The prognostic significance of heart failure with preserved left ventricular ejection fraction: A literature-based meta-analysis

Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
European Journal of Heart Failure (Impact Factor: 6.53). 09/2009; 11(9):855-62. DOI: 10.1093/eurjhf/hfp103
Source: PubMed


Heart failure (HF) with normal or preserved left ventricular (LV) ejection fraction (HFPEF) has been reported to be associated with similar outcome as HF with reduced EF (HFREF) in registry-based and epidemiological analyses, but many of these studies excluded patients who did not have EF measurements. Conversely, prior prospective studies have reported better outcome for patients with HFPEF. We performed a meta-analysis of prospective observational studies comparing all-cause mortality in patients with HFREF and HFPEF.
We searched several online databases for studies comparing outcome in HFREF and HFPEF, published before 2007. Inclusion criteria: prospective, clinical HF, near complete EF data, and mortality outcome. Review Manager version 4.2.3 software was used for the analysis. Overall, 24 501 patients [9299 deaths (38%)] from 17 studies are included. Average follow-up was 47 months; the HFPEF group was older (69 vs. 66 years) and more likely to be female (44% vs. 26%). Of the 7688 patients with HFPEF 2468 died (32.1%), compared with 6831 of the 16 813 patients with HFREF (40.6%): odds ratio 0.51 (95% CI: 0.48, 0.55).
This literature-based meta-analysis demonstrates that mortality among patients with HFPEF was half that observed in those with HFREF, in contrast to previous reports suggesting that mortality may be similar between both groups.

3 Reads
  • Source
    • "Under these circumstances, they need diuretics and blood pressure control [23] [31]. Hence, we certainly have to improve their treatment to decrease their cardiovascular morbidity [30]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The relevance of electrical and mechanical dyssynchrony has been demonstrated in heart failure with reduced ejection fraction. Preserved ejection fraction is present in as many as 50% of patients with chronic heart failure. Recent small studies suggest that both electrical and mechanical left ventricular dyssynchrony are sometimes present in patients with heart failure and preserved ejection fraction (HFPEF). These data remain controversial and a robust validation of this hypothesis has to be achieved. In the present paper, we review in detail the concepts and try to justify the ongoing KaRen registry. This is a prospective, multicentre, international, observational study to characterize the prevalence of electrical or mechanical dyssynchrony in HFPEF and the resultant effect on prognosis. Patients are enrolled currently at the time of an acute congestive episode. The diagnosis of HFPEF is made according to clinical data, natriuretic peptides and echocardiography for the measurement of ejection fraction. Once stabilized, patients return for a hospital check-up. They undergo clinical and biological evaluation, electrocardiography and Doppler echocardiography. Thereafter, patients are followed every six months, for at least 18 months for mortality, and heart failure-related and non-cardiovascular hospitalizations. KaRen aims to characterize electrical and mechanical dyssynchrony and to assess its prognostic impact in HFPEF. The results may improve our understanding of HFPEF and generate answers to the question of whether or not dyssynchrony could be a target for cardiac resynchronization therapy in HFPEF.
    Archives of cardiovascular diseases 06/2010; 103(6-7):404-10. DOI:10.1016/j.acvd.2010.01.009 · 1.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A simple analytical threshold voltage models for long and short-channel fully depleted SOI MOSFETs have been derived. The models are based on the analytical solution of the potential distribution in the silicon film (front silicon), which is for the short-channel case is taken as the sum of the long-channel solution to the Poisson's equation and the short-channel solution to the Laplace equation, and the solution of the Poisson's equation in the silicon substrate (back silicon). The proposed models accounts for the effects of the back gate substrate induced surface potential (SISP) at the buried oxide-substrate interface. The models predications are in close agreement with PISCES simulation results
    Microelectronics, 1997. Proceedings., 1997 21st International Conference on; 10/1997
  • [Show abstract] [Hide abstract]
    ABSTRACT: An improved model for MESFET noise parameter prediction by using standard circuit simulator is proposed in this paper. Starting from the previously developed model with two noise sources, the correlation between these sources is included by using an additional model parameter complex correlation coefficient. A set of equation describing the noise parameters as the function of all model elements is derived. The proposed procedure is implemented within the circuit simulator Libra
    Microelectronics, 1997. Proceedings., 1997 21st International Conference on; 10/1997
Show more