Heart failure with preserved ejection fraction as an independent risk factor of mortality after cardiothoracic surgery

Background: The prognostic role of heart failure with preserved ejection fraction (HFpEF) remains unclear. This study aimed to assess HFpEF prognostic value after cardiothoracic surgery, adjusting for European System for Cardiac Operative Risk (EuroSCORE II) criteria. Methods: Patients with left ventricular ejection fraction (LVEF) >= 50% undergoing cardiothoracic surgery between 2012 and 2016 were included. Patients with HFpEF were compared to control patients with LVEF >= 50%. HFpEF was defined following 2016 European Society of Cardiology guidelines: LVEF >= 50%, symptomatic HF with New York Heart Association (NYHA) class 2 or greater, elevated brain natriuretic peptide (BNP) and relevant echocardiographic findings (LV hypertrophy, LA enlargement, or diastolic filling anomaly). The primary endpoint was in-hospital mortality, and the secondary endpoint was postoperative shock. Multivariate analyses were performed to determine mortality and shock risk-factors. Results: Among 1743 patients, 427 (24.5%) presented HFpEF. HFpEF was highly associated with in-hospital mortality (hazard ratio= 1.86; 95% confidence interval [CI], 1.16-2.98; P=.01). This association remained independent when adjusting for EuroSCORE II (adjusted hazard ratio= 1.6; 95% CI, 1.0-2.6; P=.049). Postoperative shock occurred more in HFpEF than in control patients (17.8% vs 6.7%; P<.001). HFpEF was an independent risk factor of postoperative shock (adjusted odds ratio= 2.9; 95% CI, 1.5-3.0; P<. 001). Conclusions: HFpEF was an independent risk-factor of mortality and postoperative shock after cardiothoracic surgery, after adjustment regarding EuroSCORE II.