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ABSTRACT: Systolic blood pressure (SBP) at hospital admission predicts in-hospital and postdischarge mortality in patients with left ventricular systolic dysfunction. The relationship between admission SBP and mortality in heart failure with preserved (≥50%) ejection fraction (HFPEF) is still unclear.
We aimed to investigate the relationship between admission SBP and 5-year outcome in 368 consecutive patients hospitalized for new-onset HFPEF. Five-year all-cause mortality rates according to admission SBP categories (<120, 120-139, 140-159, 160-179, and ≥180 mm Hg) were 75 ± 7%, 53 ± 6%, 52 ± 7%, 55 ± 4%, and 60 ± 7%, respectively (P = .029). Survival analysis showed an inverse relation between admission SBP and mortality with increased risk of death for SBP <120 mm Hg. SBP <120 mm Hg independently predicted 5-year all-cause mortality (adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.08-2.63) and cardiovascular mortality (adjusted HR 1.89, 95% CI 1.21-2.97). In patients discharged alive, after adjustment for medical treatment at discharge, admission SBP <120 mm Hg remained predictive of all-cause mortality (adjusted HR 1.52, 95% CI 1.04-2.43) and cardiovascular mortality (adjusted HR 1.69, 95% CI 1.06-2.73). There was no interaction between any of the therapeutic classes and outcome prediction of SBP.
In HFPEF, low SBP (<120 mm Hg) at the time of hospital admission is associated with excess long-term mortality. Further studies are required to determine the mechanism of this association.
Journal of cardiac failure 11/2011; 17(11):907-15. · 3.25 Impact Factor
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Christophe Tribouilloy,
Dan Rusinaru,
Catherine Szymanski,
Sonia Mezghani,
Alexandre Fournier, Franck Lévy,
Marcel Peltier,
Ammar Ben Ammar,
Doron Carmi,
Jean-Paul Remadi,
Thierry Caus,
Gilles Touati
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ABSTRACT: Left ventricular (LV) dysfunction is the first cause of late mortality after mitral valve surgery. In this retrospective analysis, we studied the association between preoperative echocardiographic LV measures and occurrence of LV dysfunction after mitral valve repair (MVR).
Between 1991 and 2009, 335 consecutive patients underwent MVR for severe mitral regurgitation due to leaflet prolapse in our institution. Echocardiography was performed preoperatively and at 10.8 (9.1-12.0) months after surgery in 303 patients who represented the study population. Cardiac events were recorded during follow-up. LV ejection fraction (EF) decreased from 68 ± 9% before surgery to 59 ± 9% post-operatively (P < 0.001). Preoperative EF <64% and LV end-systolic diameter (ESD) ≥ 37 mm were the best cut-off values for the prediction of post-operative LV dysfunction (EF < 50%). On the basis of a combined analysis, the occurrence of post-operative LV dysfunction was 9% when EF was ≥ 64% and LVESD < 37 mm, 21% with EF < 64% or LVESD ≥ 37 mm, and 33% with EF < 64% and LVESD ≥ 37 mm (P for trend < 0.001). The combined variable EF < 64% and LVESD ≥ 37 mm added incremental prognostic value to the multivariable regression model (P = 0.001).
Simple preoperative echocardiography measures allow the prediction of LV dysfunction after MVR in patients with leaflet prolapse. Patients with preoperative EF ≥ 64% and LVESD < 37 mm incur relatively low risk of post-operative LV dysfunction.
European Heart Journal – Cardiovascular Imaging 08/2011; 12(9):702-10. · 2.32 Impact Factor
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Christophe Tribouilloy, Franck Lévy,
Dan Rusinaru,
Pascal Guéret,
Hélène Petit-Eisenmann,
Serge Baleynaud,
Yannick Jobic,
Catherine Adams,
Bernard Lelong,
Agnès Pasquet,
Christophe Chauvel,
Damien Metz,
Jean-Paul Quéré,
Jean-Luc Monin
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ABSTRACT: This study investigated whether aortic valve replacement (AVR) is associated with improved survival in patients with severe low-flow/low-gradient aortic stenosis (LF/LGAS) without contractile reserve (CR) on dobutamine stress echocardiography (DSE).
