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

Autor:	Morbach C; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany., Simon I; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany., Danner E; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany., Gelbrich G; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Institute of Clinical Epidemiology and Biometry, University Würzburg, Joseph-Schneider-Str. 2, 97080 Würzburg, Germany.; Clinical Trial Center, University Hospital Würzburg, Joseph-Schneider-Str. 2, 97080 Würzburg, Germany., Stefenelli U; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany., Sahiti F; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany., Scholz N; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany., Cejka V; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany., Albert J; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany., Ertl G; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany., Angermann CE; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany., Güder G; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany., Frantz S; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany., Heuschmann PU; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Institute of Clinical Epidemiology and Biometry, University Würzburg, Joseph-Schneider-Str. 2, 97080 Würzburg, Germany.; Clinical Trial Center, University Hospital Würzburg, Joseph-Schneider-Str. 2, 97080 Würzburg, Germany., Maack C; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany., Störk S; Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.; Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany.
Jazyk:	angličtina
Zdroj:	European heart journal. Imaging methods and practice [Eur Heart J Imaging Methods Pract] 2023 Sep 12; Vol. 1 (2), pp. qyad020. Date of Electronic Publication: 2023 Sep 12 (Print Publication: 2023).
DOI:	10.1093/ehjimp/qyad020
Abstrakt:	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. Competing Interests: Conflicts of interest: C.M. reports research cooperation with the University of Würzburg and Tomtec Imaging Systems funded by a research grant from the Bavarian Ministry of Economic Affairs, Regional Development and Energy, Germany; advisory and speakers honoraria as well as travel grants from Amgen, Tomtec, Alnylam, Sobi, Alexion, Janssen, Pfizer, and EBR Systems; principal investigator in trials sponsored by Alnylam, AstraZeneca, and Bayer. J.A. reports a clinician scientist scholarship from the Interdisciplinary Center for Clinical Research (IZKF) at the University of Würzburg. G.Ge. reports research cooperation with the University Hospital Würzburg and Tomtec Imaging Systems funded by a research grant from the Bavarian Ministry of Economic Affairs, Regional Development and Energy, Germany. Ch.M. reports honoraria for medical advice and speaker duties from Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Berlin Chemie, Bayer, Edwards, NovoNordisk, Novartis, and Servier. S.S. is supported by the CHFC Würzburg, and by the German Federal Ministry of Education and Research (BMBF). He has received consultancy and lecture fees as well as reimbursement of travel costs from AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Pfizer, and Servier. The rest of the authors have no conflicts of interest regarding the present work. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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