Association between cardiovascular vs. non-cardiovascular co-morbidities and outcomes in heart failure with preserved ejection fraction

被引:122
作者
Lund, Lars H. [1 ,2 ]
Donal, Erwan [3 ,4 ,5 ]
Oger, Emmanuel [6 ]
Hage, Camilla [1 ,2 ]
Persson, Hans [7 ,8 ]
Haugen-Lofman, Ida [1 ,2 ]
Ennezat, Pierre-Vladimir [9 ]
Sportouch-Dukhan, Catherine [10 ]
Drouet, Elodie [11 ]
Daubert, Jean-Claude [3 ,4 ,5 ]
Linde, Cecilia [1 ,2 ]
机构
[1] Karolinska Inst, Dept Med, Stockholm, Sweden
[2] Karolinska Univ Hosp, Dept Cardiol, S-17176 Stockholm, Sweden
[3] Ctr Hosp Univ Rennes, Dept Cardiol, Rennes, France
[4] Ctr Hosp Univ Rennes, CIC IT U 804, Rennes, France
[5] Univ Rennes 1, INSERM, LTSI, F-1099 Rennes, France
[6] Clin Invest Ctr CIC 1414, INSERM, Rennes, France
[7] Karolinska Inst, Dept Clin Sci Danderyd, Stockholm, Sweden
[8] Danderyd Hosp, Dept Cardiol, Stockholm, Sweden
[9] CHU Lille, Serv Cardiol, Lille, France
[10] CHU Montpellier, Dept Cardiol, Montpellier, France
[11] Soc Francaise Cardiol, Paris, France
基金
瑞典研究理事会;
关键词
Heart failure with preserved ejection fraction; Diastolic heart failure; Diastolic function; Co-morbidity; Outcomes; VENTRICULAR DYSFUNCTION; PROGNOSTIC-SIGNIFICANCE; SYSTOLIC FUNCTION; PREVALENCE; MORTALITY; COMORBIDITIES; POPULATION; TRENDS; IMPACT;
D O I
10.1002/ejhf.137
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
AimsThe prevalence of cardiovascular and non-cardiovascular co-morbidities and their relative importance for outcomes in heart failure with preserved ejection fraction (HFPEF) remain poorly characterized. This study aimed to investigate this. Methods and resultsThe Karolinska-Rennes (KaRen) Study was a multinational prospective observational study designed to characterize HFPEF. Inclusion required acute HF, defined by the Framingham criteria, LVEF 45%, and NT-pro-BNP 300ng/L or BNP 100ng/L. Detailed clinical data were collected at baseline and patients were followed prospectively for 18 months. Predictors of the primary (HF hospitalization or all-cause mortality) and secondary (all-cause mortality) outcomes were assessed with multivariable Cox regression. A total of 539 patients [56% women; median (interquartile range) age 79 (72-84) years; NT-pro-BNP/BNP 2448 (1290-4790)/429 (229-805) ng/L] were included. Known history of HF was present in 40%. Co-morbidities included hypertension (78%), atrial fibrillation/flutter (65%), anaemia (51%), renal dysfunction (46%), CAD (33%), diabetes (30%), lung disease (25%), and cancer (16%). The primary outcome occurred in 268 patients [50%; 106 deaths (20%) and 162 HF hospitalizations (30%)]. Important independent predictors of the primary and/or secondary outcomes were age, history of non-cardiovascular syncope, valve disease, anaemia, lower sodium, and higher potassium, but no cardiovascular co-morbidities. Renin-angiotensin system antagonist and mineralocorticoid receptor antagonist use predicted improved prognosis. ConclusionHFPEF was associated with higher age, female gender, hypertension, atrial fibrillation/flutter, and numerous non-cardiovascular co-morbidities. Prognosis was determined by non-cardiovascular co-morbidities, but use of conventional heart failure medications may still be associated with improved outcomes.
引用
收藏
页码:992 / 1001
页数:10
相关论文
共 35 条
[1]   Impact of Noncardiac Comorbidities on Morbidity and Mortality in a Predominantly Male Population With Heart Failure and Preserved Versus Reduced Ejection Fraction [J].
Ather, Sameer ;
Chan, Wenyaw ;
Bozkurt, Biykem ;
Aguilar, David ;
Ramasubbu, Kumudha ;
Zachariah, Amit A. ;
Wehrens, Xander H. T. ;
Deswal, Anita .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2012, 59 (11) :998-1005
[2]   The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis [J].
