BMJ Open (Sep 2021)
Left atrial pressure overload and prognosis in elderly patients with heart failure and preserved ejection fraction: a prospective multicenter observational study
- Shinichiro Suna,
- Shungo Hikoso,
- Takahisa Yamada,
- Masaaki Uematsu,
- Yoshio Yasumura,
- Akito Nakagawa,
- Toshihiro Takeda,
- Takayuki Kojima,
- Hirota Kida,
- Akihiro Sunaga,
- Tomoharu Dohi,
- Katsuki Okada,
- Hiroya Mizuno,
- Daisaku Nakatani,
- Yasushi Matsumura,
- Yasushi Sakata,
- Oeun Bolrathanak,
- Shunsuke Tamaki,
- Masatake Fukunami,
- Takaharu Hayashi,
- Yoshiharu Higuchi,
- Masaharu Masuda,
- Mitsutoshi Asai,
- Toshiaki Mano,
- Hisakazu Fuji,
- Daisaku Masuda,
- Yoshihiro Takeda,
- Yoshiyuki Nagai,
- Shizuya Yamashita,
- Masami Sairyo,
- Yusuke Nakagawa,
- Shuichi Nozaki,
- Haruhiko Abe,
- Yasunori Ueda,
- Yukihiro Koretsune,
- Kunihiko Nagai,
- Masamichi Yano,
- Masami Nishino,
- Jun Tanouchi,
- Yoh Arita,
- Shinji Hasegawa,
- Takamaru Ishizu,
- Minoru Ichikawa,
- Yuzuru Takano,
- Eisai Rin,
- Tetsuya Watanabe,
- Shiro Hoshida,
- Masahiro Izumi,
- Hiroyoshi Yamamoto,
- Hiroyasu Kato,
- Kazuhiro Nakatani,
- Hisatoyo Hiraoka,
- Mayu Nishio,
- Keiji Hirooka,
- Takahiro Yoshimura,
- Yoshinori Yasuoka,
- Akihiro Tani,
- Yasushi Okumoto,
- Hideharu Akagi,
- Yasunaka Makino,
- Toshinari Ohnishi,
- Katsuomi Iwakura,
- Nagahiro Nishikawa,
- Yoshiyuki Kijima,
- Takashi Kitao,
- Hideyuki Kanai,
- Wataru Shioyama,
- Masashi Fujita,
- Koichiro Harada,
- Masahiro Kumada,
- Osamu Nakagawa,
- Ryo Araki,
- Takayuki Yamada,
- Fusako Sera,
- Kei Nakamoto,
- Hidetaka Kioka,
- Tomohito Ohtani,
- Yukinori Shinoda,
- Koichi Tachibana,
- Tomoko Minamisaka
Affiliations
- Shinichiro Suna
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Shungo Hikoso
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Takahisa Yamada
- 6 Division of Cardiology, Osaka General Medical Center, Osaka, Japan
- Masaaki Uematsu
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
- Yoshio Yasumura
- 9 Division of Cardiology, Amagasaki Chuo Hospital, Amagasaki, Japan
- Akito Nakagawa
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Toshihiro Takeda
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
- Takayuki Kojima
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Hirota Kida
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Akihiro Sunaga
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Tomoharu Dohi
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Katsuki Okada
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Hiroya Mizuno
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Daisaku Nakatani
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Yasushi Matsumura
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
- Yasushi Sakata
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Oeun Bolrathanak
- Shunsuke Tamaki
- 2 Department of Cardiology, Rinku General Medical Center, Izumisano, Japan
- Masatake Fukunami
- Takaharu Hayashi
- 8 Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
- Yoshiharu Higuchi
- Cardiovascular Division, Osaka Police Hospital, Osaka, Osaka, Japan
- Masaharu Masuda
- Mitsutoshi Asai
- Toshiaki Mano
- Hisakazu Fuji
- Cardiovascular Division, Kobe Ekisaikai Hospital, Kobe, Hyogo, Japan
- Daisaku Masuda
- Yoshihiro Takeda
- Yoshiyuki Nagai
- Shizuya Yamashita
- Masami Sairyo
- Yusuke Nakagawa
- 10 Division of Cardiology, Kawanishi City Medical Center, Kawanishi, Japan
- Shuichi Nozaki
- Haruhiko Abe
- Department of Cardiovascular Medicine, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
- Yasunori Ueda
- Yukihiro Koretsune
- National Hospital Organization Osaka National Hospital, Osaka, Japan
- Kunihiko Nagai
- Masamichi Yano
- 7 Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
- Masami Nishino
- Jun Tanouchi
- Yoh Arita
- Shinji Hasegawa
- Takamaru Ishizu
- Minoru Ichikawa
- Yuzuru Takano
- Eisai Rin
- Tetsuya Watanabe
- Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
- Masahiro Izumi
- Hiroyoshi Yamamoto
- Hiroyasu Kato
- Kazuhiro Nakatani
- Hisatoyo Hiraoka
- Mayu Nishio
- Keiji Hirooka
- Takahiro Yoshimura
- Yoshinori Yasuoka
- Akihiro Tani
- Yasushi Okumoto
- Hideharu Akagi
- Yasunaka Makino
- Toshinari Ohnishi
- Katsuomi Iwakura
- Nagahiro Nishikawa
- Yoshiyuki Kijima
- Takashi Kitao
- Hideyuki Kanai
- Wataru Shioyama
- Masashi Fujita
- Koichiro Harada
- Masahiro Kumada
- Osamu Nakagawa
- Ryo Araki
- Takayuki Yamada
- 2 Department of Medicine, Division of Nephrology, University of Washington, Seattle, Washington, USA
- Fusako Sera
- Kei Nakamoto
- Hidetaka Kioka
- Tomohito Ohtani
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Yukinori Shinoda
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
- Koichi Tachibana
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
- Tomoko Minamisaka
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
- DOI
- https://doi.org/10.1136/bmjopen-2020-044605
- Journal volume & issue
-
Vol. 11,
no. 9
Abstract
Objectives The severity of diastolic dysfunction is assessed using a combination of several indices of left atrial (LA) volume overload and LA pressure overload. We aimed to clarify which overload is more associated with the prognosis in patients with heart failure and preserved ejection fraction (HFpEF).Setting A prospective, multicenter observational registry of collaborating hospitals in Osaka, Japan.Participants We enrolled hospitalised patients with HFpEF showing sinus rhythm (men, 79; women, 113). Blood tests and transthoracic echocardiography were performed before discharge. The ratio of diastolic elastance (Ed) to arterial elastance (Ea) was used as a relative index of LA pressure overload.Primary outcome measures All-cause mortality and admission for heart failure were evaluated at >1 year after discharge.Results In the multivariable Cox regression analysis, Ed/Ea, but not LA volume index, was significantly associated with all-cause mortality or admission for heart failure (HR 2.034, 95% CI 1.059 to 3.907, p=0.032), independent of age, sex, and the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level. In patients with a higher NT-proBNP level, the effect of higher Ed/Ea on prognosis was prominent (p=0.015).Conclusions Ed/Ea, an index of LA pressure overload, was significantly associated with the prognosis in elderly patients with HFpEF showing sinus rhythm.Trial registration number UMIN000021831.
