Heart rate-corrected systolic ejection time: population-based reference values and differential prognostic utility in acute heart failure
Caroline Morbach1,2, Isabelle Simon1, Elisabeth Danner1
1Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.
Insights
Systolic ejection time indexed for heart rate (SETc) shows prognostic value in heart failure (HF). SETc changes predict outcomes differently in HF with reduced EF (HFrEF) and preserved EF (HFpEF), suggesting personalized HF treatment.
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.
Aims:
Systolic ejection time (SET) is discussed as a treatment target in patients with heart failure (HF) and a reduced left ventricular (LV) ejection fraction (EF). We derived reference values for SET correcting for its dependence on heart rate (SETc), and explored its prognostic utility in patients admitted with decompensated HF.
Methods And Results:
SETc was derived in 4836 participants of the population-based STAAB study (mean age 55 ± 12 years, 52% women). There, mean SETc was 328 ± 18 ms, increased with age (+4.7 ms per decade), was shorter in men than women (-14.9 ms), and correlated with arterial elastance (r = 0.30; all P < 0.001). In 134 patients hospitalized with acute HF, SETc at admission was shorter when compared with the general population and differed between patients with HF with reduced EF (HFrEF; LVEF ≤40%; 269 ± 35 ms), HF with mildly reduced EF (HFmrEF; LVEF 41-49%; 294 ± 27 ms), and HF with preserved EF (HFpEF; LVEF ≥50%; 317 ± 35 ms; P < 0.001). In proportional hazard regression, an in-hospital increase in SETc was associated with an age- and sex-adjusted hazard ratio of 0.38 (95% confidence interval 0.18-0.79) in patients with HFrEF, but a hazard ratio of 2.39 (95% confidence interval 1.24-4.64) in patients with HFpEF.
Conclusion:
In the general population, SETc increased with age and an elevated afterload. SETc was mildly reduced in patients hospitalized with HFpEF, but markedly reduced in patients with HFrEF. In-hospital prolongation of SETc predicted a favourable outcome in HFrEF, but an adverse outcome in HFpEF. Our results support the concept of a U-shaped relationship between cardiac systolic function and risk, providing a rationale for a more individualized treatment approach in patients with HF.
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