Combining diastolic dysfunction and natriuretic peptides to risk stratify patients with heart failure with reduced ejection fraction. (15th July 2021)

• Record Type: Journal Article
• Authors: Gori, Mauro; Claggett, Brian; Senni, Michele; Shah, Amil M.; Goldenberg, Ilan; Kutyifa, Valentina; Knappe, Dorit; Pouleur, Ann-Catherine; Solomon, Scott D.
• Is Part Of: International journal of cardiology. Volume 335(2021)
• Page Start: 59
• Page End: 65
• Publication Date: 2021-07-15
• Subjects: Diastolic dysfunction -- Natriuretic peptides -- HFrEF; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.04.028
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Diastolic dysfunction (DD) might help to risk stratify patients with heart failure (HF) with reduced ejection fraction (HFrEF). Nonetheless, HF guidelines/risk scores don't consider DD. We aimed to show the independent prognostic value of DD for nonfatal HF/death in patients with HFrEF on top of natriuretic peptides (NP). Methods: We analyzed 1155 baseline echocardiograms of the MADIT-CRT study (LVEF≤30%, QRS ≥ 130 ms, NYHA class I/II), classifying DD according to 2016 ASE/EACVI classification. Results: Patients were 64 ± 11 years-old, 24% females, LVEF was 24 ± 5%, 58% had abnormal BNP (≥100 pg/ml). While 45% had impaired relaxation, 33% had pseudonormal filling, 12% restrictive pattern, 6% indeterminate diastolic function, 4% were not classifiable due to missing data. During a follow-up of 2.1 ± 1.0 years, there were 233 HF/death. Compared to patients without pseudonormal/restrictive filling and with normal NP (23%), patients with pseudonormal/restrictive filling, alone (15%) or combined to elevated NP (30%), were at higher risk of events (respectively padj = 0.025 and padj < 0.001), as opposed to those with abnormal NP alone (22%; padj = 0.55). Adding DD to conventional markers of risk and NP improved prediction (C-statistic 0.733 versus 0.708, p = 0.024). DD was the first parameter to be considered to risk stratify MADIT-CRT population, according to Classification-And-Regression-Tree analysis. Conclusions: Among HFrEF patients with mild symptoms, pseudonormal/restrictive filling, either alone or combined with elevated NP, was associated with high risk of events, as opposed to isolated elevation of NP. DD provided incremental risk prediction for death/HF beyond commonly used markers. These data might suggest to integrate DD into HF guidelines/risk scores. Highlights: We assessed the independent prognostic value of diastolic dysfunction (DD) for nonfatal HF/death in patients with HFrEF DD, either alone or combined with elevated NP, was associated with high risk of events, as opposed to isolated NP elevation DD provides incremental risk prediction for death/HF beyond commonly used markers. These data might suggest to integrate DD into HF guidelines/risk scores