Comparison of 5-Year Outcomes After Coronary Artery Bypass Grafting in Heart Failure Patients With Versus Without Preserved Left Ventricular Ejection Fraction (from the CREDO-Kyoto CABG Registry Cohort-2)

Marui, Akira; Nishiwaki, Noboru; Komiya, Tatsuhiko; Hanyu, Michiya; Tanaka, Shiro; Kimura, Takeshi; Sakata, Ryuzo

doi:10.1016/j.amjcard.2015.05.020

Cited by 26 publications

(23 citation statements)

References 22 publications

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“…Notably, the better prognosis of HFpEF observed in the current study is likely in part caused by a higher proportion of the HFpEF group having previous PCIs than the HFrEF group. In a small study of patients with HFpEF with CAD, those who underwent CABG had similar short‐term mortality but better long‐term survival than those who underwent PCI 12. This study and ours support the importance of timely revascularization in women with HFpEF.…”

Section: Discussionsupporting

confidence: 73%

“…Similar to a recent Swedish population‐based study,11 our research found the adjusted mortality risk to be higher in HFpEF than in rEF without HF and higher in HFrEF than HFpEF. On the contrary, a small Japanese study found no difference in 5‐year survival post‐CABG in patients with HFpEF and HFrEF 12. This discrepancy is likely attributable to regional and ethnic differences in HF risk factors and outcomes, as well as possible increased awareness of the HFpEF syndrome in Japan.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, population‐based reports suggest that HFpEF can be associated with CAD and is more prevalent in elderly women with a history of hypertension or diabetes mellitus 10. Despite the importance of HFpEF,11, 12 its epidemiology has not been elucidated in the diverse ethnic mix of surgical patients in North America, nor have sex‐stratified analyses of long‐term outcomes of patients with HFpEF who have undergone CABG ever been performed. We investigated the prevalence and prognosis of HFpEF and HFrEF in men and women who underwent CABG in Ontario, Canada, from 2008 to 2015.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Sun

Eddeen

2018

JAHA

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BackgroundHeart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting.Methods and ResultsWe conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population‐based database of all Ontarians with physician‐diagnosed HF. We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all‐cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan–Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age‐standardized HFpEF mortality rates at 4±2 years of follow‐up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men.ConclusionsWe found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow‐up should be focused on women and men with HF rather than on rEF alone.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Sun

Eddeen

2018

JAHA

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“…The syndrome can be further dichotomized by its dysfunction into diastolic HF with preserved ejection fraction and systolic HF with reduced ejection fraction 1. In addition, HF is associated with increased (i) rates of hospital readmission, (ii) prolonged length of stay, and (iii) significant mortality reaching 50% within 3–5 years of diagnosis 2. Still, despite our current level of understanding of the pathophysiology of HF, we are left questioning why seemingly similar patients may have drastically different prognoses following intervention.…”

Section: Introductionmentioning

confidence: 99%

Recovery free of heart failure after acute coronary syndrome and coronary revascularization

et al. 2017

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AimsPrevious studies have examined risk factors for the development of heart failure (HF) subsequent to acute coronary syndrome (ACS). Our study seeks to clarify the clinical variables that best characterize patients who remain free from HF after coronary artery bypass grafting (CABG) surgery for ACS to determine novel biological factors favouring freedom from HF in prospective translational studies.Methods and resultsNova Scotia residents (1995–2012) undergoing CABG within 3 weeks of ACS were included. The primary outcome was freedom from readmission to hospital due to HF. Descriptive statistics were generated, and a Cox proportional hazards model assessed outcome with adjustment for clinical characteristics. Of 11 936 Nova Scotians who underwent isolated CABG, 3264 (27%) had a recent ACS and were included. Deaths occurred in 210 (6%) of subjects prior to discharge. A total of 3054 patients were included in the long‐term analysis. During follow‐up, HF necessitating readmission occurred in 688 (21%) subjects with a hazard ratio of 12% at 2 years. The adjusted Cox model demonstrated significantly better freedom from HF for younger, male subjects without metabolic syndrome and no history of chronic obstructive pulmonary disease, renal insufficiency, atrial fibrillation, or HF.ConclusionsOur findings have outlined important clinical variables that predict freedom from HF. Furthermore, we have shown that 12% of patients undergoing CABG after ACS develop HF (2 years). Our findings support our next phase in which we plan to prospectively collect blood and tissue specimens from ACS patients undergoing CABG in order to determine novel biological mechanism(s) that favour resolution of post‐ACS inflammation.

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“…HFpEF was defined as an EF 50%. 15) Left atrial diameter was evaluated from long and short axes of the apical four-chamber view. Peak velocities of early (E) and late (A) filling from the mitral valve Doppler echocardiography were evaluated, and we calculated the E/A ratio.…”

Section: )mentioning

confidence: 99%

Effect of Switching from Cilnidipine to Azelnidipine on Cardiac Sympathetic Nerve Function in Patients with Heart Failure Preserved Ejection Fraction

et al. 2018

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SummaryCardiac sympathetic nerve activity is known to play a key role in the development and progression of heart failure (HF). Azelnidipine, an L-type calcium channel blocker (CCB), inhibits the sympathetic nerve activity of the central system. In contrast, cilnidipine, an N-type CCB, inhibits the sympathetic nerve activity of the peripheral system. CCBs are recommended as class IIa in patients with HF preserved ejection fraction (HFpEF); however, there are no comparative data on the difference in effect of cilnidipine and azelnidipine in patients with HFpEF and hypertension. We investigated the difference in effect of azelnidipine compared with cilnidipine in patients with HFpEF. Twenty-four consecutive HF patients who received angiotensin II type1a receptor blocker and beta blocker from April 2013 to January 2015 were enrolled. Cilnidipine was switched to azelnidipine during the follow-up period. Blood pressures, heart rate, blood tests, echocardiography, and 123 Imetaiodobenzylguanidine (MIBG) cardiac-scintigraphy were measured before and after 6 months from azelnidipine administration. B-type natriuretic peptide tended to decrease after switching to azelnidipine; however, there were no significant differences between the pre-state and post-state (pre-state: 118.5 pg/mL and post-state: 78.4 pg/mL, P = 0.137). Other laboratory findings, including catecholamine, also did not change significantly. In echocardiography, there were no significant differences in systolic and diastolic functions at the pre-state and post-state. As for MIBG, there were no significant changes in heart/mediastinum ratio. However, washout rate was significantly reduced (pre-state: 42.9 and post-state: 39.6, P = 0.030). Azelnidipine improved the dysfunction of cardiac sympathetic nerve activity compared with cilnidipine in patients with HFpEF.(Int Heart J 2018; 59: 120-125)

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Comparison of 5-Year Outcomes After Coronary Artery Bypass Grafting in Heart Failure Patients With Versus Without Preserved Left Ventricular Ejection Fraction (from the CREDO-Kyoto CABG Registry Cohort-2)

Cited by 26 publications

References 22 publications

Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Recovery free of heart failure after acute coronary syndrome and coronary revascularization

Effect of Switching from Cilnidipine to Azelnidipine on Cardiac Sympathetic Nerve Function in Patients with Heart Failure Preserved Ejection Fraction

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