Diastolic Determinants of Excess Mortality in Heart Failure With Reduced Ejection Fraction.
JACC Heart Fail
; 7(9): 808-817, 2019 09.
Article
en En
| MEDLINE
| ID: mdl-31401099
ABSTRACT
OBJECTIVES:
The objective of this study was to determine short- and long-term excess mortality associated with diastolic echocardiographic measures (primarily E/e' ratio) in patients with HF with reduced ejection fraction.BACKGROUND:
In patients with heart failure (HF), Doppler echocardiography diastolic alterations are frequently but not convincingly linked to survival. Consequently, they are not included in risk-score algorithms or substantially mentioned in HF guidelines.METHODS:
Consecutive patients with HF Stage B to C, diagnosed between 2003 and 2011, with ejection fraction <50%, Doppler diastolic characterization, complete clinical evaluation, and estimated pulmonary pressure, were analyzed. Outcome measure was mortality under medical management.RESULTS:
The 12,421 eligible patients were 69 ± 14 years of age, 32% were women, 72% had Stage C HF, with ejection fraction 36 ± 10% and E/e' ratio of 17 ± 9. During median follow-up 4.0 (1.1 to 7.0) years, 1-year and 5-year mortality were 17 ± 0.4% and 42 ± 0.5%. E/e' ratio >20 was linked to elevated 1-year mortality (adjusted odds ratio 1.45 [95% confidence interval (CI) 1.16 to 1.83]; p = 0.001). Long-term E/e' ratios >20 and >14 to 20 were associated with reduced survival (adjusted hazard ratio 1.21 [95% CI 1.07 to 1.37]; p = 0.003, and adjusted hazard ratio 1.15 [95% CI 1.02 to 1.29]; p = 0.02), independent of all HF characteristics and in all patients' subsets, including HF Stage B and Stage C. Guideline-based diastolic-grade algorithm also independently predicted mortality (p < 0.0001) but was definable less frequently (70%).CONCLUSIONS:
In reduced ejection fraction HF, diastolic Doppler alterations entail considerable mortality independent of all presentation characteristics. Elevated E/e' ratio, associated with worse HF at diagnosis, is also, independent of presentation, linked to substantial short-term reduced survival and long-term sustained excess mortality and should be incorporated into HF risk assessment.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Volumen Sistólico
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Insuficiencia Cardíaca
Tipo de estudio:
Etiology_studies
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Guideline
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
JACC Heart Fail
Año:
2019
Tipo del documento:
Article
País de afiliación:
Italia