Dataset Information

Cardiovascular phenotype and prognosis of patients with heart failure induced by cancer therapy.

ABSTRACT: OBJECTIVE:This study compared the clinical features, cardiac structure and function evaluated by echocardiography, cardiopulmonary response to exercise and long-term clinical outcomes between patients with heart failure (HF) induced by cancer therapy (CTHF) and heart failure not induced by cancer therapy (NCTHF). METHODS:We evaluated 75 patients with CTHF and 894 with NCTHF who underwent clinically indicated cardiopulmonary exercise testing, and followed these individuals for a median of 4.5 (3.0-5.8) years, during which 187 deaths and 256 composite events (death, heart transplantation and left ventricular (LV) assistant device implantation) occurred. RESULTS:Compared with NCTHF, patients with CTHF were younger, with lower prevalence of cardiovascular comorbidities, higher LV ejection fraction (LVEF), but similar global longitudinal strain. LV diastolic function (higher E/e' ratio) and compliance (higher end-diastolic pressure/LV end-diastolic volume index ratio) were worse in CTHF and were both associated with adverse outcomes. Despite a favourable clinical profile, peak VO2 and VE/VCO2 slope were similarly impaired in CTHF and NCTHF. In multivariable Cox regression analysis including clinical characteristics, cardiopulmonary exercise testing variables and LVEF, CTHF was associated with a significantly higher risk of death (HR 2.64; 95%?CI 1.53 to 4.55; p=0.001) and composite events (HR 1.79; 95%?CI 1.10 to 2.91; p=0.019) compared with NCTHF. CONCLUSIONS:CTHF is characterised by a distinct clinical profile, better LVEF but worse LV diastolic properties, and similarly impaired global longitudinal strain, functional capacity and ventilatory efficiency. Accounting for differences in clinical characteristics, CTHF was associated with worse long-term prognosis than NCTHF.

SUBMITTER: Nadruz W

PROVIDER: S-EPMC7333864 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Cardiovascular phenotype and prognosis of patients with heart failure induced by cancer therapy.

Nadruz Wilson W West Erin E Sengeløv Morten M Grove Gabriela L GL Santos Mário M Groarke John D JD Forman Daniel E DE Claggett Brian B Skali Hicham H Nohria Anju A Shah Amil M AM

Heart (British Cardiac Society) 20180515 1

<h4>Objective</h4>This study compared the clinical features, cardiac structure and function evaluated by echocardiography, cardiopulmonary response to exercise and long-term clinical outcomes between patients with heart failure (HF) induced by cancer therapy (CTHF) and heart failure not induced by cancer therapy (NCTHF).<h4>Methods</h4>We evaluated 75 patients with CTHF and 894 with NCTHF who underwent clinically indicated cardiopulmonary exercise testing, and followed these individuals for a me ...[more]

PMID: 29764969

Similar Datasets

Project description:BackgroundHeart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome, with several underlying etiologic and pathophysiologic factors. The presence of diabetes might identify an important phenotype, with implications for therapeutic strategies. While diabetes is associated with worse prognosis in HFpEF, the prognostic impact of glycemic control is yet unknown. Hence, we investigated phenotypic differences between diabetic and non-diabetic HFpEF patients (pts), and the prognostic impact of glycated hemoglobin (HbA1C).MethodsWe prospectively enrolled 183 pts with HFpEF (78?±?9 years, 38% men), including 70 (38%) diabetics (type 2 diabetes only). They underwent 2D echocardiography (n?=?183), cardiac magnetic resonance (CMR) (n?=?150), and were followed for a combined outcome of all-cause mortality and first HF hospitalization. The prognostic impact of diabetes and glycemic control were determined with Cox proportional hazard models, and illustrated by adjusted Kaplan Meier curves.ResultsDiabetic HFpEF pts were younger (76?±?9 vs 80?±?8 years, p?=?0.002), more obese (BMI 31?±?6 vs 27?±?6 kg/m2, p?=?0.001) and suffered more frequently from sleep apnea (18% vs 7%, p?=?0.032). Atrial fibrillation, however, was more frequent in non-diabetic pts (69% vs 53%, p?=?0.028). Although no echocardiographic difference could be detected, CMR analysis revealed a trend towards higher LV mass (66?±?18 vs 71?±?14 g/m2, p?=?0.07) and higher levels of fibrosis (53% vs 36% of patients had ECV by T1 mapping?>?33%, p?=?0.05) in diabetic patients. Over 25?±?12 months, 111 HFpEF pts (63%) reached the combined outcome (24 deaths and 87 HF hospitalizations). Diabetes was a significant predictor of mortality and hospitalization for heart failure (HR: 1.72 [1.1-2.6], p?=?0.011, adjusted for age, BMI, NYHA class and renal function). In diabetic patients, lower levels of glycated hemoglobin (HbA1C?<?7%) were associated with worse prognosis (HR: 2.07 [1.1-4.0], p?=?0.028 adjusted for age, BMI, hemoglobin and NT-proBNP levels).ConclusionOur study highlights phenotypic features characterizing diabetic patients with HFpEF. Notably, they are younger and more obese than their non-diabetic counterpart, but suffer less from atrial fibrillation. Although diabetes is a predictor of poor outcome in HFpEF, intensive glycemic control (HbA1C?<?7%) in diabetic patients is associated with worse prognosis.

