The limited prognostic role of echocardiograms in short-term follow-up after acute decompensated heart failure

An analysis of the Korean Heart Failure (KorHF) Registry

Sung Hea Kim, Hyun Joong Kim, Seongwoo Han, Byungsu Yoo, Dong Ju Choi, Jae Joong Kim, Eun Seok Jeon, Myeong Chan Cho, Shung Chull Chae, Kyu Hyung Ryu

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Abstract

Background The prognostic values of the left ventricular ejection fraction (LVEF) and end-diastolic dimension (LVEDD) have primarily been shown among patients with chronic heart failure (HF), with little representation of patients with acute HF (AHF). Therefore, we investigated the value of these echocardiographic parameters in predicting clinical outcomes among patients in the Korean Heart Failure (KorHF) Registry. Methods The KorHF Registry consists of 3,200 patients who were hospitalized with AHF from 2005 to 2009. The Kaplan-Meier method was used to estimate survival and readmission, and differences were assessed using the log-rank test. Predictors of survival were identified using univariate and multivariate Cox proportional hazards regression analyses. Results Echocardiograms from 2,910 of the 3,200 patients (90.9%) were evaluated. The median LVEF and LVEDD (37% and 56 mm, respectively) were used as cut-offs for the binary transformation of each parameter. The cumulative death-free survival rates for all patients did not significantly differ based on LVEF or LVEDD quartiles; however, an LVEF greater than the median was associated with a better prognosis in ischemic HF patients (log-rank test; p = 0.039). Among ischemic HF patients, LVEF (dichotomized) was a significant predictor of death in a Cox model after adjusting for a history of HF, age, systolic blood pressure (SBP), serum sodium, sex, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), acute myocardial infarction (AMI), atrial fibrillation (Af) and anemia (hazard ratio (HR) 1.475, 95% confidence interval (CI) 1.099–1.979, p = 0.010). The cumulative readmission-free survival rates significantly differed among ischemic HF patients only when based on LVEDD quartiles (log-rank test; p = 0.001). In multivariate Cox proportional hazards regression analyses, LVEDD (dichotomized) remained a significant variable only among patients with ischemic HF after adjusting for sex, age, AMI, DM, COPD, serum sodium, SBP, blood urea nitrogen (BUN) and anemia (HR 1.401, 95% CI 1.067–1.841, p = 0.015). Conclusions Among ischemic AHF patients in the KorHF Registry, LVEF is associated with mortality, whereas LVEDD is only associated with readmission in a binary transformed form.

Original languageEnglish
Article numbere0188938
JournalPloS one
Volume12
Issue number12
DOIs
Publication statusPublished - 2017 Dec 1

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heart failure
Failure analysis
Registries
Heart Failure
Stroke Volume
Hazards
Pulmonary diseases
Blood Pressure
Blood pressure
Medical problems
myocardial infarction
systolic blood pressure
diabetes mellitus
blood serum
anemia
respiratory tract diseases
Chronic Obstructive Pulmonary Disease
Anemia
confidence interval
Diabetes Mellitus

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Kim, Sung Hea ; Kim, Hyun Joong ; Han, Seongwoo ; Yoo, Byungsu ; Choi, Dong Ju ; Kim, Jae Joong ; Jeon, Eun Seok ; Cho, Myeong Chan ; Chae, Shung Chull ; Ryu, Kyu Hyung. / The limited prognostic role of echocardiograms in short-term follow-up after acute decompensated heart failure : An analysis of the Korean Heart Failure (KorHF) Registry. In: PloS one. 2017 ; Vol. 12, No. 12.
@article{1192af12713d4a4daf1c1f17b83a8a3c,
title = "The limited prognostic role of echocardiograms in short-term follow-up after acute decompensated heart failure: An analysis of the Korean Heart Failure (KorHF) Registry",
abstract = "Background The prognostic values of the left ventricular ejection fraction (LVEF) and end-diastolic dimension (LVEDD) have primarily been shown among patients with chronic heart failure (HF), with little representation of patients with acute HF (AHF). Therefore, we investigated the value of these echocardiographic parameters in predicting clinical outcomes among patients in the Korean Heart Failure (KorHF) Registry. Methods The KorHF Registry consists of 3,200 patients who were hospitalized with AHF from 2005 to 2009. The Kaplan-Meier method was used to estimate survival and readmission, and differences were assessed using the log-rank test. Predictors of survival were identified using univariate and multivariate Cox proportional hazards regression analyses. Results Echocardiograms from 2,910 of the 3,200 patients (90.9{\%}) were evaluated. The median LVEF and LVEDD (37{\%} and 56 mm, respectively) were used as cut-offs for the binary transformation of each parameter. The cumulative death-free survival rates for all patients did not significantly differ based on LVEF or LVEDD quartiles; however, an LVEF greater than the median was associated with a better prognosis in ischemic HF patients (log-rank test; p = 0.039). Among ischemic HF patients, LVEF (dichotomized) was a significant predictor of death in a Cox model after adjusting for a history of HF, age, systolic blood pressure (SBP), serum sodium, sex, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), acute myocardial infarction (AMI), atrial fibrillation (Af) and anemia (hazard ratio (HR) 1.475, 95{\%} confidence interval (CI) 1.099–1.979, p = 0.010). The cumulative readmission-free survival rates significantly differed among ischemic HF patients only when based on LVEDD quartiles (log-rank test; p = 0.001). In multivariate Cox proportional hazards regression analyses, LVEDD (dichotomized) remained a significant variable only among patients with ischemic HF after adjusting for sex, age, AMI, DM, COPD, serum sodium, SBP, blood urea nitrogen (BUN) and anemia (HR 1.401, 95{\%} CI 1.067–1.841, p = 0.015). Conclusions Among ischemic AHF patients in the KorHF Registry, LVEF is associated with mortality, whereas LVEDD is only associated with readmission in a binary transformed form.",
author = "Kim, {Sung Hea} and Kim, {Hyun Joong} and Seongwoo Han and Byungsu Yoo and Choi, {Dong Ju} and Kim, {Jae Joong} and Jeon, {Eun Seok} and Cho, {Myeong Chan} and Chae, {Shung Chull} and Ryu, {Kyu Hyung}",
year = "2017",
month = "12",
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doi = "10.1371/journal.pone.0188938",
language = "English",
volume = "12",
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issn = "1932-6203",
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The limited prognostic role of echocardiograms in short-term follow-up after acute decompensated heart failure : An analysis of the Korean Heart Failure (KorHF) Registry. / Kim, Sung Hea; Kim, Hyun Joong; Han, Seongwoo; Yoo, Byungsu; Choi, Dong Ju; Kim, Jae Joong; Jeon, Eun Seok; Cho, Myeong Chan; Chae, Shung Chull; Ryu, Kyu Hyung.

