Coronary artery disease and 10‐year outcome after hospital admission for heart failure with preserved and with reduced ejection fraction

Ruşinaru, Dan; Houpe, D.; Szymanski, Catherine; Lévy, F.; Maréchaux, Sylvestre; Tribouilloy, Christophe

doi:10.1002/ejhf.142

Cited by 65 publications

(53 citation statements)

References 33 publications

(77 reference statements)

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“…Second, the study population was comprised of patients undergoing cardiac catheterization, which could bias our findings by over‐representation of ischemic phenotypes. We suggest that such bias is unlikely for the following 2 reasons: (1) Results were adjusted for an angiographically determined number of diseased coronary vessels as well as 9 other demographic and clinical risk factors; (2) and the prevalence of CAD in our HF cohorts (57% in HFpEF, 67% in HFrEF) was in alignment with epidemiological estimates 70, 71, 72…”

Section: Discussionmentioning

confidence: 94%

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Hunter

Kelly

McGarrah

et al. 2016

JAHA

186

137

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BackgroundMetabolic impairment is an important contributor to heart failure (HF) pathogenesis and progression. Dysregulated metabolic pathways remain poorly characterized in patients with HF and preserved ejection fraction (HFpEF). We sought to determine metabolic abnormalities in HFpEF and identify pathways differentially altered in HFpEF versus HF with reduced ejection fraction (HFrEF).Methods and ResultsWe identified HFpEF cases, HFrEF controls, and no‐HF controls from the CATHGEN study of sequential patients undergoing cardiac catheterization. HFpEF cases (N=282) were defined by left ventricular ejection fraction (LVEF) ≥45%, diastolic dysfunction grade ≥1, and history of HF; HFrEF controls (N=279) were defined similarly, except for having LVEF <45%. No‐HF controls (N=191) had LVEF ≥45%, normal diastolic function, and no HF diagnosis. Targeted mass spectrometry and enzymatic assays were used to quantify 63 metabolites in fasting plasma. Principal components analysis reduced the 63 metabolites to uncorrelated factors, which were compared across groups using ANCOVA. In basic and fully adjusted models, long‐chain acylcarnitine factor levels differed significantly across groups (P<0.0001) and were greater in HFrEF than HFpEF (P=0.0004), both of which were greater than no‐HF controls. We confirmed these findings in sensitivity analyses using stricter inclusion criteria, alternative LVEF thresholds, and adjustment for insulin resistance.ConclusionsWe identified novel circulating metabolites reflecting impaired or dysregulated fatty acid oxidation that are independently associated with HF and differentially elevated in HFpEF and HFrEF. These results elucidate a specific metabolic pathway in HF and suggest a shared metabolic mechanism in HF along the LVEF spectrum.

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Section: Discussionmentioning

confidence: 94%

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Hunter

Kelly

McGarrah

et al. 2016

JAHA

186

137

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“…Not surprisingly, patients with HFpEF and CAD experience a greater deterioration of LV function and a worse prognosis than patients with only HFpEF 198, 201, 202, 203. However, a fatal outcome does not appear to be related to the presence of CAD in patients hospitalized for a first episode of HFpEF decompensation 203. Patients with HFpEF and angina are at a significantly greater risk of myocardial infarction, coronary revascularization, stroke, and death than HFpEF patients without angina 201.…”

Section: Cad Phenotypementioning

confidence: 98%

“…In contrast, the prevalence of myocardial ischemia is less than 4% in a multiethnic population of patients presenting with shortness of breath and without wall motion abnormalities 200. Not surprisingly, patients with HFpEF and CAD experience a greater deterioration of LV function and a worse prognosis than patients with only HFpEF 198, 201, 202, 203. However, a fatal outcome does not appear to be related to the presence of CAD in patients hospitalized for a first episode of HFpEF decompensation 203.…”

Section: Cad Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

102

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“…3,4 The reasons behind these conflicting results are not clear but small sample sizes, heterogeneous patient cohorts, and differences in the variables used to adjust survival may all contribute. In this study, patients with CAD, irrespective of angina, had higher risk of death than those without CAD or angina, even after extensive adjustment for other prognostic variables, including NT-proBNP.…”

Section: Relationship Between Cad Angina and Mortalitymentioning

confidence: 99%

“…2 However, these findings contradict those of a Framingham cohort analysis and a multicenter, prospective European study where in both there was no difference in mortality between HF-PEF patients with and without CAD. 3,4 Even less is known about the relationship between CAD and modes of cardiovascular mortality, such as sudden death, which to our knowledge has only been examined in a handful of previous studies.…”

mentioning

confidence: 99%

Clinical Characteristics and Outcomes of Patients With Coronary Artery Disease and Angina

Badar

Moreno

Hawkins

et al. 2015

Circ: Heart Failure

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Background— The aim of our study was to investigate the relationship between coronary artery disease (CAD), angina, and clinical outcomes in patients with heart failure and preserved ejection fraction enrolled in the irbesartan in patients with heart failure and preserved systolic function (I-Preserve) trial. Methods and Results— The mean follow-up period for the 4128 patients enrolled in I-Preserve was 49.5 months. Patients were divided into 4 mutually exclusive groups according to history of CAD and angina: patients with no history of CAD or angina (n=2008), patients with no history of CAD but a history of angina (n=649), patients with a history of CAD but no angina (n=468), and patients with a history of CAD and angina (n=1003); patients with no known CAD or angina were the reference group. After adjustment for other prognostic variables using Cox proportional-hazard models, patients with CAD but no angina were found to be at higher risk of all-cause mortality (hazard ratio [HR], 1.58 [1.22–2.04]; P <0.01) and sudden death (HR, 2.12 [1.33–3.39]; P <0.01), compared with patients with no CAD or angina. Patients with CAD and angina were also at higher risk of all-cause mortality (HR, 1.29 [1.05–1.59]; P =0.02) and sudden death (HR, 1.83 [1.24–2.69]; P <0.01) compared with the same reference group and had the highest risk of unstable angina or myocardial infarction (HR, 5.84 [3.43–9.95]; P <0.01). Conclusions— Patients with heart failure and preserved ejection fraction and CAD are at higher risk of all-cause mortality and sudden death when compared with those without CAD. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00095238.

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Coronary artery disease and 10‐year outcome after hospital admission for heart failure with preserved and with reduced ejection fraction

Cited by 65 publications

References 33 publications

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Clinical Characteristics and Outcomes of Patients With Coronary Artery Disease and Angina

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