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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Heart failure and preserved left ventricular function: long term clinical outcome
Israel Gotsman1, Donna Zwas, Chaim Lotan
1Heart Institute, Hadassah University Hospital, Jerusalem, Israel. igotsman@bezeqint.net
Insights
Heart failure with preserved left ventricular function (LVF) carries a poor long-term prognosis, similar to reduced LVF. Key mortality predictors include age, functional capacity, and urea levels.
Area of Science:
- Cardiology
- Clinical Medicine
- Prognostics
Background:
- Heart failure (HF) is a condition with a generally poor prognosis.
- A growing number of HF patients exhibit preserved left ventricular function (LVF).
- The long-term outlook for HF with preserved LVF may be more severe than previously thought.
Purpose of the Study:
- To assess the long-term clinical outcomes for patients diagnosed with HF and preserved LVF.
- To identify predictors of clinical outcomes in this patient cohort.
Main Methods:
- Prospective evaluation of 309 hospitalized patients with a confirmed HF diagnosis.
- Mean follow-up duration of 6.5 years to monitor clinical outcomes.
- Echocardiography used to determine preserved systolic LVF.
Main Results:
- 36% of patients demonstrated preserved systolic LVF.
- Long-term survival rates were poor and statistically similar between preserved (28%) and reduced (23%) LVF groups.
- Event-free survival from death or HF re-hospitalization was low and not significantly different between groups (12% vs. 10%).
- Predictors of mortality in preserved LVF patients included age, functional capacity, and serum urea levels.
Conclusions:
- Patients with heart failure and preserved LVF experience a poor long-term clinical outcome.
- The prognosis for HF with preserved LVF is comparable to that of HF with reduced LVF.
Background:
Patients with heart failure (HF) have a poor prognosis. The proportion of patients with HF and preserved left ventricular function (LVF) is increasing. Long term prognosis of HF with preserved LVF may not be so benign.
Objectives:
To evaluate the long term clinical outcome of patients with HF and preserved LVF and predictors of outcome.
Methods:
We prospectively evaluated 309 patients hospitalized with a definite clinical diagnosis of HF. Patients were followed for a mean of 6.5 years for clinical outcome.
Results:
More than a third (36%) of the patients had preserved systolic LVF based on echocardiography. The long term survival rate in this group was poor and not significantly different from patients with reduced LVF (28% vs 23% respectively, P=0.2). The adjusted survival rate by Cox regression analysis was also not significantly different (hazard ratio 1.16, 95% confidence interval 0.87-1.55, P=0.31). The event free survival from death or heart failure re-hospitalization was also low in both groups and not significantly different between patients with preserved vs. reduced LVF (12% vs. 10% respectively, P=0.2). Predictors of mortality in patients with preserved LVF were age, functional capacity and serum urea levels.
Conclusions:
The long term clinical outcome of patients with heart failure and preserved LVF is poor and not significantly different from patients with reduced LVF.
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