Abstract 11958: Predicting Heart Failure With Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes

Ho, Jennifer E.; Brouwers, Frank P.; Enserro, Danielle; Shah, Sanjiv J.; Psaty, Bruce M.; Bartz, Traci M.; Santhanakrishnan, Rajalakshmi; Lee, Douglas S.; Liu, Kiang; Blaha, Michael J.; Hillege, Hans L.; Harst, Pim van der; Gilst, Wiek H. van; Kop, Willem J.; Gansevoort, Ron T.; Vasan, Ramachandran S.; Gardin, Julius M.; Kizer, Jorge R.; Levy, Daniel; Gottdiener, John S.; Boer, Rudolf A. de; Larson, Martin G.

doi:10.1161/circ.132.suppl_3.11958

Cited by 50 publications

(86 citation statements)

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“…Each incident HF event was categorized as HFpEF (LVEF≥50%), HFrEF (LVEF<50%), or unclassified (no LV function assessment available at or around the time of HF event). 30…”

Section: Clinical Outcome Ascertainmentmentioning

confidence: 99%

Matrix Gla Protein Levels Are Associated With Arterial Stiffness and Incident Heart Failure With Preserved Ejection Fraction

Malhotra

Nicholson

Wang

et al. 2022

ATVB

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Objective: Arterial stiffness is a risk factor for cardiovascular disease, including heart failure with preserved ejection fraction. MGP (matrix Gla protein) is implicated in vascular calcification in animal models, and circulating levels of the uncarboxylated, inactive form of MGP (ucMGP) are associated with cardiovascular disease-related and all-cause mortality in human studies. However, the role of MGP in arterial stiffness is uncertain. Approach and Results: We examined the association of ucMGP levels with vascular calcification, arterial stiffness including carotid-femoral pulse wave velocity (PWV), and incident heart failure in community-dwelling adults from the Framingham Heart Study. To further investigate the link between MGP and arterial stiffness, we compared aortic PWV in age- and sex-matched young (4-month-old) and aged (10-month-old) wild-type and Mgp +/− mice. Among 7066 adults, we observed significant associations between higher levels of ucMGP and measures of arterial stiffness, including higher PWV and pulse pressure. Longitudinal analyses demonstrated an association between higher ucMGP levels and future increases in systolic blood pressure and incident heart failure with preserved ejection fraction. Aortic PWV was increased in older, but not young, female Mgp +/− mice compared with wild-type mice, and this augmentation in PWV was associated with increased aortic elastin fiber fragmentation and collagen accumulation. Conclusions: This translational study demonstrates an association between ucMGP levels and arterial stiffness and future heart failure with preserved ejection fraction in a large observational study, findings that are substantiated by experimental studies showing that mice with Mgp heterozygosity develop arterial stiffness. Taken together, these complementary study designs suggest a potential role of therapeutically targeting MGP in heart failure with preserved ejection fraction.

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“…Each incident HF event was categorized as HFpEF (LVEF≥50%), HFrEF (LVEF<50%), or unclassified (no LV function assessment available at or around the time of HF event). 30…”

Section: Clinical Outcome Ascertainmentmentioning

confidence: 99%

Matrix Gla Protein Levels Are Associated With Arterial Stiffness and Incident Heart Failure With Preserved Ejection Fraction

Malhotra

Nicholson

Wang

et al. 2022

ATVB

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“…Although risk factors for symptomatic HF are well described, 7 , 8 early mechanisms of HF pathogenesis that may differentially impact cardiac structure and function are yet to be fully elucidated. We therefore investigated risk factors associated with isolated and combined asymptomatic echocardiographic structural, systolic, and diastolic abnormalities that predict symptomatic HF to gain insight into early mechanisms of the pathogenesis of symptomatic HF.…”

Section: Discussionmentioning

confidence: 99%

“… 24 , 25 , 26 However, the associations of increased BMI, increased waist circumference, and increased TG level with lower risk of isolated diastolic abnormality were in contrast to the association of increased BMI with E/e′ ratio, 26 , 27 and the prediction of HFpEF by BMI. 7 , 8 , 28 The predominant echocardiographic criterion for diastolic abnormality in the SCREEN‐HF cohort was increased LAVI in ~50% of participants, with reduced septal e′ and increased septal E/e′ ratio in <10% of participants. 5 We previously showed that BMI was associated with lower LAVI and lower e′ in univariate, but not multivariable, analyses of the SCREEN‐HF cohort, whereas BMI was associated with higher E/e′ ratio in both univariate and multivariable analyses.…”

