Predictors and outcomes of heart failure with mid-range ejection fraction

Vijeta Bhambhani, Jorge Kizer, Joao A.C. Lima, Pim van der Harst, Hossein Bahrami, Matthew Nayor, Christopher R. de Filippi, Danielle Enserro, Michael J. Blaha, Mary Cushman, Thomas J. Wang, Ron T. Gansevoort, Caroline S. Fox, Hanna K. Gaggin, Willem J. Kop, Kiang Liu, Ramachandran S. Vasan, Bruce M. Psaty, Douglas S. Lee, Frank P. BrouwersHans L. Hillege, Traci M. Bartz, Emelia J. Benjamin, Cheeling Chan, Matthew Allison, Julius M. Gardin, James L. Januzzi, Daniel Levy, David M. Herrington, Wiek H. van Gilst, Alain G. Bertoni, Martin G. Larson, Rudolf A. de Boer, John S. Gottdiener, Sanjiv J. Shah, Jennifer E. Ho

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)651-659
Number of pages9
JournalEuropean Journal of Heart Failure
Volume20
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Heart Failure
Natriuretic Peptides
Confidence Intervals
Blood Pressure
Cystatin C
Troponin
Mortality
Proportional Hazards Models
Diabetes Mellitus
Biomarkers
Myocardial Infarction

Keywords

  • Ejection fraction
  • Heart failure
  • Risk factor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bhambhani, V., Kizer, J., Lima, J. A. C., van der Harst, P., Bahrami, H., Nayor, M., ... Ho, J. E. (2018). Predictors and outcomes of heart failure with mid-range ejection fraction. European Journal of Heart Failure, 20(4), 651-659. https://doi.org/10.1002/ejhf.1091

Predictors and outcomes of heart failure with mid-range ejection fraction. / Bhambhani, Vijeta; Kizer, Jorge; 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.

In: European Journal of Heart Failure, Vol. 20, No. 4, 01.04.2018, p. 651-659.

Research output: Contribution to journalArticle

Bhambhani, V, Kizer, J, Lima, JAC, van der Harst, P, Bahrami, H, Nayor, M, de Filippi, CR, Enserro, D, Blaha, MJ, Cushman, M, Wang, TJ, Gansevoort, RT, Fox, CS, Gaggin, HK, Kop, WJ, Liu, K, Vasan, RS, Psaty, BM, Lee, DS, Brouwers, FP, Hillege, HL, Bartz, TM, Benjamin, EJ, Chan, C, Allison, M, Gardin, JM, Januzzi, JL, Levy, D, Herrington, DM, van Gilst, WH, Bertoni, AG, Larson, MG, de Boer, RA, Gottdiener, JS, Shah, SJ & Ho, JE 2018, 'Predictors and outcomes of heart failure with mid-range ejection fraction', European Journal of Heart Failure, vol. 20, no. 4, pp. 651-659. https://doi.org/10.1002/ejhf.1091
Bhambhani V, Kizer J, Lima JAC, van der Harst P, Bahrami H, Nayor M et al. Predictors and outcomes of heart failure with mid-range ejection fraction. European Journal of Heart Failure. 2018 Apr 1;20(4):651-659. https://doi.org/10.1002/ejhf.1091
Bhambhani, Vijeta ; Kizer, Jorge ; 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. / Predictors and outcomes of heart failure with mid-range ejection fraction. In: European Journal of Heart Failure. 2018 ; Vol. 20, No. 4. pp. 651-659.
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abstract = "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.",
keywords = "Ejection fraction, Heart failure, Risk factor",
author = "Vijeta Bhambhani and Jorge Kizer and Lima, {Joao A.C.} and {van der Harst}, Pim and Hossein Bahrami and Matthew Nayor and {de Filippi}, {Christopher R.} and Danielle Enserro and Blaha, {Michael J.} and Mary Cushman and Wang, {Thomas J.} and Gansevoort, {Ron T.} and Fox, {Caroline S.} and Gaggin, {Hanna K.} and Kop, {Willem J.} and Kiang Liu and Vasan, {Ramachandran S.} and Psaty, {Bruce M.} and Lee, {Douglas S.} and Brouwers, {Frank P.} and Hillege, {Hans L.} and Bartz, {Traci M.} and Benjamin, {Emelia J.} and Cheeling Chan and Matthew Allison and Gardin, {Julius M.} and Januzzi, {James L.} and Daniel Levy and Herrington, {David M.} and {van Gilst}, {Wiek H.} and Bertoni, {Alain G.} and Larson, {Martin G.} and {de Boer}, {Rudolf A.} and Gottdiener, {John S.} and Shah, {Sanjiv J.} and Ho, {Jennifer E.}",
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TY - JOUR

T1 - Predictors and outcomes of heart failure with mid-range ejection fraction

AU - Bhambhani, Vijeta

AU - Kizer, Jorge

AU - Lima, Joao A.C.

AU - van der Harst, Pim

AU - Bahrami, Hossein

AU - Nayor, Matthew

AU - de Filippi, Christopher R.

AU - Enserro, Danielle

AU - Blaha, Michael J.

AU - Cushman, Mary

AU - Wang, Thomas J.

AU - Gansevoort, Ron T.

AU - Fox, Caroline S.

AU - Gaggin, Hanna K.

AU - Kop, Willem J.

AU - Liu, Kiang

AU - Vasan, Ramachandran S.

AU - Psaty, Bruce M.

AU - Lee, Douglas S.

AU - Brouwers, Frank P.

AU - Hillege, Hans L.

AU - Bartz, Traci M.

AU - Benjamin, Emelia J.

AU - Chan, Cheeling

AU - Allison, Matthew

AU - Gardin, Julius M.

AU - Januzzi, James L.

AU - Levy, Daniel

AU - Herrington, David M.

AU - van Gilst, Wiek H.

AU - Bertoni, Alain G.

AU - Larson, Martin G.

AU - de Boer, Rudolf A.

AU - Gottdiener, John S.

AU - Shah, Sanjiv J.

AU - Ho, Jennifer E.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - 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.

AB - 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.

KW - Ejection fraction

KW - Heart failure

KW - Risk factor

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