in 1021 consecutive ambulatory heart failure patients. End points were the number of all‐cause, cardiovascular, and AHF hospitalizations during…

Antigen carbohydrate 125 as a biomarker in heart failure: a narrative review.

Congestion explains many of the signs and symptoms of acute heart failure (AHF) and disease progression. However, accurate quantification of congestion is challenging in daily practice. Antigen carbohydrate 125 (CA125) or mucin 16 (MUC16), a large glycoprotein synthesized by mesothelial cells, has emerged as a reliable proxy of congestion and inflammation in patients with heart failure. In AHF syndromes, CA125 is strongly associated with right-sided heart failure parameters and a higher risk of adverse clinical events beyond standard prognostic factors, including natriuretic peptides. Furthermore, CA125 has the potential for both monitoring and guide HF treatment following a decompensated H…

Unraveling the Molecular Mechanism of Action of Empagliflozin in Heart Failure With Reduced Ejection Fraction With or Without Diabetes

Visual Abstract

Additional file 8 of Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

Additional file 8: Figure S4. Survival and event-free survival curves related to the presence of diabetes mellitus and to etiology (ischemic vs. non-ischemic). Panel B: Event-free survival curves (composite end-point of all-cause death or HF hospitalizations). Diabetic patients from ischemic etiology (dark purple) showed the worse prognosis, while non-diabetic from non-ischemic etiology (blue) showed the best. Remarkably diabetic patients from non-ischemic etiology (soft orange) showed slightly worse prognosis than non-diabetic patients from ischemic etiology (green).

Additional file 1 of Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

Additional file 1: Figure S1. Distribution of the number of echocardiograms performed per patient. Number of echocardiograms per patient ranged from 2 (minimum inclusion criteria) to 9 (patients with all the per protocol pre-specified echocardiograms).

Additional file 6 of Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

Additional file 6: Figure S3. Loess spline curves of long-term LVEF trajectories based on sex. Panel B: Women. P value for trajectory changes on LVEF &lt;0.001 for both groups. P for comparison between groups (interaction between trajectory changes and diabetes) = 0.14. Shaded regions displayed around curves represent the confidence interval at level = 0.95.

Additional file 5 of Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

Additional file 5: Figure S3. Loess spline curves of long-term LVEF trajectories based on sex. Panel A: Men. Diabetic (orange) vs. non-diabetic (blue) patients. P value for trajectory changes on LVEF

Additional file 3 of Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

Additional file 3: Figure S2. Loess spline curves of long-term LVEF trajectories based on heart failure duration. Panel A: Patients with HF duration ≤ 12 months; Diabetic (orange) vs. non-diabetic (blue) patients. P value for trajectory changes on LVEF

Additional file 4 of Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

Additional file 4: Figure S2. Loess spline curves of long-term LVEF trajectories based on heart failure duration. Panel B: Patients with HF duration &gt; 12 months. P value for trajectory changes on LVEF

Additional file 7 of Long-term LVEF trajectories in patients with type 2 diabetes and heart failure: diabetic cardiomyopathy may underlie functional decline

Additional file 7: Figure S4. Survival and event-free survival curves related to the presence of diabetes mellitus and to etiology (ischemic vs. non-ischemic). Panel A: All-cause death survival curves.