Premium
Predictors and outcomes of heart failure with mid‐range ejection fraction
Author(s) -
Bhambhani Vijeta,
Kizer Jorge R.,
Lima Joao A.C.,
van der Harst Pim,
Bahrami Hossein,
Nayor Matthew,
de Filippi Christopher R.,
Enserro Danielle,
Blaha Michael J.,
Cushman Mary,
Wang Thomas J.,
Gansevoort Ron T.,
Fox Caroline S.,
Gaggin Hanna K.,
Kop Willem J.,
Liu Kiang,
Vasan Ramachandran S.,
Psaty Bruce M.,
Lee Douglas S.,
Brouwers Frank P.,
Hillege Hans L.,
Bartz Traci M.,
Benjamin Emelia J.,
Chan Cheeling,
Allison Matthew,
Gardin Julius M.,
Januzzi James L.,
Levy Daniel,
Herrington David M.,
van Gilst Wiek H.,
Bertoni Alain G.,
Larson Martin G.,
de Boer Rudolf A.,
Gottdiener John S.,
Shah Sanjiv J.,
Ho Jennifer E.
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1091
Subject(s) - medicine , ejection fraction , heart failure , hazard ratio , cardiology , proportional hazards model , confidence interval , myocardial infarction , confounding , heart failure with preserved ejection fraction , troponin , cystatin c , renal function
Aims While heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) are well described, determinants and outcomes of heart failure with mid‐range ejection fraction (HFmrEF) remain unclear. We sought to examine clinical and biochemical predictors of incident HFmrEF in the community. Methods and results We pooled data from four community‐based longitudinal cohorts, with ascertainment of new heart failure (HF) classified into HFmrEF [ejection fraction (EF) 41–49%], HFpEF (EF ≥50%), and HFrEF (EF ≤40%). Predictors of incident HF subtypes were assessed using multivariable Cox models. Among 28 820 participants free of HF followed for a median of 12 years, there were 200 new HFmrEF cases, compared with 811 HFpEF and 1048 HFrEF. Clinical predictors of HFmrEF included age, male sex, systolic blood pressure, diabetes mellitus, and prior myocardial infarction (multivariable adjusted P ≤ 0.003 for all). Biomarkers that predicted HFmrEF included natriuretic peptides, cystatin‐C, and high‐sensitivity troponin ( P ≤ 0.0004 for all). Natriuretic peptides were stronger predictors of HFrEF [hazard ratio (HR) 2.00 per 1 standard deviation increase, 95% confidence interval (CI) 1.81–2.20] than of HFmrEF (HR 1.51, 95% CI 1.20–1.90, P = 0.01 for difference), and did not differ in their association with incident HFmrEF and HFpEF (HR 1.56, 95% CI 1.41–1.73, P = 0.68 for difference). All‐cause mortality following the onset of HFmrEF was worse than that of HFpEF (50 vs. 39 events per 1000 person‐years, P = 0.02), but comparable to that of HFrEF (46 events per 1000 person‐years, P = 0.78). Conclusions We found overlap in predictors of incident HFmrEF with other HF subtypes. In contrast, mortality risk after HFmrEF was worse than HFpEF, and similar to HFrEF.