Clinical Investigation
Echocardiographic Markers of Outcome
Updated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization

https://doi.org/10.1016/j.echo.2019.06.006Get rights and content

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.

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.

Section snippets

Study Population

We designed a single-center, retrospective study and included 272 hospitalized patients with HF who underwent echocardiographic studies within 5 days of discharge. The study covered the period between January 2013 and October 2017. The exclusion criteria were as follows: patients who had undergone valve replacement (n = 22) and those with severe valvular disease (n = 4), pacemaker implantation (n = 6), active cancer (n = 4), and chronic obstructive pulmonary disease (n = 4). Following

Patient Characteristics

Table 1 shows patients' baseline characteristics at discharge. The 232 hospitalized patients with HF (mean age, 70 ± 14 years; 60% men) were divided into two groups: those with HFrEF (LVEF < 50%; n = 127) and those with HFpEF (LVEF ≥ 50%; n = 105). In the present study, we examined indices at admission and discharge.

Predictors for HF Readmission and Cardiac Mortality

Over a period of 24 months (range, 2 to 54 months), 49 patients with HFrEF and 37 with HFpEF reached the primary end point. Cardiac death occurred in nine patients with HFrEF and

Discussion

In the present study, we compared the association between the 2009 and 2016 recommendations for the assessment of elevated LAP. Specifically, we compared the prognostic value of the 2009 and 2016 DD grading recommendations. We found that elevated LAP by 2016 guidelines was independently associated with higher risk for readmission and cardiac death. Importantly, the 2016 recommendation had an incremental diagnostic value over several readmission risk scores. To the best of our knowledge, ours is

Conclusion

Elevated LAP at discharge was associated with readmission for HF and cardiac mortality. Thus, we believe that elevated LAP as determined by the 2016 algorithm can be useful for the assessment of readmission and cardiac mortality risk in patients with HFrEF and those with HFpEF. Combining this assessment of elevated LAP with one of several readmission risk sores can provide additional information in the management of patients with HF.

Acknowledgments

We thank Enago for English language review. We also acknowledge Kathryn Brock, BA, for editing the manuscript.

References (28)

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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).

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