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Multicenter Study
. 2022 Aug 2;11(15):e025300.
doi: 10.1161/JAHA.122.025300. Epub 2022 Jul 29.

Predictors and Outcomes of Heart Failure With Preserved Ejection Fraction in Patients With a Left Ventricular Ejection Fraction Above or Below 60

Akito Nakagawa  1   2 , Yoshio Yasumura  1 , Chikako Yoshida  1 , Takahiro Okumura  1 , Jun Tateishi  1 , Junichi Yoshida  1 , Masahiro Seo  3 , Masamichi Yano  4 , Takaharu Hayashi  5 , Yusuke Nakagawa  6 , Shunsuke Tamaki  7 , Takahisa Yamada  3 , Hiroyuki Kurakami  8 , Yohei Sotomi  9 , Daisaku Nakatani  9 , Shungo Hikoso  9 , Yasushi Sakata  9 ; Osaka CardioVascular Conference (OCVC)‐Heart Failure Investigators
Affiliations
Multicenter Study

Predictors and Outcomes of Heart Failure With Preserved Ejection Fraction in Patients With a Left Ventricular Ejection Fraction Above or Below 60

Akito Nakagawa et al. J Am Heart Assoc. .

Abstract

Background Although potential therapeutic candidates for heart failure with preserved ejection fraction (HFpEF) are emerging, it is still unclear whether they will be effective in patients with left ventricular ejection fraction (LVEF) of 60% or higher. Our aim was to identify the clinical characteristics of these patients with HFpEF by comparing them to patients with LVEF below 60%. Methods and Results From a multicenter, prospective, observational cohort (PURSUIT-HFpEF [Prospective Multicenter Obsevational Study of Patients with Heart Failure with Preserved Ejection Fraction]), we investigated 812 consecutive patients (median age, 83 years; 57% women), including 316 with 50% ≤ LVEF <60% and 496 with 60% ≤ LVEF, and compared the clinical backgrounds of the 2 groups and their prognoses for cardiac mortality or HF readmission. Two hundred four adverse outcomes occurred at a median of 366 days. Multivariable Cox regression tests adjusted for age, sex, heart rate, atrial fibrillation, estimated glomerular filtration rate, N-terminal pro-B-type natriuretic peptide, and prior heart failure hospitalization revealed that systolic blood pressure (hazard ratio [HR], 0.925 [95% CI, 0.862-0.992]; P=0.028), high-density lipoprotein to C-reactive protein ratio (HR, 0.975 [95% CI, 0.944-0.995]; P=0.007), and left ventricular end-diastolic volume index (HR, 0.870 [95% CI, 0.759-0.997]; P=0.037) were uniquely associated with outcomes among patients with 50% ≤ LVEF <60%, whereas only the ratio of peak early mitral inflow velocity to velocity of mitral annulus early diastolic motion e'(HR, 1.034 [95% CI, 1.003-1.062]; P=0.034) was associated with outcomes among patients with 60% ≤ LVEF. Conclusions Prognostic factors show distinct differences between patients with HFpEF with 50% ≤ LVEF <60% and with 60% ≤ LVEF. These findings suggest that the 2 groups have different inherent pathophysiology. Registration URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024414; Unique identifier: UMIN000021831 PURSUIT-HFpEF.

Keywords: heart failure with preserved ejection fraction; left ventricular ejection fraction; prognostic factor.

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Figures

Figure 1
Figure 1. Patients analyzed in this study.
Tree chart of the patient‐selection process. HCM indicates hypertrophic cardiomyopathy; HFpEF, heart failure with preserved ejection fraction; and LVEF, left ventricular ejection fraction.
Figure 2
Figure 2. Kaplan‐Meier curves of patients with HFpEF whose LVEF was below or above 60%.
HF indicates heart failure; HFpEF, heart failure with preserved ejection fraction; and LVEF, left ventricular ejection fraction.
Figure 3
Figure 3. Kaplan‐Meier curves by potential specific prognostic factors for patients with 50% ≤ LVEF <60%.
Patients are divided with the median values of systolic blood pressure (A), heart rate (B), HDL/CRP ratio (C) and LVEDVI (D). CRP indicates C‐reactive protein; HDL, high‐density lipoprotein; HF, heart failure; LVEDVI, left ventricular end‐diastolic volume index; LVEF, left ventricular ejection fraction; and SBP, systolic blood pressure.
Figure 4
Figure 4. Kaplan‐Meier curves by potential specific prognostic factors for patients with 60% ≤ LVEF.
Patients are divided with the median values of hematocrit (A), LAVI (B) and E/e' (C). E/e′, ratio of peak early mitral inflow velocity to velocity of mitral annulus early diastolic motion e′; HF, heart failure; LAVI, left atrial volume index; and LVEF, left ventricular ejection fraction.
Figure 5
Figure 5. Predictors of composite outcome assessed by univariable Cox regression.
Forest plot depicting univariable HRs for the composite outcome (time to cardiac mortality or heart failure rehospitalization). CRP indicates C‐reactive protein; eGFR, estimated glomerular filtration rate; E/e′, ratio of peak early mitral inflow velocity to velocity of mitral annulus early diastolic motion e′; HF, heart failure; HR, hazard ratio; LAVI, left atrial volume index; log NT‐proBNP, log‐transformed N‐terminal pro–B‐type natriuretic peptide; LVEDVI, left ventricular end‐diastolic volume index; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; PASP, pulmonary arterial systolic pressure; SBP, systolic blood pressure; SVI, stroke volume index; and TAPSE, tricuspid annular plane systolic excursion.
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