Relationship of ejection fraction and natriuretic peptide trajectories in heart failure with baseline reduced and mid-range ejection fraction - 26/11/21
, Patrick Stafford, MD a, Olusola Laja, MD a, Comfort Elumogo, MD a, Persey Bediako, MD a, Nora Tolbert, MD a, Douglas Sawch, MD a, Sthuthi David, MD, MS a, Nishtha Sodhi, MD a, Anita Barber, BS a, Younghoon Kwon, MD b, Nishaki Mehta, MD c, Brandy Patterson, MD a, Khadijah Breathett, MD, MS d, Sula Mazimba, MD, MPH aAbstract |
Background |
The prognostic importance of trajectories of neurohormones relative to left ventricular function over time in heart failure with reduced and mid-range EF (HFrEF and HFmrEF) is poorly defined.
Objective |
To evaluate left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP) trajectories in HFrEF and HFmrEF.
Methods |
Analyses of LVEF and BNP trajectories after incident HF admissions presenting with abnormal LV systolic function were performed using 3 methods: a Cox proportional hazards model with time-varying covariates, a dual longitudinal-survival model with shared random effects, and an unsupervised analysis to capture 3 discrete trajectories for each parameter.
Results |
Among 1,158 patients (68.9 ± 13.0 years, 53.3% female), both time-varying LVEF measurements (P=.001) and log-transformed BNP measurements (p-values=2 × 10−16) were independently associated with survival during 6 years after covariate adjustment. In the dual longitudinal/survival model, both LVEF and BNP trajectories again were independently associated with survival (P<.0001 in each model); however, LVEF was more dynamic than BNP (P <.0001 for time covariate in LVEF longitudinal model versus P=.88 for the time covariate in BNP longitudinal model). In the unsupervised analysis, 3 discrete LVEF trajectories (dividing the cohort into approximately thirds) and 3 discrete BNP trajectories were identified. Discrete LVEF and BNP trajectories had independent prognostic value in Kaplan-Meier analyses (P<.0001), and substantial membership variability across BNP and LVEF trajectories was noted.
Conclusion |
Although LVEF trajectories have greater temporal variation, BNP trajectories provide additive prognostication and an even stronger association with survival times in heart failure patients with abnormal LV systolic function.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Dual Trajectory Analysis for Prognosis in Heart Failure. Trajectory analyses based on the survival model with time-varying covariates and the dual longitudinal-survival model with shared random effects were performed, then an unsupervised analysis based on discrete trajectories was performed. The 3 discrete LVEF trajectories, the 3 BNP trajectories, and their associations with prognosis are shown.
Abbreviations : ACE inhibitor, ARB, ARNI, BB, BNP, BUN, COPD, HF, HFmrEF, HFpEF, HFrEF, LVEF, NT-proBNP
Plan
Vol 243
P. 1-10 - janvier 2022 Retour au numéro
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