Time-sensitive prognostic performance of an afterload-integrated diastolic index in heart failure with preserved ejection fraction: a prospective multicentre observational study

• Published in: BMJ open Vol. 12; no. 8; p. e059614
• Main Authors: Hoshida, Shiro, Hikoso, Shungo, Shinoda, Yukinori, Tachibana, Koichi, Minamisaka, Tomoko, Shunsuke, Tamaki, Yano, Masamichi, Hayashi, Takaharu, Nakagawa, Akito, Nakagawa, Yusuke, Yamada, Takahisa, Yasumura, Yoshio, Nakatani, Daisaku, Sakata, Yasushi, Tamaki, Shunsuke, Watanabe, Tetsuya, Higuchi, Yoshiharu, Masuda, Masaharu, Asai, Mitsutoshi, Mano, Toshiaki, Fuji, Hisakazu, Masuda, Daisaku, Takeda, Yoshihiro, Nagai, Yoshiyuki, Yamashita, Shizuya, Sairyo, Masami, Nozaki, Shuichi, Abe, Haruhiko, Ueda, Yasunori, Uematsu, Masaaki, Koretsune, Yukihiro, Nagai, Kunihiko, Nishino, Masami, Tanouchi, Jun, Arita, Yoh, Hasegawa, Shinji, Ishizu, Takamaru, Ichikawa, Minoru, Takano, Yuzuru, Rin, Eisai, Izumi, Masahiro, Yamamoto, Hiroyoshi, Kato, Hiroyasu, Nakatani, Kazuhiro, Yasuga, Yuji, Nishio, Mayu, Hirooka, Keiji, Yoshimura, Takahiro, Yasuoka, Yoshinori, Tani, Akihiro, Okumoto, Yasushi, Akagi, Hideharu, Makino, Yasunaka, Onishi, Toshinari, Iwakura, Katsuomi, Nishikawa, Nagahiro, Kijima, Yoshiyuki, Kitao, Takashi, Kanai, Hideyuki, Shioyama, Wataru, Fujita, Masashi, Harada, Koichiro, Kumada, Masahiro, Nakagawa, Osamu, Araki, Ryo, Yamada, Takayuki, Sato, Taiki, Sunaga, Akihiro, Oeun, Bolrathanak, Kida, Hirota, Kojima, Takayuki, Sotomi, Yohei, Dohi, Tomoharu, Nakamoto, Kei, Okada, Katsuki, Sera, Fusako, Suna, Shinichiro, Kioka, Hidetaka, Ohtani, Tomohito, Takeda, Toshihiro, Mizuno, Hiroya, Matsumura, Yasushi
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 01-08-2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Blood pressure; cardiac epidemiology; Cardiovascular disease; Data collection; echocardiography; Ejection fraction; Heart failure; Hypertension; Laboratories; Medical Management; Medical prognosis; Mortality; Observational studies; Patients; Survival analysis; Variables; Japan
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-059614

ObjectivesThe 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.SettingA prospective, multicentre observational registry of collaborating hospitals in Osaka, Japan.ParticipantsWe 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 measuresAll-cause mortality and/or re-admission for heart failure were evaluated after discharge.ResultsHigh 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.ConclusionsTime-sensitive prognostic performance of Ed/Ea, an afterload-integrated diastolic index, was observed in older patients with HFpEF.Trial registration numberUMIN000021831.