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AIM: Patients with Heart Failure (HF) commonly have poor quality of life (QoL), secondary to the persistence and severity of HF symptoms. We aimed to evaluate the prognostic value of QoL measures on all-cause mortality in patients with HF from the Colombian registry of heart failure (RECOLFACA). METHODS AND RESULTS: We analyzed data from patients registered in RECOLFACA during 2017-2019. QoL was measured using the EuroQol-5D questionnaire (EQ-5D). From the questionnaire, two independent predictors of mortality were obtained, the visual analogue scale (VAS) and the utility score (US). Primary outcome was all-cause mortality, and secondary variables evaluated were demographic factors, comorbidities, NYHA classification, medications used and laboratory test results. To analyze survival among patients, the Kaplan-Meier method and the hierarchical Cox proportional-hazards regression model were used. This study included 2514 patients from RECOLFACA. Most patients were male (57.6%), and mean age was 67.8 years. Mean value and standard deviation (SD) of the VAS score was 78.8 ± 20.1 points, while the mean and SD of the US score was 0.81 ± 0.20. As the Kaplan-Meier curve illustrated, patients in the lower quartiles of both VAS and US scores had a significantly higher probability of mortality (log-rank test: p<0.001 for both scores). CONCLUSION: QoL, as calculated by the EQ-5D questionnaire, served as an independent predictor of mortality in patients from RECOLFACA. Further studies may be needed to evaluate whether provision of optimizing therapies and follow-up care based on patients' perceived QoL reduces short- and long-term mortality rates in this population.
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Resumen Introducción: La insuficiencia cardiaca constituye el estadio final de muchas cardiopatias. Aunque los cambios en la composición de la matriz extracelular relacionados con el proceso de remodelamiento ventricular han sido descritos, ni la evolución ni el impacto clínico de la fibrogénesis miocárdica en pacientes con IC están completamente entendidos. Objetivo: Determinar si los precursores de la síntesis y degradación del colágeno son útiles en la predicción de hospitalización, muerte o necesidad de trasplante cardiaco en pacientes con insuficiencia cardiaca crónica. Métodos: Se estudiaron 204 pacientes con insuficiencia cardiaca crónica entre 2015 y 2016; 106 con miocardiopatía isquémica y 98 con miocardiopatía dilatada. Se midieron los niveles séricos de noradrenalina, fracción N-terminal del propéptido natriurético cerebral, propéptido N-terminal del procolágeno tipo I (PINP) y propéptido N-terminal del procolágeno tipo III (PIIINP). Se determinaron volúmenes y fracción de eyección del ventrículo izquierdo, clase funcional y tratamiento médico. Resultados: Durante el seguimiento hubo 55 hospitalizaciones, 7 muertes y 9 trasplantes. La edad (p < 0,001), los niveles de PINP (p = 0,04), PIIINP (p = 0,016) y volúmenes del ventrículo izquierdo (p < 0,05), fueron significativamente mayores en los pacientes que alcanzaron el desenlace primario. En pacientes con dilatación severa del ventrículo izquierdo (IVTDVI > 110ml/m2, IVTSVI > 50ml/m2), niveles de PIIINP > 6,2 (g/L y PINP > 40 (g/L se asociaron con mayor riesgo de hospitalización, muerte o necesidad de trasplante (sobrevida libre de eventos a 12 meses: 45% versus 95%, p < 0,0001). Conclusiones: Los niveles circulantes de PINP y PIIINP, se correlacionan con el remodelamiento del ventrículo izquierdo y predicen desenlaces en pacientes con insuficiencia cardiaca crónica.
Abstract Introduction: Heart failure (HF) is the end-stage of many heart diseases. Although the changes in the composition of the extracellular matrix associated with the ventricular remodelling process have been described, neither the evolution nor the clinical impact of the myocardial fibrogenesis in patients with HF are completely understood. Objective: To determine if the precursors of the synthesis and degradation of collagen are useful in the prediction of hospital admissions, death, or the need for a heart transplant in patients with chronic heart failure (CHF). Methods: A total of 204 patients with chronic heart failure were studied between the years 2015 and 2016, of whom 106 had ischaemic heart disease, and 98 had dilated cardiomyopathy. Measurements were made of the serum levels of noradrenaline, N-terminal pro-B-type natriuretic peptide, procollagen type I N-terminal propeptide, and procollagen type III N-terminal propeptide (PIIINP). The left ventricular volumes and ejection fraction were determined, as well a record made of the functional class and medical treatment. Results: During follow-up, there were 55 hospital admissions, 7 deaths and 9 transplants. Age (p<0,001), PINP levels (p=0,04), PIIINP levels (p=0,016), and left ventricular volumes (p<0,05), were significantly higher in patients who achieved the primary outcome. In patients with severe dilation of the left ventricle (LV diastolic volume index, LVDVI > 110 ml/m2, LV systolic volume index, LVTSVI > 50 ml/m2), PIIINP levels > 6.2 (g/L and a PINP > 40 (g/L, were associated with a higher risk of hospital admission, death, or need of a transplant (event-free survival at 12 months: 45% versus 95%, p<0,0001). Conclusions: The circulating levels of PINP and PIIINP are associated with left ventricular remodelling, and predict the outcomes in patients with chronic heart failure.