TY - JOUR
T1 - Relationship of ejection fraction and natriuretic peptide trajectories in heart failure with baseline reduced and mid-range ejection fraction
AU - Bilchick, Kenneth C.
AU - Stafford, Patrick
AU - Laja, Olusola
AU - Elumogo, Comfort
AU - Bediako, Persey
AU - Tolbert, Nora
AU - Sawch, Douglas
AU - David, Sthuthi
AU - Sodhi, Nishtha
AU - Barber, Anita
AU - Kwon, Younghoon
AU - Mehta, Nishaki
AU - Patterson, Brandy
AU - Breathett, Khadijah
AU - Mazimba, Sula
N1 - Funding Information:
This work was supported by grant R56 HL135556 from the National Heart, Lung, and Blood Institute (NHLBI) (Dr. Bilchick). Other support for Dr. Bilchick includes grants R21 HL140445 , R01 HL147104 , and U01 HL127654 from the NHLBI and grant 18TPA34170579 from the American Heart Association. Dr. Breathett is supported by grants K01HL142848 , R25HL126146 subaward 11692sc , and L30HL148881 from the NHLBI , a University of Arizona Health Sciences, Strategic Priorities Faculty Initiative Grant, a University of Arizona, Sarver Heart Center, Novel Research Project Award in the Area of Cardiovascular Disease and Medicine, Anthony and Mary Zoia Research Award, and a Women as One award.
Funding Information:
Dr. Bilchick has research grant support from Medtronic and Siemens Healthineers.
Publisher Copyright:
© 2021
PY - 2022/1
Y1 - 2022/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ahj.2021.08.015
DO - 10.1016/j.ahj.2021.08.015
M3 - Article
C2 - 34453882
AN - SCOPUS:85122487930
VL - 243
SP - 1
EP - 10
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -