title: New echocardiographic predictors of clinical outcome in patients presenting with heart failure and a preserved left ventricular ejection fraction: a subanalysis of the Ka (Karolinska) Ren (Rennes) Study.
abstract: OBJECTIVE
  To identify electrocardiographic and echocardiographic predictors of mortality and hospitalizations for heart failure (HF) in the KaRen study.
  
  
  BACKGROUND
  KaRen is a prospective, observational study of the long-term outcomes of patients presenting with heart failure and a preserved ejection fraction (HFpEF).
  
  
  METHODS
  We identified 538 patients who presented with acute cardiac decompensation, a >100 pg/mL serum b-type natriuretic peptide (BNP) or >300 pg/mL N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration and a left ventricular ejection fraction (LVEF) >45%. After 4-8 weeks of standard treatment, 413 patients (mean age = 76 ± 9 years, 55.9% women) returned for analyses of their clinical status, laboratory screen, and detailed electrocardiographic and Doppler echocardiographic recordings. They were followed for a mean of 28 months thereafter. The primary study endpoint was time to death from all causes or first hospitalization for heart failure.
  
  
  RESULTS
  Mean LVEF was 62.4 ± 6.9% and median NT-proBNP 1410 pmol/L. PR interval >200 ms was present in 11.2% of patients and 14.9% had a >120 ms QRS duration, with left bundle branch block in only 6.3%. Over a mean follow-up of 28 months, 177 patients (42.9%) reached a primary study endpoint, including 61 deaths and 116 hospitalizations for heart failure. After adjustment for age, gender, New York Heart Association class, atrial fibrillation history, creatinine, sodium, BNP, ejection fraction, and right ventricular fractional shortening, only E/e' remained as a predictor, with a hazard ratio = 1.49 and P = 0.0012.
  
  
  CONCLUSIONS
  The incidence of hospitalizations for HF and deaths in KaRen was high and E/e' predicted adverse clinical outcomes. These observations should help in the risk stratification and therapy of HFpEF.
authors.affiliation: Cardiology department & CIC-IT U 804, Hôpital Pontchaillou-CHU Rennes, Rennes University Health Centre, rue Henri Le Guillou, 35000, Rennes, France.|LTSI, Rennes 1 University, INSERM 1099, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.affiliation: Clinical Investigation Center INSERM CIC-1414, CHU Rennes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.affiliation: Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Camilla
authors.initials: C
authors.lastname: Hage
authors.affiliation: Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Persson
authors.affiliation: LTSI, Rennes 1 University, INSERM 1099, Rennes, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Reynaud
authors.affiliation: Cardiology Department, Lille University Health Centre, Lille, France.
authors.forename: Pierre-Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.affiliation: Cardiology Department, Rouen University Health Centre, Rouen, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bauer
authors.affiliation: French Society of Cardiology, Paris, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Drouet
authors.affiliation: Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Linde
authors.affiliation: Cardiology department & CIC-IT U 804, Hôpital Pontchaillou-CHU Rennes, Rennes University Health Centre, rue Henri Le Guillou, 35000, Rennes, France.|LTSI, Rennes 1 University, INSERM 1099, Rennes, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Daubert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Heart failure; Left ventricular function; Preserved ejection fraction