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

DOI
https://doi.org/10.1136/bmjopen-2021-059614
Journal volume & issue
Vol. 12, no. 8

Abstract

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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.