Heart rate-corrected systolic ejection time: population-based reference values and differential prognostic utility in...

Area of Science:

• Cardiology
• Heart Failure Pathophysiology
• Clinical Prognostics

Background:

• Systolic ejection time (SET) is a potential therapeutic target in heart failure (HF) with reduced left ventricular ejection fraction (LVEF).
• Heart rate correction is crucial for accurate SET assessment, leading to the derivation of SET indexed for heart rate (SETc).
• Understanding SETc's prognostic utility in decompensated HF is essential for refining treatment strategies.

Purpose of the Study:

• To derive reference values for SETc in a general population, accounting for age and sex.
• To investigate the prognostic significance of SETc in patients hospitalized with acute decompensated heart failure.
• To explore differential SETc values and prognostic implications across HF phenotypes (HFrEF, HFmrEF, HFpEF).

Main Methods:

• SETc reference values were established using data from 4836 participants in the population-based STAAB study.
• SETc was measured at admission in 134 patients hospitalized with acute HF.
• Proportional hazard regression models were employed to assess the association between in-hospital SETc changes and patient outcomes.

Main Results:

• In the general population, SETc increased with age, was shorter in men than women, and correlated with arterial elastance.
• Patients with HF exhibited lower SETc compared to the general population, with marked reductions in HFrEF and milder reductions in HFpEF.
• An in-hospital increase in SETc predicted a favorable outcome in HFrEF (HR 0.38) but an adverse outcome in HFpEF (HR 2.39).

Conclusions:

• SETc is reduced in HF patients, particularly those with HFrEF, and its prognostic implications vary by HF phenotype.
• In-hospital changes in SETc can predict clinical outcomes in HF, with opposite trends observed for HFrEF and HFpEF.
• These findings support a U-shaped relationship between cardiac systolic function and risk, advocating for individualized HF treatment approaches.