Prognostic Factors After Index Hospitalization for Heart Failure With Preserved Ejection Fraction

• Published in: The American journal of cardiology Vol. 119; no. 12; pp. 2017 - 2020
• Main Authors: Huang, Weiting, MRCP, Chai, Siang Chew, MRCP, Lee, Shao Guang Sheldon, MRCP, MacDonald, Michael R., FESC, Leong, Kui Toh Gerard, FRCP
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.06.2017; Elsevier Limited
• Subjects: Acquired immune deficiency syndrome; Age; Aged; AIDS; Aldosterone; Beta blockers; Body mass; Body mass index; Cardiology; Cardiovascular; Cause of Death; Circulation; Clinical trials; Comorbidity; Complications; Computer programs; Congestive heart failure; Coronary artery disease; Death; Deformation; Diabetes mellitus; Diagnosis; Eccentricity; Echocardiography; Ejection fraction; Electronic medical records; Ethnic factors; Female; Fibrillation; Follow-Up Studies; Heart Arrest - epidemiology; Heart Arrest - etiology; Heart failure; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Heart rate; Hemiplegia; Hospitalization; Hospitalization - trends; Hospitals; Humans; Immunodeficiency; Incidence; Kidney diseases; Leukemia; Liver; Liver diseases; Longitudinal studies; Lung diseases; Lymphoma; Male; Medical prognosis; Metastases; Morbidity; Mortality; Myocardium; Patients; Population studies; Prognosis; Quality; Regression analysis; Retrospective Studies; Singapore - epidemiology; Stroke Volume - physiology; Survival; Survival Rate - trends; Systole; Ventricle; Ventricular Function, Left - physiology; Body Mass Index; Heart Failure preserved Ejection Fraction; Obesity Paradox; Longitudinal strain; Prognosis; Charlson Comorbidity Index
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.03.032

Abstract Heart failure with preserved ejection fraction (HFpEF) has a high clinical burden and constitutes approximately 20-30% of heart failure patients in Asia. Impaired global longitudinal strain (GLS), defined as an absolute value of <15.8%, has been shown to be a predictor of heart failure hospitalization, cardiovascular death, and aborted cardiac arrest in HFpEF. We sought to validate this finding in our Asian cohort and identify other prognostic factors in HFpEF. In this cohort study, we included all patients with an index hospitalization for heart failure and left ventricular ejection fraction of more than 45%, between 1st January 2012 and 31st December 2012. All patients had follow-up for at least 3 years. In our study, the absolute value of mean GLS was impaired at 13.50±4.00%, while mean LVEF was 52.00±7.67%. In multivariate Cox regression, impaired GLS of absolute value <15.8% (hazard ratio 4.72, 95% CI 1.25-17.81, p=0.022), every unit increase in age-adjusted Charlson Comorbidity Index (hazard ratio 1.46, 95% CI 1.03-2.05, p=0.031) and low body mass index <18.5kg/m2 (hazard ratio 4.30, 95% CI 1.25-14.78, p=0.020) were associated with a shorter time to mortality over the three year period. Our study validates absolute GLS value of <15.8% to be a prognostic marker for HFpEF patients.