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Prognostic value of coronary CT angiography in heart failure patients with preserved ejection fraction
Meng-Meng Yu1, Wu-Xu Zuo2, Xin Zhao3
1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No.180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
Insights
Coronary artery disease is prevalent in heart failure with preserved ejection fraction (HFpEF) patients. Higher coronary atherosclerosis scores (CAD-RADS) significantly increase risks for major adverse cardiovascular events, including MI, cardiovascular death, and HF hospitalization.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) affects a significant patient population.
- The role of coronary artery disease (CAD) in HFpEF prognosis requires further elucidation.
- Coronary CT angiography (CCTA) is a valuable tool for non-invasive assessment of coronary atherosclerosis.
Purpose of the Study:
- To evaluate the prognostic significance of CCTA findings in patients diagnosed with HFpEF.
- To determine the association between coronary atherosclerosis severity and major adverse cardiovascular events (MACEs) in HFpEF.
- To assess the risk of cardiovascular mortality, myocardial infarction, and heart failure hospitalization based on CCTA-derived scores.
Main Methods:
- A prospective cohort study included 6497 participants undergoing CCTA and echocardiography from 2009-2013.
- Participants were categorized into HFpEF and non-HFpEF groups.
- The primary endpoint was MACEs, defined as cardiovascular death, nonfatal MI, or HF hospitalization, over a median follow-up of 11 years.
Main Results:
- The HFpEF group (n=3096) showed a higher prevalence of coronary atherosclerosis (78.3%) compared to the non-HFpEF group (n=3401) (64.9%, p < 0.001).
- HFpEF patients exhibited increased MACE risk across all CAD-RADS categories (0, 1-2, ≥3) (p < 0.001).
- In risk-adjusted analysis, CAD-RADS 1-2 increased non-fatal MI risk 2.5-fold (aHR: 2.5), while CAD-RADS ≥3 elevated cardiovascular mortality risk 3.9-fold (aHR: 3.9) and HF hospitalization risk 3.1-fold (aHR: 3.1) compared to CAD-RADS 0.
Conclusions:
- Coronary artery disease is highly prevalent in HFpEF patients and significantly impacts cardiovascular outcomes.
- CCTA-derived coronary atherosclerosis severity, indicated by CAD-RADS categories, is a strong independent predictor of MACEs in HFpEF.
- Specific CAD-RADS scores identify distinct risks: CAD-RADS 1-2 for non-fatal MI, and CAD-RADS ≥3 for cardiovascular mortality and HF hospitalization.
Objectives:
To investigate the prognostic value of coronary CT angiography (CCTA) in heart failure patients with preserved ejection fraction (HFpEF).
Methods:
Between January 2009 and December 2013, 6497 participants (mean age 63 ± 9.4 [range 32-86] years; 4111 men) who underwent CCTA and echocardiography were prospectively included. Participants were divided into HFpEF group and without HFpEF group. The primary endpoint was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction (MI), or hospitalization for heart failure (HF).
Results:
Among those participants, 3096 were identified with HFpEF and 3401 were without HFpEF. Higher prevalence of coronary atherosclerosis was observed in HFpEF group than those without (78.3% vs. 64.9%, p < 0.001). During a median of 11.0 [IQR: 9.0-12.0] years follow-up, participants with HFpEF exhibit a heightened risk of MACEs in CAD-RADS = 0, 1-2, and ≥ 3 respectively (p < 0.001 for all). In the risk-adjusted hazard analysis among participants with HFpEF, CAD-RADS = 1-2 increased a 2.5-time risk for non-fatal MI (adjusted HR: 2.5, 95% CI: 1.5 to 4.3, p < 0.001), while CAD-RADS ≥ 3 conferred 3.9-fold and 3.1-fold higher risk for cardiovascular mortality (adjusted HR: 3.9, 95% CI: 2.2 to 7.1, p < 0.001) and hospitalization due to HF (adjusted HR: 3.1, 95% CI: 1.9 to 5.3, p < 0.001) with reference to CAD-RADS = 0 respectively.
Conclusions:
Coronary artery disease is common in participants with HFpEF and associated with MACEs. Among those participants, the presence of CAD-RADS = 1-2 increased the risk of nonfatal MI, while CAD-RADS ≥ 3 were correlated with cardiovascular mortality and hospitalization due to HF.
Key Points:
• Higher median of CACS and higher CAD-RADS categories were observed in the HFpEF group than those without (p < 0.001 for both). • Participants with HFpEF exhibit a heightened risk of MACEs in CAD-RADS = 0, 1-2, and ≥ 3 respectively (p < 0.001 for all). • In the risk-adjusted hazard analysis among participants with HFpEF, CAD-RADS =1-2 increased a 2.5-time risk for non-fatal MI (adjusted HR: 2.5, 95% CI: 1.5 to 4.3, p < 0.001) with reference to CAD-RADS = 0 respectively.
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