Dynamic Trajectories of Left Ventricular Ejection Fraction in Heart Failure

Lupón, Josep; Gavidia-Bovadilla, Giovana; Ferrer, Elena; Antonio, Marta de; Perera-Lluna, Alexandre; López-Ayerbe, Jorge; Domingo, Mar; Núñez, Julio; Zamora, Elisabet; Moliner, Pedro; Díaz-Ruata, Patricia; Santesmases, Javier; Bayés‐Genís, Antoni

doi:10.1016/j.jacc.2018.05.042

Cited by 146 publications

(184 citation statements)

References 18 publications

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“…This finding is consistent with previous AHF registry data, with evidence that reduced LVEF is a powerful predictor of CV outcomes in post‐myocardial infarction patients and with recent evidence that the association between ischaemic status and new ischaemic or HF events was greater in patients with lower LVEF . The stronger association between LVEF and risk of future CV events in patients with ischaemic heart disease vs. those with non‐ischaemic aetiologies might be related to disease in other organs that ultimately influenced outcomes or to a lower likelihood of improvement of LVEF over time as some patients with an ischaemic aetiology experience less remodelling compared to those with a non‐ischaemic aetiology of HF …”

Section: Discussionsupporting

confidence: 91%

Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial

Janwanishstaporn

Feng

Teerlink

et al. 2020

European J of Heart Fail

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Aims Although left ventricular ejection fraction (LVEF) is routinely used to categorize patients with heart failure (HF), whether it predicts outcomes after hospitalization for acute heart failure (AHF) is uncertain. Consequently, we assessed the relationship between LVEF and cardiovascular (CV) outcomes in a large, well characterized cohort of patients hospitalized for AHF. Methods and results The 6128 patients from the RELAX‐AHF‐2 trial who had LVEF measured during AHF hospitalization were separated into LVEF quartiles and the relationship between LVEF and a composite of CV mortality and rehospitalization for HF or renal failure through 180 days was assessed. We found progressively lower risk for this composite outcome as LVEF increased (hazard ratio 0.95, 95% confidence interval 0.93–0.98 per 5% LVEF increase, P < 0.001) that was driven predominantly by decreased risk for rehospitalization. The smoothed spline curve depicting risk remained stable as LVEF decreased until reaching approximately 40%, at which point risk increased progressively with further reductions in LVEF. Significant differences between LVEF quartiles for post‐discharge CV risk were seen in patients with an ischaemic aetiology or with a history of HF preceding index hospitalization, but were less robust in patients with non‐ischaemic aetiology and absent in those with de novo HF. Conclusion In patients hospitalized with AHF, CV events over 180 days were more frequent in patients with lower LVEF. This was due predominantly to a significant increase in risk for HF/renal failure rehospitalization but not in either CV or all‐cause mortality. LVEF had greater prognostic value in patients with ischaemic aetiology or pre‐existing HF.

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Section: Discussionsupporting

confidence: 91%

Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial

Janwanishstaporn

Feng

Teerlink

et al. 2020

European J of Heart Fail

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“…Multiple seminal heart failure studies have reported that low baseline LVEF is significantly associated with a greater increase in LVEF over time. [21][22][23][24][25] Several prior published studies in cardio-oncology support our observations. In the Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast) trial, for example, a negative relationship was observed between baseline LVEF and change in LVEF.…”

Section: Discussionsupporting

confidence: 88%

Detailed phenotyping reveals distinct trajectories of cardiovascular function and symptoms with exposure to modern breast cancer therapy

