Retrospective Analysis of Factors Predicting Mortality in Heart Failure Patients with Preserved Ejection Fraction

Yıl 2024, Cilt: 7 Sayı: 2, 67 - 73, 29.06.2024

Fulya Odabaş Şükriye Miray Kılınçer Bozgül Devrim Bozkurt

https://doi.org/10.54996/anatolianjem.1473257

Öz

Aim: Heart failure with preserved ejection fraction
(HFpEF) is an important health problem with high morbidity and mortality rates in clinical practice. This study aims to retrospectively analyze the factors affecting mortality in patients with HFpEF.

Material and Methods: In this retrospective study, 105 patients with HFpEF were analyzed. Demographic characteristics, clinical data and laboratory results of the patients were evaluated and factors that may have an effect on mortality were analyzed by univariate and multivariate logistic regression analyses. Statistical significance level was accepted as p<0.05.

Results: As a result of the analysis, the need for vasopressor support(p=0.004) and the need for hemodialysis (p=0.007) were significantly associated with mortality. In addition, laboratory markers such as high levels of N- terminal-pro-brain natriuretic peptide, C-Reactive Protein and Lactate dehydrogenase were also found to be associated with mortality risk. Multivariate logistic regression analysis showed that changes in Δ% Creatinine and Δ% Hemoglobin levels independently affected mortality risk ( p=0.042 and p=0.023, respectively).

Conclusion: Our study provides a comprehensive analysis of factors that increase the risk of mortality in patients with HFpEF. It reveals that the need for vasopressor support and hemodialysis, as well as certain laboratory markers, should be considered in the management of these patients. The findings emphasize that future research should examine these factors in more depth and tailor treatment strategies for patients with HFpEF accordingly.

Anahtar Kelimeler

Mortality, Vasopressor, Heart Failure, Preserved Ejection Fraction

Etik Beyan

Ege Üniversitesi Hastanesi Etik Kurulu çalışmayı onaylamıştır ( 18-2/28 karar numarası ).

Korunmuş Ejeksiyon Fraksiyonlu Kalp Yetmezliği Hastalarında Mortaliteyi Belirleyen Faktörlerin Retrospektif Analizi

Öz

Amaç: Korunmuş ejeksiyon fraksiyonlu kalp yetmezliği, klinik pratiğinde yüksek morbidite ve mortalite oranlarına sahip olmasıyla önemli bir sağlık sorunudur. Bu çalışma, korunmuş ejeksiyon fraksiyonlu kalp yetmezliği tanılı hastalarda mortaliteyi etkileyen faktörleri retrospektif olarak analiz etmeyi amaçlamaktadır.

Gereç ve Yöntem: Bu retrospektif çalışmada 105 hasta incelenmiştir. Hastaların demografik özellikleri, klinik verileri ve laboratuvar sonuçları değerlendirilmiş; mortalite üzerinde etkili olabilecek faktörler tek ve çok değişkenli lojistik regresyon analizleri ile analiz edilmiştir. İstatistiksel anlamlılık düzeyi p<0.05 olarak kabul edilmiştir.

Bulgular: Analiz sonucunda, vazopressor destek gereksinimi (p=0.004) ve hemodiyaliz ihtiyacı ( p=0.007) mortalite ile anlamlı olarak ilişkili bulunmuştur. Ayrıca, yüksek N-terminal-pro-brain natriüretik peptit, C-Reaktif Protein ve Laktat dehidrogenaz düzeyleri gibi laboratuvar belirteçlerinin de mortalite riski ile ilişkili olduğu tespit edilmiştir. Çok değişkenli lojistik regresyon analizi, Δ% Kreatinin ve Δ% Hemoglobin düzeylerindeki değişikliklerin mortalite riskini bağımsız olarak etkilediğini göstermiştir (sırasıyla p=0.042 ve p=0.023).

Sonuç: Çalışmamız, korunmuş ejeksiyon fraksiyonlu kalp yetmezliği tanılı hastalarda mortalite riskini artıran faktörlerin kapsamlı bir analizini sunmaktadır. Vasopressor desteği ve hemodiyaliz ihtiyacının yanı sıra belirli laboratuvar belirteçlerinin de bu hastaların yönetiminde dikkate alınması gerektiğini ortaya koymaktadır. Bulgular, gelecekteki araştırmalarda bu faktörlerin daha derinlemesine incelenmesi ve korunmuş ejeksiyon fraksiyonlu kalp yetmezliği hastalarının tedavi stratejilerinin buna göre düzenlenmesi gerektiğini vurgulamaktadır.

