1. Time-sensitive prognostic performance of an afterload-integrated diastolic index in heart failure with preserved ejection fraction: a prospective multicentre observational study
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Shinichiro Suna, Shungo Hikoso, Takahisa Yamada, Masaaki Uematsu, Yoshio Yasumura, Akito Nakagawa, Toshihiro Takeda, Takayuki Kojima, Hirota Kida, Bolrathanak Oeun, Akihiro Sunaga, Tomoharu Dohi, Katsuki Okada, Hiroya Mizuno, Daisaku Nakatani, Yasushi Matsumura, Yasushi Sakata, Shunsuke Tamaki, Takaharu Hayashi, Yoshiharu Higuchi, Masaharu Masuda, Mitsutoshi Asai, Toshiaki Mano, Hisakazu Fuji, Daisaku Masuda, Yoshihiro Takeda, Yoshiyuki Nagai, Shizuya Yamashita, Masami Sairyo, Yusuke Nakagawa, Shuichi Nozaki, Haruhiko Abe, Yasunori Ueda, Yukihiro Koretsune, Kunihiko Nagai, Masamichi Yano, Masami Nishino, Jun Tanouchi, Yoh Arita, Shinji Hasegawa, Takamaru Ishizu, Minoru Ichikawa, Yuzuru Takano, Eisai Rin, Tetsuya Watanabe, Shiro Hoshida, Masahiro Izumi, Hiroyoshi Yamamoto, Hiroyasu Kato, Kazuhiro Nakatani, Mayu Nishio, Keiji Hirooka, Takahiro Yoshimura, Yoshinori Yasuoka, Akihiro Tani, Yasushi Okumoto, Hideharu Akagi, Yasunaka Makino, Katsuomi Iwakura, Nagahiro Nishikawa, Yoshiyuki Kijima, Takashi Kitao, Hideyuki Kanai, Wataru Shioyama, Masashi Fujita, Koichiro Harada, Masahiro Kumada, Osamu Nakagawa, Ryo Araki, Takayuki Yamada, Fusako Sera, Kei Nakamoto, Hidetaka Kioka, Tomohito Ohtani, Yukinori Shinoda, Koichi Tachibana, Tomoko Minamisaka, Yohei Sotomi, Taiki Sato, Yuji Yasuga, Toshinari Onishi, and Tamaki Shunsuke
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Medicine - Abstract
Objectives The prognostic significance of an afterload-integrated diastolic index, the ratio of diastolic elastance (Ed) to arterial elastance (Ea) (Ed/Ea=[E/e′]/[0.9×systolic blood pressure]), is valid for 1 year after discharge in older patients with heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the association with changes in Ed/Ea from enrolment to 1 year and prognosis thereafter in patients with HFpEF.Setting A prospective, multicentre observational registry of collaborating hospitals in Osaka, Japan.Participants We enrolled 659 patients with HFpEF hospitalised for acute decompensated heart failure (men/women: 296/363). Blood tests and transthoracic echocardiography were performed before discharge and at 1 year after.Primary outcome measures All-cause mortality and/or re-admission for heart failure were evaluated after discharge.Results High Ed/Ea assessed before discharge was a significant prognostic factor during the first, but not the second, year after discharge in all-cause mortality or all-cause mortality and/or re-admission for heart failure. When re-analysis was performed using the value of Ed/Ea at 1 year after discharge, high Ed/Ea was significant for the prognosis during the second year for both end points (p=0.012 and p=0.033, respectively). The poorest mortality during 1‒2 years after enrolment was observed in those who showed a worsening Ed/Ea during the first year associated with larger left ventricular mass index and reduced left ventricular ejection fraction. In all-cause mortality and/or re-admission for heart failure, the event rate during 1‒2 years was highest in those with persistently high Ed/Ea even after 1 year.Conclusions Time-sensitive prognostic performance of Ed/Ea, an afterload-integrated diastolic index, was observed in older patients with HFpEF.Trial registration number UMIN000021831.
- Published
- 2022
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