Demissei

Finkelman

Hubbard

et al. 2019

Cancer

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Background Breast cancer therapies are associated with a risk of cardiac dysfunction, most commonly defined by changes in left ventricular ejection fraction (LVEF). Recently, the authors identified 3 classes of LVEF change after exposure to anthracyclines and/or trastuzumab using latent class growth modeling. The objective of the current study was to characterize the clinical, biochemical, and functional profiles associated with LVEF trajectory class membership. Methods Transthoracic echocardiography and biomarker assessments were performed and questionnaires were administered at standardized intervals in a longitudinal cohort of 314 patients with breast cancer who were treated with anthracyclines and/or trastuzumab. Univariable and multivariable multinomial regression analyses evaluated associations between baseline variables and LVEF trajectory class membership. Generalized estimating equations were used to define mean changes in cardiovascular measures over time within each class. Results Among the 3 distinct subgroups of LVEF changes identified (stable [class 1]; modest, persistent decline [class 2]; and significant early decline followed by partial recovery [class 3]), higher baseline LVEF, radiotherapy, and sequential therapy with anthracyclines and/or trastuzumab were associated with class 2 or 3 membership. Sustained abnormalities in longitudinal strain and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) were observed in patients in class 2, as were heart failure symptoms. Similar abnormalities were observed in patients in class 3, but there was a trend toward recovery, particularly for longitudinal strain. Conclusions Patients with modest, persistent LVEF declines experienced sustained abnormalities in imaging and biochemical markers of cardiac function and heart failure symptoms. Further investigation is needed to characterize the long‐term risk of heart failure, particularly in those with modest LVEF declines.

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“…Patients were referred to the HF clinic mostly by the cardiology or internal medicine departments, and to a lesser extent by the emergency or other hospital departments. The criteria for referral to the HF clinic were HF with at least one hospitalization and/or depressed systolic function . All patients were seen regularly for follow‐up visits at the HF clinic according to their clinical needs and treated according to a unified protocol.…”

Section: Methodsmentioning

confidence: 99%

“…The criteria for referral to the HF clinic were HF with at least one hospitalization and/or depressed systolic function. 9,10 All patients were seen regularly for follow-up visits at the HF clinic according to their clinical needs and treated according to a unified protocol. Follow-up visits included a minimum of one visit with a nurse every 3 months and one visit with a physician (cardiologist, internist, or family physician) every 6 months, as well as optional visits with specialists in geriatrics, psychiatry, and rehabilitation.…”

Section: Study Population and Outcomesmentioning

confidence: 99%

“…Follow-up visits included a minimum of one visit with a nurse every 3 months and one visit with a physician (cardiologist, internist, or family physician) every 6 months, as well as optional visits with specialists in geriatrics, psychiatry, and rehabilitation. 9,10 Modes of death were classified as progression of HF (worsening HF or treatment-resistant HF in the absence of another cause), sudden death (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death), acute myocardial infarction, stroke, procedural (post-diagnostic or post-therapeutic), other CV causes (e.g. rupture of an aneurysm, peripheral ischaemia, or aortic dissection), or non-CV.…”

Section: Study Population and Outcomesmentioning

confidence: 99%

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Trends in modes of death in heart failure over the last two decades: less sudden death but cancer deaths on the rise

Moliner

Lupón

Antonio

et al. 2019

European J of Heart Fail

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AimsBetter management of heart failure (HF) over the past two decades has improved survival, mainly by reducing the incidence of death due to cardiovascular (CV) causes. Deaths due to non-CV causes, particularly cancer, may be increasing. This study explored the modes of death of consecutive patients who attended a HF clinic over A total of 935 deaths were ascertained from 2002 to 2018 among 1876 patients (mean age 65.8 ± 12.5 years, 75% men, left ventricular ejection fraction < 50%) admitted to our HF clinic. Median follow-up was 4.2 years [1.9-7.8].Mode of death was curated from patient health records and verified by the Catalan and Spanish health system databases. Trends for every mode of death were assessed by polynomial regression. Two trends were observed: a significant reduction in sudden death (P = 0.03) without changes in HF progression as mode of death (P = 0.26), and a significant increase in non-CV modes of death (P < 0.001). Non-CV deaths accounted for 17.4% of deaths in 2002 and 65.8% of deaths in 2018. A total 138 deaths were due to cancer (37% of non-CV deaths). A significant trend was observed towards a progressive increase in cancer deaths over time (P = 0.002).

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Dynamic Trajectories of Left Ventricular Ejection Fraction in Heart Failure

Abstract: LVEF trajectories vary in HF depending on a number of disease modifiers, but an inverted U-shaped pattern with lower LVEF at both ends of the distribution emerged. A declining LVEF in the preceding period was associated with higher mortality.

Cited by 146 publications

References 18 publications

Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial

Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial

Detailed phenotyping reveals distinct trajectories of cardiovascular function and symptoms with exposure to modern breast cancer therapy

Trends in modes of death in heart failure over the last two decades: less sudden death but cancer deaths on the rise

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