Anahtar Kelimeler

Mortalite, Vazopressor, Kalp Yetmezliği, Korunmuş Ejeksiyon Fraksiyonu

Etik Beyan

Ege Üniversitesi Hastanesi Etik Kurulu çalışmayı onaylamıştır ( 18-2/28 karar numarası ).

Destekleyen Kurum

Bu çalışma herhangi bir finansal destek almamıştır.

Kaynakça

• Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J. 2011;32(6):670-9.
• Ponikowski P, Voors AA, Anker SD, et al. 2016 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200.
• Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta- analysis. Eur Heart J. 2012;33(14):1750-7.
• Torre-Amione G. Immune activation in chronic heart failure. Am J Cardiol. 2005;95(11):3–8.
• Tschöpe C, Birner C, Böhm M, et al. Heart failure with preserved ejection fraction: current management and future strategies : Expert opinion on the behalf of the Nucleus of the "Heart Failure Working Group" of the German Society of Cardiology (DKG). Clin Res Cardiol. 2018;107(1):1-19.
• Nair N. Epidemiology and pathogenesis of heart failure with preserved ejection fraction. Rev Cardiovasc Med. 2020;21(4):531-40.
• Borlaug BA, Sharma K, Shah SJ, et al. Heart Failure With Preserved Ejection Fraction: JACC Scientific Statement. J Am Coll Cardiol. 2023;81(18):1810-34.
• Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251-9.
• Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14.
• Lamiere N, Levin A, Kellum JA, et al. Harmonizing acute and chronic kidney disease definition and classification: report of a kidney disease: improving global outcomes (kdigo) consensus conference. Kidney Int. 2021;100(3):516-26.
• Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
• Yancy CW, Lopatin M, Stevenson LW, et al. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol. 2006; 47:76.
• Kristensen SL, Mogensen UM, Jhund PS, et al. Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients With Heart Failure and Preserved Ejection Fraction: A Report From the I-Preserve Trial (Irbesartan in Heart Failure With Preserved Ejection Fraction). 2017;135(8):724-35.
• Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525– 33.
• Granger CB, McMurray JJV, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet. 2003;362(9386):772-76.
• Ovidiu Chioncel, Mitja Lainscak, Petar M. Seferovic, et all. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(12):1574-85.
• Jentzer JC, Reddy YN, Rosenbaum AN, et all. Outcomes and Predictors of Mortality Among Cardiac Intensive Care Unit Patients With Heart Failure. J Card Fail. 2022;28(7):1088-99.
• Campbell P, Rutten FH, Lee MM, et al. Heart failure with preserved ejection fraction: everything the clinician needs to know. Lancet. 2024;403(10431):1083-92.
• Nagai T, Yoshikawa T, Saito Y, et al. Clinical Characteristics, Management, and Outcomes of Japanese Patients Hospitalized for Heart Failure With Preserved Ejection Fraction - A Report From the Japanese Heart Failure Syndrome With Preserved Ejection Fraction (JASPER) Registry. Circ J. 2018;82(6):1534-45.
• Kang J, Park JJ, Cho YJ, et all. Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry. J Am Heart Assoc. 2018;7(6):e007910.
• Bakhshaliev AB, Dadashova GM, Bakhshalieva GI, et al. Gender-related features of risk factors for, and age- and gender-related differences in the severity and genesis of chronic heart failure. Ter Arkh. 2015;87(4):13-8.
• Oremus M, Don-Wauchope A, McKelvie R, et al. BNP and NT-proBNP as prognostic markers in persons with chronic stable heart failure. Heart Fail Rev. 2014;19(4):471-505.
• Bettari L, Fiuzat M, Shaw LK, et al. Hyponatremia and long-term outcomes in chronic heart failure: An observational study from the Duke Databank for Cardiovascular Diseases. J Card Fail. 2012;18(1):74-81.
• Kusaka H, Sugiyama S, Yamamoto E, et al. Low-Normal Serum Sodium and Heart Failure-Related Events in Patients With Heart Failure With Preserved Left Ventricular Ejection Fraction. Circ J. 2016;80(2):411-7.
• Uthamalingam S, Patvardhan EA, Subramanian S, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol. 2011;107(3):433-8.
• Rudiger A, Burckhardt OA, Harpes P, et al. The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med. 2006;24(4):451-4.
• Acanfora D, Gheorghiade M, Trojano L, et al. Relative lymphocyte count: a prognostic indicator of mortality in elderly patients with congestive heart failure. Am Heart J. 2001;142:167–73.