BMJ Open (Aug 2022)
Time-sensitive prognostic performance of an afterload-integrated diastolic index in heart failure with preserved ejection fraction: a prospective multicentre observational study
- ,
- Shinichiro Suna,
- Shungo Hikoso,
- Takahisa Yamada,
- Masaaki Uematsu,
- Yoshio Yasumura,
- Akito Nakagawa,
- Toshihiro Takeda,
- Takayuki Kojima,
- Hirota Kida,
- Bolrathanak Oeun,
- Akihiro Sunaga,
- Tomoharu Dohi,
- Katsuki Okada,
- Hiroya Mizuno,
- Daisaku Nakatani,
- Yasushi Matsumura,
- Yasushi Sakata,
- Shunsuke Tamaki,
- 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,
- Mayu Nishio,
- Keiji Hirooka,
- Takahiro Yoshimura,
- Yoshinori Yasuoka,
- Akihiro Tani,
- Yasushi Okumoto,
- Hideharu Akagi,
- Yasunaka Makino,
- 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,
- Yohei Sotomi,
- Taiki Sato,
- Yuji Yasuga,
- Toshinari Onishi,
- Tamaki Shunsuke
Affiliations
- Shinichiro Suna
- Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
- Masaaki Uematsu
- Yoshio Yasumura
- Division of Cardiology, Amagasaki Chuo Hospital, Hyogo, Japan
- Akito Nakagawa
- Division of Cardiology, Amagasaki Chuo Hospital, Hyogo, Japan
- Toshihiro Takeda
- Takayuki Kojima
- Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Yasushi Matsumura
- Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Shunsuke Tamaki
- Department of Cardiology, Rinku General Medical Center, Osaka, Japan
- Takaharu Hayashi
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
- Yoshiharu Higuchi
- Department of Cardiology, Osaka Police Hospital, 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
- Division of Cardiology, Kawanishi City Hospital, Hyogo, 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
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
- Masami Nishino
- Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
- Jun Tanouchi
- Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
- 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
- Mayu Nishio
- Keiji Hirooka
- Takahiro Yoshimura
- Yoshinori Yasuoka
- Akihiro Tani
- Yasushi Okumoto
- Hideharu Akagi
- Yasunaka Makino
- 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
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, 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
- Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Yuji Yasuga
- Toshinari Onishi
- Tamaki Shunsuke
- Department of Cardiology, Osaka General Medical Center, Osaka, Japan
- DOI
- https://doi.org/10.1136/bmjopen-2021-059614
- Journal volume & issue
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Vol. 12,
no. 8
Abstract
Objectives The prognostic significance of an afterload-integrated diastolic index, the ratio of diastolic elastance (Ed) to arterial elastance (Ea) (Ed/Ea=[E/e′]/[0.9×systolic blood pressure]), is valid for 1 year after discharge in older patients with heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the association with changes in Ed/Ea from enrolment to 1 year and prognosis thereafter in patients with HFpEF.Setting A prospective, multicentre observational registry of collaborating hospitals in Osaka, Japan.Participants We enrolled 659 patients with HFpEF hospitalised for acute decompensated heart failure (men/women: 296/363). Blood tests and transthoracic echocardiography were performed before discharge and at 1 year after.Primary outcome measures All-cause mortality and/or re-admission for heart failure were evaluated after discharge.Results High Ed/Ea assessed before discharge was a significant prognostic factor during the first, but not the second, year after discharge in all-cause mortality or all-cause mortality and/or re-admission for heart failure. When re-analysis was performed using the value of Ed/Ea at 1 year after discharge, high Ed/Ea was significant for the prognosis during the second year for both end points (p=0.012 and p=0.033, respectively). The poorest mortality during 1‒2 years after enrolment was observed in those who showed a worsening Ed/Ea during the first year associated with larger left ventricular mass index and reduced left ventricular ejection fraction. In all-cause mortality and/or re-admission for heart failure, the event rate during 1‒2 years was highest in those with persistently high Ed/Ea even after 1 year.Conclusions Time-sensitive prognostic performance of Ed/Ea, an afterload-integrated diastolic index, was observed in older patients with HFpEF.Trial registration number UMIN000021831.