Section: Discussionmentioning

confidence: 99%

“…This includes delineating the role of hypertension, diabetes, smoking, and serum cholesterol in the pathogenesis of ischaemic heart disease. 6 Many risk factors for incident symptomatic HF have been identified, 7 , 8 and we previously identified key differences between risk factors for incident symptomatic HF with reduced (HFrEF) and preserved ejection fraction (HFpEF), and valvular HF in the SCReening Evaluation of the Evolution of New HF (SCREEN‐HF) Study cohort, a community‐based evaluation of the use of serum amino‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) to identify individuals with cardiac dysfunction (as assessed by echocardiography) and increased risk of symptomatic HF and other CVD events. 5 , 8 , 9 , 10 Asymptomatic echocardiographic structural, systolic, and diastolic abnormalities that predict symptomatic HF represent an early stage in the evolution of symptomatic HF.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure

et al. 2021

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Aims Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure (HF) may provide insight into early mechanisms of HF pathogenesis. We examined risk factors associated with asymptomatic echocardiographic structural, systolic, and diastolic abnormalities, separately and in combination, and interactions between risk factors, in the prospective community‐based SCReening Evaluation of the Evolution of New HF (SCREEN‐HF) Study cohort of 3190 participants at increased risk of cardiovascular disease. Methods and results Inclusion criteria were age ≥ 60 years with one or more of hypertension, diabetes, ischaemic heart disease, valvular heart disease, abnormal heart rhythm, cerebrovascular disease, or renal impairment. Exclusion criteria were known HF, ejection fraction < 50%, or >mild valve abnormality. Structural, systolic, and diastolic echocardiographic abnormalities were defined according to the Atherosclerosis Risk in Communities study criteria, and risk factors for asymptomatic structural, systolic, and diastolic abnormalities were identified using logistic regression analysis. In multivariable analysis, increased body mass index (BMI), non‐steroidal anti‐inflammatory drug therapy, and alcohol intake were risk factors for isolated structural abnormality, whereas male gender, increased heart rate, atrial fibrillation (AF), angiotensin‐converting enzyme inhibitor therapy, and obstructive sleep apnoea were associated with a lower risk. Moreover, male gender, smoking, increased systolic blood pressure, and physical inactivity were risk factors for isolated systolic abnormality, whereas increased pulse pressure and antihypertensive therapy were associated with a lower risk. Furthermore, increased age, blood pressure, amino‐terminal pro‐B‐type natriuretic peptide level, and warfarin therapy (associated with AF) were risk factors for isolated diastolic abnormality, whereas increased heart rate and triglyceride level (associated with BMI) were associated with a lower risk. The association of increased heart rate with lower risk of structural and diastolic abnormalities was independent of β‐blocker therapy. Interactions between risk factors differed for structural, systolic, and diastolic abnormalities. Conclusions The different risk factors for asymptomatic structural, systolic, and diastolic abnormalities that predict symptomatic HF, and the interactions between risk factors, illustrate how these structural, systolic, and diastolic abnormalities represent unique trajectories that lead to symptomatic HF. Improved understanding of these trajectories may assist in the design of HF prevention strategies.

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“…Sex difference is a well-established issue in a heart failure (HF) setting [ 1 , 2 ] as well as in the context of acute myocardial infarction [ 3 ]. Women with HF effectively show advanced age as compared to men, non-ischemic aetiology of HF, higher incidences of HF with preserved ejection fraction (HFpEF), and more symptomatic forms of HF [ 4 , 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in the Evaluation of Congestion Markers in Patients with Acute Heart Failure

Scicchitano¹,

Paolillo

Palo

et al. 2022

JCDD

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The impact of sex on the assessment of congestion in acute heart failure (AHF) is still a matter of debate. The objective of this analysis was to evaluate sex differences in the evaluation of congestion at admission in patients hospitalized for AHF. We consecutively enrolled 494 AHF patients (252 female). Clinical congestion assessment, B-type natriuretic peptide levels analysis, blood urea nitrogen to creatinine ratio (BUN/Cr), plasma volume status estimate (by means of Duarte or Kaplam-Hakim PVS), and hydration status evaluation through bioimpedance analysis were performed. There was no difference in medications between men and women. Women were older (79 ± 9 yrs vs. 77 ± 10 yrs, p = 0.005), and had higher left ventricular ejection fraction (45 ± 11% vs. 38 ± 11%, p < 0.001), and lower creatinine clearance (42 ± 25 mL/min vs. 47 ± 26 mL/min, p = 0.04). The prevalence of peripheral oedema, orthopnoea, and jugular venous distention were not significantly different between women and men. BUN/Cr (27 ± 9 vs. 23 ± 13, p = 0.04) and plasma volume were higher in women than men (Duarte PVS: 6.0 ± 1.5 dL/g vs. 5.1 ± 1.5 dL/g, p < 0.001; Kaplam–Hakim PVS: 7.9 ± 13% vs. −7.3 ± 12%, p < 0.001). At multivariate logistic regression analysis, female sex was independently associated with BUN/Cr and PVS. Female sex was independently associated with subclinical biomarkers of congestion such as BUN/Cr and PVS in patients with AHF. A sex-guided approach to the correct evaluation of patients with AHF might become the cornerstone for the correct management of these patients.

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Abstract 11958: Predicting Heart Failure With Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes

Cited by 50 publications

References 0 publications

Matrix Gla Protein Levels Are Associated With Arterial Stiffness and Incident Heart Failure With Preserved Ejection Fraction

Matrix Gla Protein Levels Are Associated With Arterial Stiffness and Incident Heart Failure With Preserved Ejection Fraction

Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure

Sex Differences in the Evaluation of Congestion Markers in Patients with Acute Heart Failure

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