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Title: Myocardial contractile dysfunction associated with increased 3-month and 1-year mortality in hospitalized patients with heart failure and preserved ejection fraction
Authors: Zhong, L.
Ng, K.K.C.
Sim, L.L.
Allen, J.C. 
Lau, Y.H.
Sim, D.K.L.
Lee, R.K.K.
Poh, K.K.
Chua, T.S.J. 
Kassab, G.S.
Kwok, B.W.K.
Tan, R.S. 
Keywords: Contractility
Heart failure
Normalized wall-stress
Issue Date: 3-Oct-2013
Citation: Zhong, L., Ng, K.K.C., Sim, L.L., Allen, J.C., Lau, Y.H., Sim, D.K.L., Lee, R.K.K., Poh, K.K., Chua, T.S.J., Kassab, G.S., Kwok, B.W.K., Tan, R.S. (2013-10-03). Myocardial contractile dysfunction associated with increased 3-month and 1-year mortality in hospitalized patients with heart failure and preserved ejection fraction. International Journal of Cardiology 168 (3) : 1975-1983. ScholarBank@NUS Repository.
Abstract: Background There is a clinical need for a contractility index that reflects myocardial contractile dysfunction even when ejection fraction (EF) is preserved. We used novel relative load-independent global and regional contractility indices to compare left ventricular (LV) contractile function in three groups: heart failure (HF) with preserved ejection fraction (HFPEF), HF with reduced ejection fraction (HFREF) and normal subjects. Also, we determined the associations of these parameters with 3-month and 1-year mortality in HFPEF patients. Methods 199 HFPEF patients [median age (IQR): 75 (67-80) years] and 327 HFREF patients [69 (59-76) years] were recruited following hospitalization for HF; 22 normal control subjects [65 (54-71) years] were recruited for comparison. All patients underwent standard two-dimensional Doppler and tissue Doppler echocardiography to characterize LV dimension, structure, global and regional contractile function. Results The median (IQR) global LV contractility index, dσ*/dtmax was 4.30 s- 1 (3.51-4.57 s- 1) in normal subjects but reduced in HFPEF [2.57 (2.08-3.64)] and HFREF patients [1.77 (1.34-2.30)]. Similarly, median (IQR) regional LV contractility index was 99% (88-104%) in normal subjects and reduced in HFPEF [81% (66-96%)] and HFREF [56% (41-71%)] patients. Multi-variable logistic regression analysis on HFPEF identified sc-mFS < 76% as the most consistent predictor of both 3-month (OR = 7.15, p < 0.05) and 1-year (OR = 2.57, p < 0.05) mortality after adjusting for medical conditions and other echocardiographic measurements. Conclusion Patients with HFPEF exhibited decreased LV global and regional contractility. This population-based study demonstrated that depressed regional contractility index was associated with higher 3-month and 1-year mortality in HFPEF patients. © 2013 Elsevier Ireland Ltd. All rights reserved.
Source Title: International Journal of Cardiology
ISSN: 01675273
DOI: 10.1016/j.ijcard.2012.12.084
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