In: PloS one, Vol. 12, No. 12, e0188938, 01.12.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The limited prognostic role of echocardiograms in short-term follow-up after acute decompensated heart failure

T2 - An analysis of the Korean Heart Failure (KorHF) Registry

AU - Kim, Sung Hea

AU - Kim, Hyun Joong

AU - Han, Seongwoo

AU - Yoo, Byungsu

AU - Choi, Dong Ju

AU - Kim, Jae Joong

AU - Jeon, Eun Seok

AU - Cho, Myeong Chan

AU - Chae, Shung Chull

AU - Ryu, Kyu Hyung

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background The prognostic values of the left ventricular ejection fraction (LVEF) and end-diastolic dimension (LVEDD) have primarily been shown among patients with chronic heart failure (HF), with little representation of patients with acute HF (AHF). Therefore, we investigated the value of these echocardiographic parameters in predicting clinical outcomes among patients in the Korean Heart Failure (KorHF) Registry. Methods The KorHF Registry consists of 3,200 patients who were hospitalized with AHF from 2005 to 2009. The Kaplan-Meier method was used to estimate survival and readmission, and differences were assessed using the log-rank test. Predictors of survival were identified using univariate and multivariate Cox proportional hazards regression analyses. Results Echocardiograms from 2,910 of the 3,200 patients (90.9%) were evaluated. The median LVEF and LVEDD (37% and 56 mm, respectively) were used as cut-offs for the binary transformation of each parameter. The cumulative death-free survival rates for all patients did not significantly differ based on LVEF or LVEDD quartiles; however, an LVEF greater than the median was associated with a better prognosis in ischemic HF patients (log-rank test; p = 0.039). Among ischemic HF patients, LVEF (dichotomized) was a significant predictor of death in a Cox model after adjusting for a history of HF, age, systolic blood pressure (SBP), serum sodium, sex, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), acute myocardial infarction (AMI), atrial fibrillation (Af) and anemia (hazard ratio (HR) 1.475, 95% confidence interval (CI) 1.099–1.979, p = 0.010). The cumulative readmission-free survival rates significantly differed among ischemic HF patients only when based on LVEDD quartiles (log-rank test; p = 0.001). In multivariate Cox proportional hazards regression analyses, LVEDD (dichotomized) remained a significant variable only among patients with ischemic HF after adjusting for sex, age, AMI, DM, COPD, serum sodium, SBP, blood urea nitrogen (BUN) and anemia (HR 1.401, 95% CI 1.067–1.841, p = 0.015). Conclusions Among ischemic AHF patients in the KorHF Registry, LVEF is associated with mortality, whereas LVEDD is only associated with readmission in a binary transformed form.

AB - Background The prognostic values of the left ventricular ejection fraction (LVEF) and end-diastolic dimension (LVEDD) have primarily been shown among patients with chronic heart failure (HF), with little representation of patients with acute HF (AHF). Therefore, we investigated the value of these echocardiographic parameters in predicting clinical outcomes among patients in the Korean Heart Failure (KorHF) Registry. Methods The KorHF Registry consists of 3,200 patients who were hospitalized with AHF from 2005 to 2009. The Kaplan-Meier method was used to estimate survival and readmission, and differences were assessed using the log-rank test. Predictors of survival were identified using univariate and multivariate Cox proportional hazards regression analyses. Results Echocardiograms from 2,910 of the 3,200 patients (90.9%) were evaluated. The median LVEF and LVEDD (37% and 56 mm, respectively) were used as cut-offs for the binary transformation of each parameter. The cumulative death-free survival rates for all patients did not significantly differ based on LVEF or LVEDD quartiles; however, an LVEF greater than the median was associated with a better prognosis in ischemic HF patients (log-rank test; p = 0.039). Among ischemic HF patients, LVEF (dichotomized) was a significant predictor of death in a Cox model after adjusting for a history of HF, age, systolic blood pressure (SBP), serum sodium, sex, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), acute myocardial infarction (AMI), atrial fibrillation (Af) and anemia (hazard ratio (HR) 1.475, 95% confidence interval (CI) 1.099–1.979, p = 0.010). The cumulative readmission-free survival rates significantly differed among ischemic HF patients only when based on LVEDD quartiles (log-rank test; p = 0.001). In multivariate Cox proportional hazards regression analyses, LVEDD (dichotomized) remained a significant variable only among patients with ischemic HF after adjusting for sex, age, AMI, DM, COPD, serum sodium, SBP, blood urea nitrogen (BUN) and anemia (HR 1.401, 95% CI 1.067–1.841, p = 0.015). Conclusions Among ischemic AHF patients in the KorHF Registry, LVEF is associated with mortality, whereas LVEDD is only associated with readmission in a binary transformed form.

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