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Reclassification of Heart Failure with Preserved Ejection Fraction Following Cardiac Sympathetic Nervous System
Toshihiko Goto1, Takafumi Nakayama2, Junki Yamamoto1
1Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
Insights
A left ventricular ejection fraction (LVEF) of 58% better reclassifies heart failure patients based on cardiac sympathetic nervous system (SNS) activity and prognosis than the standard 50% threshold. This finding aids in understanding heart failure heterogeneity.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Heart failure with preserved left ventricular ejection fraction (HFpEF) is complex and current LVEF cutoffs (50%) for classification are debated.
- Cardiac sympathetic nervous system (SNS) activation is a known characteristic of heart failure.
Purpose of the Study:
- To investigate if a left ventricular ejection fraction (LVEF) of 58% is a more suitable threshold than 50% for stratifying heart failure patients based on cardiac SNS activity and prognosis.
- To compare cardiac SNS activity and all-cause mortality between heart failure patients with LVEF ≥ 58% and LVEF < 58%.
Main Methods:
- Retrospective observational study of 63 heart failure patients.
- 123I-metaiodobenzylguanidine (MIBG) scintigraphy was used to assess cardiac SNS activity.
- Patients were analyzed using LVEF thresholds of 58% and 50%.
Main Results:
- Patients with LVEF ≥ 58% showed significantly higher delayed heart/mediastinum (H/M) ratios (indicating lower SNS activity) compared to those with LVEF < 58% (2.1 vs. 1.7, p=0.004).
- All-cause mortality was significantly lower in the LVEF ≥ 58% group (log-rank, p=0.04).
- No significant differences in H/M ratio or mortality were observed between LVEF ≥ 50% and LVEF < 50% groups.
Conclusions:
- An LVEF of 58% serves as a more appropriate cutoff for reclassifying heart failure patients according to cardiac SNS activity.
- This revised threshold may improve prognostic stratification in heart failure patients.
Abstract:
Heart failure (HF) with preserved left ventricular ejection fraction (LVEF) is a heterogeneous syndrome. An LVEF of 50% is widely used to categorize patients with HF; however, this is controversial. Previously, we have reported that patients with an LVEF of ≥ 58% have good prognoses. Further, cardiac sympathetic nervous system (SNS) activation is a feature of HF. In this retrospective, observational study, the cardiac SNS activity of HF patients (n = 63, age: 78.4 ± 9.6 years; male 49.2%) with LVEF ≥ 58% (n = 15) and LVEF < 58% (n = 48) were compared using 123I-metaiodobenzylguanidine scintigraphy. During the follow-up period (median, 3.0 years), 18 all-cause deaths occurred. The delayed heart/mediastinum (H/M) ratio was significantly higher in the LVEF ≥ 58% group than in the LVEF < 58% group (2.1 ± 0.3 vs. 1.7 ± 0.4, p = 0.004), and all-cause mortality was significantly lower in patients in the former than those in the latter group (log-rank, p = 0.04). However, when these patients were divided into LVEF ≥ 50% (n = 22) and LVEF < 50% (n = 41) groups, no significant differences were found in the delayed H/M ratio, and the all-cause mortality did not differ between the groups (log-rank, p = 0.09). In conclusion, an LVEF of 58% is suitable for reclassifying patients with HF according to cardiac SNS activity.
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