Patients with LF/LGAS without CR have a high mortality rate with conservative therapy. The benefit of AVR in this subset of patients remains controversial.
Eighty-one consecutive patients with symptomatic calcified LF/LGAS (valve area <or=1 cm(2), left ventricular ejection fraction <or=40%, mean pressure gradient [MPG] <or=40 mm Hg) without CR on DSE were enrolled. Absence of CR was defined as the absence of increase in stroke volume of >or=20% compared with the baseline value. Multivariable analysis and propensity scores were used to compare survival according to whether or not AVR was performed (n = 55).
Five-year survival was higher in AVR patients compared with medically managed patients (54 +/- 7% vs. 13 +/- 7%, p = 0.001) despite a high operative mortality of 22% (n = 12). An AVR was independently associated with lower 5-year mortality (adjusted hazard ratio from 0.16 to 5.21 varying with time [95% confidence interval: 0.12-3.16 to 0.21-8.50], p = 0.00026). In 42 propensity-matched patients, 5-year survival was markedly improved by AVR (65 +/- 11% vs. 11 +/- 7%, p = 0.019). Associated bypass surgery (p = 0.007) and MPG <or=20 mm Hg (p = 0.035) were independently predictive of operative mortality. Late survival after AVR (excluding operative death) was 69 +/- 8% at 5 years.
In patients with LF/LGAS without CR on DSE, AVR is associated with better outcome compared with medical management. Surgery should not be withheld from this subset of patients solely on the basis of lack of CR on DSE.
Journal of the American College of Cardiology 06/2009; 53(20):1865-73. · 14.16 Impact Factor
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ABSTRACT: Comorbidities have an adverse influence on the outcome of patients with heart failure (HF).
We investigated the impact of peripheral vascular disease (PVD) on long-term mortality in hospitalized patients with HF.
We included prospectively consecutive patients (N=799) hospitalized for a first episode of HF in all healthcare establishments within a single French department during 2000. Patients with peripheral arterial disease and/or history of stroke were considered to have PVD. Baseline characteristics and 5-year mortality were compared according to PVD status.
PVD was diagnosed in 172 patients (22%) and clinical coronary artery disease in 302 patients (38%). Patients with PVD were older, predominantly men, smokers, and more often had diabetes and coronary artery disease. PVD was associated with an increased risk of crude 5-year overall mortality (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.35-2.03; P<0.001). After adjustment for covariates, the relationship remained significant (HR 1.33, 95% CI 1.08-1.65; P=0.008). Compared with the expected survival, the 5-year survival of the PVD group was dramatically lower (24% versus 67%). The risk of cardiovascular death was higher for PVD patients (HR 1.39, 95% CI 1.07-1.80; P=0.014). PVD probably modulates the impact of other covariates on outcome.
PVD is a potent predictor of adverse outcome in patients with new-onset HF.
Archives of Cardiovascular Diseases 02/2009; 102(1):11-8. · 1.51 Impact Factor
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ABSTRACT: Heart failure (HF) is a major issue of public health in contemporary aging populations. The objectives of the present study were to assess the long-term survival of a contemporary cohort of patients discharged after a first hospitalization for HF and identify variables associated with adverse outcome.
We prospectively included consecutive patients (n=735) discharged from 11 healthcare establishments of the Somme department (France) after a first hospitalization for HF during 2000. The 7-year observed survival was compared with the expected survival of the general population.
Mean age of the study group was 75+/-12 years and 48% of patients were women. Left ventricular ejection fraction was measured in 628 patients (85%). During the 7-year follow-up, 483 patients (67%) died. The 5- and 7-year observed survival rates were dramatically lower than the expected survival of the matched general population (42% vs. 70%, and 33% vs. 59%, respectively). Relative survival (observed/expected survival) was 60% at 5 years and 55% at 7 years. Multivariable analysis identified cancer, stroke, diabetes, prior myocardial infarction, chronic obstructive pulmonary disease, chronic atrial fibrillation, age, and hyponatraemia as independent predictors of 7-year mortality.
In Europe, the long-term outcome of patients with new-onset HF is still extremely poor. Better implementation of guideline-oriented therapeutic strategies is needed to improve prognosis of this increasingly prevalent condition.
