Prognostic factors of heart failure with preserved ejection fraction: a 12-year prospective cohort follow-up study.
BACKGROUND
Although heart failure with preserved ejection fraction (HFpEF) is a clinically important issue, the factors that affect its prognosis are still unclear. The aim of this study was to establish prognostic factors and develop a severity scale for the disease based on a long-term follow-up cohort of HFpEF patients.


METHODS
The study included 438 HFpEF patients, as confirmed via echocardiography. Baseline characteristics, including echocardiographic findings and genetic polymorphisms, were determined. Patients were followed-up for up to 12 years. Kaplan-Meier curves and Cox regression models were used to determine the risk factors for mortality and major cardiovascular events (MACE). A severity scale was established using the significant risk factors. The receiver operating characteristics (ROC) curves for the scale were plotted.


RESULTS
The prescription of angiotensin-converting enzyme (ACE) inhibitors [hazard ratio (HR) 0.28; 95% confidence interval (CI): 0.13-0.58 for mortality] and calcium channel blockers (CCB) was associated with a significant decrease in overall mortality and MACE. Echocardiographic E/Em ratio and ACE gene D polymorphisms were powerful factors associated with both mortality and MACE [(E/Em; HR 1.66; 95% CI: 1.32-2.29 for mortality) and (ACE gene D allele, HR 1.99; 95% CI: 1.26-3.16 for mortality)]. The ROC curves indicated a good diagnostic efficiency for severity scores (area under the curve 0.72).


CONCLUSIONS
In a long-term follow-up cohort of HFpEF patients, simple clinical, echocardiographic, medication, and even genetic variables were associated with MACE or mortality, and the developed composite severity scale identified patients with a higher probability of experiencing the events.
Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Cho-Kai
CK
Wu
Department of Laboratory Medicine, National Taiwan University Hospital, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan; Department of Clinical Pathology and Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Jen-Kuang
JK
Lee
Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taiwan.
Fu-Tien
FT
Chiang
Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan.
Lian-Yu
LY
Lin
Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan.
Jou-Wei
JW
Lin
Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan.
Juey-Jen
JJ
Hwang
Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan.
Chuen-Den
CD
Tseng
Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan. Electronic address: cttsai@ntuh.gov.tw.
Chia-Ti
CT
Tsai
D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors
Cohort studies; Genetic; Heart failure with preserved ejection fraction; Long-term prognosis