Project description:ImportanceAdditional treatments are needed for heart failure with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 (SGLT2) inhibitors may be an effective treatment for patients with HFrEF, even those without diabetes.ObjectiveTo evaluate the effects of dapagliflozin in patients with HFrEF with and without diabetes.Design, setting, and participantsExploratory analysis of a phase 3 randomized trial conducted at 410 sites in 20 countries. Patients with New York Heart Association classification II to IV with an ejection fraction less than or equal to 40% and elevated plasma N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019.InterventionsAddition of once-daily 10 mg of dapagliflozin or placebo to recommended therapy.Main outcomes and measuresThe primary outcome was the composite of an episode of worsening heart failure or cardiovascular death. This outcome was analyzed by baseline diabetes status and, in patients without diabetes, by glycated hemoglobin level less than 5.7% vs greater than or equal to 5.7%.ResultsAmong 4744 patients randomized (mean age, 66 years; 1109 [23%] women; 2605 [55%] without diabetes), 4742 completed the trial. Among participants without diabetes, the primary outcome occurred in 171 of 1298 (13.2%) in the dapagliflozin group and 231 of 1307 (17.7%) in the placebo group (hazard ratio, 0.73 [95% CI, 0.60-0.88]). In patients with diabetes, the primary outcome occurred in 215 of 1075 (20.0%) in the dapagliflozin group and 271 of 1064 (25.5%) in the placebo group (hazard ratio, 0.75 [95% CI, 0.63-0.90]) (P value for interaction = .80). Among patients without diabetes and a glycated hemoglobin level less than 5.7%, the primary outcome occurred in 53 of 438 patients (12.1%) in the dapagliflozin group and 71 of 419 (16.9%) in the placebo group (hazard ratio, 0.67 [95% CI, 0.47-0.96]). In patients with a glycated hemoglobin of at least 5.7%, the primary outcome occurred in 118 of 860 patients (13.7%) in the dapagliflozin group and 160 of 888 (18.0%) in the placebo group (hazard ratio, 0.74 [95% CI, 0.59-0.94]) (P value for interaction = .72). Volume depletion was reported as an adverse event in 7.3% of patients in the dapagliflozin group and 6.1% in the placebo group among patients without diabetes and in 7.8% of patients in the dapagliflozin group and 7.8% in the placebo group among patients with diabetes. A kidney adverse event was reported in 4.8% of patients in the dapagliflozin group and 6.0% in the placebo group among patients without diabetes and in 8.5% of patients in the dapagliflozin group and 8.7% in the placebo group among patients with diabetes.Conclusions and relevanceIn this exploratory analysis of a randomized trial of patients with HFrEF, dapagliflozin compared with placebo, when added to recommended therapy, significantly reduced the risk of worsening heart failure or cardiovascular death independently of diabetes status.Trial registrationClinicalTrials.gov Identifier: NCT03036124.

Dataset Information

Cardiovascular phenotype and prognosis of patients with heart failure induced by cancer therapy.

Publications

Cardiovascular phenotype and prognosis of patients with heart failure induced by cancer therapy.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets