Journal of the American Society of Echocardiography
Clinical InvestigationEchocardiographic Markers of OutcomeUpdated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization
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.
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2021, Heart Failure ClinicsCitation Excerpt :Two schemes are presented, one for diagnosing DD when LV ejection fraction is normal and no cardiac disease is suspected, the other to diagnose DD and estimate LV filling pressures (LA pressure) in patients with depressed or preserved LV ejection fraction and concurrent cardiac disease (Fig. 2). In HFpEF, the algorithm has subsequently been proven useful for estimating the risk of hospitalizations and cardiac mortality.37 One challenge with the diastolic grading algorithm is that it places some patients in the category of indeterminate LA pressure.34
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2021, Journal of the American Society of EchocardiographyCitation Excerpt :Although there were no differences in heart rate (75 ± 17 vs 75 ± 17 beats/min, P = .395), systolic blood pressure (112 ± 22 vs 113 ± 22 mm Hg, P = .898), diastolic blood pressure (66 ± 15 vs 67 ± 14 mm Hg, P = .317), and body weight (62 ± 14 vs 61 ± 14 kg, P = .186) between echocardiography and right heart catheterization in the derivation cohort, the possibility of hemodynamic changes could not be completely excluded. Fourth, Doppler parameters were obtained from an index beat in which preceding pre-preceding R-R intervals were similar in patients with AF according to a previous investigation,13 which might have weakened the diagnostic accuracy of Doppler parameters in AF patients. Fifth, we classified four patients showing monomorphic LV inflow due to sinus tachycardia as having indeterminate LVFP by the guidelines because of unavailability of the E/A ratio.
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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).