Heart Failure with Normal Systolic Function: Better or Worse Prognosis? Maria Rosa Costanzo, M.D., F.A.C.C, F.A.H.A. Medical Director, Midwest Heart Specialists Heart Failure and Pulmonary Arterial Hypertension Programs Medical Director, Edward Hospital Center for Advanced Heart Failure Naperville, Illinois, U.S.A.
23
Embed
Heart Failure with Normal Systolic Function: Better or Worse Prognosis? Maria Rosa Costanzo, M.D., F.A.C.C, F.A.H.A. Medical Director, Midwest Heart Specialists.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Heart Failure with Normal Systolic Function: Better or Worse Prognosis?
Maria Rosa Costanzo, M.D., F.A.C.C, F.A.H.A.Medical Director, Midwest Heart Specialists Heart Failure and
Pulmonary Arterial Hypertension ProgramsMedical Director, Edward Hospital Center for
Survival of Patients with HFNEF and HFREF by CauseHFNEF
HFREF
Tribouilloy C et al. EHJ 2008;29:339-47
Survival Curves by Etiology of HF with Normal EF
Impact of EF on Outcomes after PCI in HF Patients-NHLBI PTCA Registry
Holper EM et al. AHJ 2006; 151: 69-75
Kaplan–Meier Analysis of the Probability of Survival among 3166 Patients with a Recent AMI Divided by No In-Hospital CHF, HFNEF (CHF+WMI>1.3), and HFREF (CHF+WMI<1.3), and Stratified According to Age.
Møller J E et al. EJHF 2003;5:811-9
*No CHF vs. HFNEF p= 0.00001 No CHF vs. HFREF p= 0.00001
Prognostic Importance of Pulmonary Hypertension in Patients with HF
Kjaergaard J et al. AJC 2007; 99: 1146-50
69%
53%
66%
40%
22%
10%
16%
6%
47%
51%
42%
17%17%
4%7% 5%
4%2%2% 0%
0%
10%
20%
30%
40%
50%
60%
70%
6 mo readmand mort.
6 mo mort. 2 mo readm.and mort.
2 mo mort. Hosp. Mort.
Outcomes by Presence or Absence of IVCD
HFREF+IVCD
HFREF-IVCD
HFPEF+IVCD
HFPEF-IVCD
Danciu Sc et al. AJC 2006; 97: 256-9
Racial Differences in the O utcomes of Patients with Diastolic HF
CAD
NO CAD
white
AA
white
AA
P = 0.488
P = 0.002
East MA et al. AHJ 2004; 148: 151-6
56%
38%
26% 25%
17% 19%
25%
0%
10%
20%
30%
40%
50%
60%
< 20 20-25 26-30 31-35 36-40 41-45 > 45
BMI
Obesity and Survival in HFPEF
Su
rviv
al
Kapoor JR et al. AHJ 2010; 159: 75-80
Anemia and Survival in Patients with Reduced and Normal EF
Felker MG et al. AHJ 2006; 151: 457-62
Risk of Different Outcomes Associated with Diabetes in HFREF and HFNEF
MacDonald M R et al. EHJ 2008;29:1377-85
Effect of Severe Autonomic Failure on Outcomes after MI in Patients with Normal LVEF
Bauer A et al. EHJ 2009; 30:576-83
Severe autonomic failure (SAF): combination of severely impaired baroreflex function
with abnormal autonomic tone,assessed by Heart Rate Turbulence (HRT) and cardiac Deceleration Capacity (DC).
BNP Predicts Medium-Term Risk in Patients with Acute HF and Normal EF
Treatments and Performance Measures Applied at Discharge
LVSD
PSF
%
P < 0.0001
P < 0.0001
P < 0.0001
P < 0.0001
P < 0.0001
P = 0.0003
P < 0.004
P < 0.0009
Fonarow GC et al. JACC2007; 50: 767-77
Massie B et al. N Engl J Med 2008;359:2456-2467
Effects of Ibersartan in Patients with HFNEF
0
5
10
15
20
25
30
35
40
<21 21-30 31-40 >40
Hospitalizations before and after BB, by EF
HF Hosp. prior yr
HF Hosp. 1 yr f/u
EF
% o
f P
atie
nts
* **
*
* P = 0.001 vs. prior year
Massie BM et al. AJC 2007; 99: 1263-8
Dobre D et al. EJHF 2007;9:280-6
Variable N (%) Adjusted HR
95% CI P value
BB 227(51) 0.57 0.37-0.88 0.01
GFR ≤ 40 ml/min
247(56) 2.14 1.37-3.34 0.001
COPD 126(28) 1.60 1.04-2.45 0.03
Male sex 197(44) 1.48 1.00-2.19 0.05
Digoxin 98(22) 1.58 1.006-2.47 0.05
Variable N(%) Adjusted HR
95% Ci P value
BB Low Dose 93(41) 0.74 0.45-1.21 0.2
BB High Dose 134(59) 0.51 0.30-0.86 0.01
Effect of Beta Blockers on Survival in Patients with Advanced HF and Normal EF
Conclusions
The prevalence of HFNEF is increasingHospitalizations for ADHF in patients with HFNEF are increasingThe outcomes of HFNEF and HFREF are similarThe outcomes of patients with HFNEF are determined by the presence and severity of comorbiditiesWith the exception of BB, other therapies which improve the outcomes of patients with HFREF do not significantly alter morbidity and mortality of patients with HFNEF