Berry, C. ;
Doughty, R. N. ;
Granger, C. ;
Kober, L. ;
Massie, B. ;
McAlister, F. ;
McMurray, J. ;
Pocock, S. ;
Poppe, K. ;
Swedberg, K. ;
Somaratne, J. ;
Whalley, G. A. ;
Ahmed, A. ;
Andersson, B. ;
Bayes-Genis, A. ;
Berry, C. ;
Cowie, M. ;
Cubbon, R. ;
Doughty, R. N. ;
Ezekowitz, J. ;
Gonzalez-Juanatey, J. ;
Gorini, M. ;
Gotsman, I. ;
Grigorian-Shamagian, L. ;
Guazzi, M. ;
Kearney, M. ;
Kober, L. ;
Komajda, M. ;
di Lenarda, A. ;
Lenzen, M. ;
Lucci, D. ;
Macin, S. ;
Madsen, B. ;
Maggioni, A. ;
Martinez-Selles, M. ;
McAlister, F. ;
Oliva, F. ;
Poppe, K. ;
Rich, M. ;
Richards, M. ;
Senni, M. ;
Squire, I. ;
Taffet, G. ;
Tarantini, L. ;
Tribouilloy, C. ;
Troughton, R. ;
Tsutsui, H. ;
Whalley, G. A. ;
Doughty, R. N. ;
Earle, N. .
EUROPEAN HEART JOURNAL, 2012, 33 (14) :1750-1757
[3]   What Have We Learned About Patients With Heart Failure and Preserved Ejection Fraction From DIG-PEF, CHARM-Preserved, and I-PRESERVE? [J].
Campbell, Ross T. ;
Jhund, Pardeep S. ;
Castagno, Davide ;
Hawkins, Nathaniel M. ;
Petrie, Mark C. ;
McMurray, John J. V. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2012, 60 (23) :2349-2356
[4]   Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study [J].
Caruana, L ;
Petrie, MC ;
Davie, AP ;
McMurray, JJV .
BRITISH MEDICAL JOURNAL, 2000, 321 (7255) :215-218
[5]   The perindopril in elderly people with chronic heart failure (PEP-CHF) study [J].
Cleland, John G. F. ;
Tendera, Michal ;
Adamus, Jerzy ;
Freemantle, Nick ;
Polonski, Lech ;
Taylor, Jacqueline .
EUROPEAN HEART JOURNAL, 2006, 27 (19) :2338-2345
[6]   Baseline characteristics of patients with heart failure and preserved ejection fraction included in the Karolinska Rennes (KaRen) study [J].
Donal, Erwan ;
Lund, Lars H. ;
Oger, Emmanuel ;
Hage, Camilla ;
Persson, Hans ;
Reynaud, Amelie ;
Ennezat, Pierre-Vladimir ;
Bauer, Fabrice ;
Sportouch-Dukhan, Catherine ;
Drouet, Elodie ;
Daubert, Jean-Claude ;
Linde, Cecilia .
ARCHIVES OF CARDIOVASCULAR DISEASES, 2014, 107 (02) :112-121
[7]   Heart failure with a preserved ejection fraction additive value of an exercise stress echocardiography [J].
Donal, Erwan ;
Thebault, Christophe ;
Lund, Lars H. ;
Kervio, Gaelle ;
Reynaud, Amelie ;
Simon, Tabasomne ;
Drouet, Elodie ;
Nonotte, Emilie ;
Linde, Cecilia ;
Daubert, Jean-Claude .
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, 2012, 13 (08) :656-665
[8]   Rationale and design of the Karolinska-Rennes (KaRen) prospective study of dyssynchrony in heart failure with preserved ejection fraction [J].
Donal, Erwan ;
Lund, Lars H. ;
Linde, Cecilia ;
Edner, Magnus ;
Lafitte, Stephane ;
Persson, Hans ;
Bauer, Fabrice ;
Ohrvik, John ;
Ennezat, Pierre-Vladimir ;
Hage, Camilla ;
Loefman, Ida ;
Juilliere, Yves ;
Logeart, Damien ;
Derumeaux, Genevieve ;
Gueret, Pascal ;
Daubert, Jean-Claude .
EUROPEAN JOURNAL OF HEART FAILURE, 2009, 11 (02) :198-204
[9]   Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction:: a systematic overview of data from individual patients [J].
Flather, MD ;
Yusuf, S ;
Kober, L ;
Pfeffer, M ;
Hall, A ;
Murray, G ;
Torp-Pedersen, C ;
Ball, S ;
Pogue, J ;
Moyé, L ;
Braunwald, E .
LANCET, 2000, 355 (9215) :1575-1581
[10]   Anemia and mortality in heart failure patients - A systematic review and meta-analysis [J].
Groenveld, Hessel F. ;
Januzzi, James L. ;
Damman, Kevin ;
van Wijngaarden, Jan ;
Hillege, Hans L. ;
van Veldhuisen, Dirk J. ;
van der Meer, Peter .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2008, 52 (10) :818-827