International journal of cardiology 01/2009; 140(3):309-14. · 7.08 Impact Factor
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ABSTRACT: Low gradient aortic stenosis (LGAS) represents about 5% to 10% of all cases of severe AS and is the most challenging subgroup of patients with AS in terms of management. The term LGAS is usually applied to patients with a mean gradient < 30 mmHg (or 40 mmHg), an aortic valve area (AVA) < 1 cm2, and an ejection fraction (EF) < 35% (or 40%. Low EF in LGAS may be caused by severe low-flow AS with inadequate compensatory LV hypertrophy, called afterload mismatch, but also by another myocardial disease (such as extensive fibrosis, associated cardiomyopathy or myocardial infarction(MI), in which case, AS is not the primary problem. The essential problem for clinicians is to distinguish true severe low-flow AS, responsible for low EF, from pseudo-severe AS comprising mild-to-moderate AS associated with another cause of left ventricular dysfunction (LVD).Very low gradient may be observed in true severe low-flow AS, while the decreased AVA observed in pseudo-severe AS reflects poor opening of the aortic valve directly related to low transvalvular flow. For the clinician, the 2 main questions in LGAS are: -how severe is the AS? - which patients can benefit from surgery?
Heart (British Cardiac Society) 07/2008; 94(12):1526-7. · 4.22 Impact Factor
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ABSTRACT: This study was designed to identify the characteristics and long-term prognosis of heart failure with preserved ejection fraction (HFPEF) in patients hospitalized for a first episode of HF.
Consecutive patients (n = 799) hospitalized for a first episode of HF during 2000 in the Somme department (France) were recruited. EF was available in 662 (83%) patients, representing the study population. Patients with HFPEF (55.6% of cases) were significantly older, with a high proportion of women. During the 5 year follow-up, 370 patients (56%) died. Patients with HFPEF had a significantly lower 5 year survival than the age- and sex-matched general population (43 vs. 72%). Five year survival rates were not significantly different in patients with preserved and reduced EF (43 vs. 46%; P = 0.95). Both groups had similar relative 5 year survival rates compared with the general population. Multivariable analysis identified age, stroke, chronic obstructive pulmonary disease, cancer, diabetes, low glomerular filtration rate, and hyponatraemia as independent predictors of 5 year mortality in patients with HFPEF.
Heart failure with preserved ejection fraction has a poor prognosis, comparable with that of HF with reduced EF, with a 5 year survival rate after a first episode of 43% and a high excess mortality compared with the general population.
European Heart Journal 03/2008; 29(3):339-47. · 10.48 Impact Factor
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ABSTRACT: Echocardiography is recommended for all patients with a clinical diagnosis of heart failure (HF). Management of HF in daily practice differs from guidelines.
To evaluate the prognostic impact of echocardiography in patients hospitalized for a first episode of HF.
Consecutive patients (n=799) hospitalized for a first episode of HF were prospectively enrolled during 2000. Propensity scores and multivariable analyses were used to reduce the imbalance in baseline covariates between the Echo and No-Echo groups.
During hospitalization, echocardiography was not performed in 151 patients (19%). Patients in the No-Echo group were older, more likely to be female, less frequently admitted to cardiology departments, and had lower rates of life-saving drugs prescribed at discharge. After adjustment for covariates of prognostic importance, use of echocardiography was associated with lower relative risk of three-year overall mortality (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.48-0.78, p<0.001) and cardiovascular mortality (HR 0.52, 95% CI 0.39-0.70, p<0.001). The three-year relative survival of the Echo group (observed/expected survival) was higher than that of the No-Echo group. Using propensity scores, the performance of echocardiography during hospitalization remained related to reduced three-year overall mortality (HR 0.55, 95% CI 0.39-0.79, p=0.001) and cardiovascular mortality (HR 0.59, 95% CI 0.37-0.95, p=0.03).
Echocardiography is still underused in elderly patients with HF. Use of echocardiography appears to be associated with more intensive medical therapy and improved outcome.
Archives of Cardiovascular Diseases 101(7-8):465-73. · 1.51 Impact Factor
