Updated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization - 03/10/19
, Hirotsugu Yamada, MD, PhD c, Susumu Nishio, PhD a, Yukina Hirata, PhD a, Rie Amano, RT a, Masami Yamao, RT a, Robert Zheng, MD b, Yoshihito Saijo, MD, PhD b, Nao Yamada, MD b, Takayuki Ise, MD, PhD b, Koji Yamaguchi, MD, PhD b, Shusuke Yagi, MD, PhD b, Takeshi Soeki, MD, PhD b, Tetsuzo Wakatsuki, MD, PhD b, Masataka Sata, MD, PhD bAbstract |
Background |
Evaluation of diastolic dysfunction is crucial in determining elevated left atrial pressure. However, a validation of the long-term prognostic value of the newly proposed algorithm updated in 2016 has not been performed. The aim of the present study was to investigate the relative value of the updated 2016 diastolic dysfunction grading system for the incidence of readmission in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
Methods |
Two hundred thirty-two patients hospitalized with HF were retrospectively evaluated. Subjects were divided into two subgroups: those with HFrEF (n = 127) and those with HFpEF (n = 105). Readmission risk scores were calculated using the Yale Center for Outcomes Research and Evaluation HF, LACE index, and HOSPITAL scores. The primary end point was readmission following HF and cardiac death.
Results |
Over a period of 24 months, 86 patients were either readmitted or died. Multivariate Cox analysis was performed on both the HFrEF and HFpEF groups. In the HFrEF group, both the 2009 and 2016 algorithms had superior incremental value for the association of the primary end point to several readmission risk scores. In the HFpEF group, only the 2016 algorithm led to significant improvement in association with the primary end point. The 2016 algorithm had incremental value over several readmission risk scores alone.
Conclusions |
The recommendations of the 2016 algorithm can be useful for readmission and cardiac mortality risk assessment in patients with HFrEF and HFpEF. The use of echocardiography to estimate elevated left atrial pressure appears to identify a higher risk group and may allow a more tailored approach to therapy.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The 2016 ASE algorithm for LAP assessment can be useful for the assessment in HF. |
• | Elevated LAP by the algorithm has incremental value over readmission risk scores. |
• | Echocardiography to estimate elevated LAP may allow a tailored approach to therapy. |
Keywords : Echocardiography, Diastolic dysfunction, Left atrial pressure, Readmission risk
Abbreviations : AF, CORE, DD, HF, HFpEF, HFrEF, LA, LAP, LAVi, LV, LVEF, RV, TR
Plan
| This work was partially supported by Japan Society for the Promotion of Science Kakenhi Grants (grant 16K19824 to Dr. Torii, grant 17K09506 to Dr. Kusunose, and grant 19H03654 to Dr. Sata) and grants-in-aid from the Uehara Memorial Foundation (to Dr. Kusunose), the Takeda Science Foundation (to Dr. Sata), the Fugaku Trust for Medical Research (to Dr. Sata), and the Vehicle Racing Commemorative Foundation (to Dr. Sata). |
Vol 32 - N° 10
P. 1286 - octobre 2019 Retour au numéro
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