Open Heart (Dec 2020)

Diastolic index as a short-term prognostic factor in heart failure with preserved ejection fraction

  • ,
  • 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

DOI
https://doi.org/10.1136/openhrt-2020-001469
Journal volume & issue
Vol. 7, no. 2

Abstract

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Objective During follow-up time, the value of prognostic factors may change, especially in the elderly patients, and the altered extent may affect the prognosis. We aimed to clarify the significance of the ratio of diastolic elastance (Ed) to arterial elastance (Ea), (Ed/Ea=(E/e’)/(0.9×systolic blood pressure)), an afterload-integrated diastolic index, in relation to follow-up periods and other laboratory factors, on the prognosis of elderly patients with heart failure with preserved ejection fraction (HFpEF).Methods We studied 552 HFpEF patients hospitalised for acute decompensated heart failure (men/women: 255/297). Blood testing and transthoracic echocardiography were performed before discharge. The primary endpoint was all-cause mortality.Results During a median follow-up of 508 days, 88 patients (men/women: 39/49) had all-cause mortality. During the first year after discharge, Ed/Ea (p=0.045) was an independent prognostic factor in association with albumin (p<0.001) and N-terminal pro-brain natriuretic peptide (NT-proBNP, p=0.005) levels after adjusting for age and sex in the multivariate Cox hazard analysis. However, at 1 to 3 years after discharge, no other significant prognostic factors, except for albumin level (p=0.046), were detected. In the subgroup analysis, albumin, but not NT-proBNP level, showed a significant interaction with Ed/Ea for prognosis (p=0.047).Conclusion The prognostic significance of a haemodynamic parameter such as Ed/Ea may be valid only during a short-term period, but that of albumin was persisting during the entire follow-up period in the elderly patients. The clinical significance of prognostic factors in HFpEF patients may differ according to the follow-up period.