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Circulating troponin and further left ventricular ejection fraction improvement in patients with previously recovered left ventricular ejection fraction.
ESC Heart Fail. 2020 Jun 27 [Online ahead of print]EH

Abstract

AIMS

The aim of this study is to determine factors associated with long-term recovery of left ventricular ejection fraction (LVEF) in patients with heart failure with reduced EF (HFrEF) and if further recovery also occurs in this group.

METHODS AND RESULTS

Among 621 participants enrolled in the Alberta Heart Failure Etiology and Analysis Team (HEART) Study, 316 with Stage C HF underwent comprehensive imaging and biomarker testing at enrolment and at 1-year follow up. Using pre-enrolment data, HF with recovered EF (HFrecEF) was defined as an absolute improvement ≥5% in LVEF from the prior lowest LVEF value, with a final LVEF value > 35% at or prior to study baseline. Participants with all LVEF > 40% were included for comparison. Hospitalization-free survival to 5 years was performed. The median cohort age was 66 years, and time from diagnosis was 4 years; 82% were male patients. Of the 316 patients, 95 (30%) patients had HFrecEF and 56 (18%) patients pHFrEF. On multivariate analysis, only shorter duration of HF was predictive of HFrecEF status. Over 1 year, LVEF increased in the HFrecEF group 4.0% (0.15-7.90, P = 0.042) as compared with persistent HFrEF, who in turn demonstrated higher baseline serum high sensitivity Troponin-T with further increase at follow up 0.55(0.33-0.86, P = 0.011). No change in any parameter in the HFpEF/HFmrEF group at follow up was observed.

CONCLUSIONS

Patients with HFrecEF demonstrate evidence of additional late improvement in LVEF and unchanged troponin levels, in contrast to those with persistent HFrEF, where LVEF does not improve and serum troponin rises over time. These data help to inform mechanisms relating to late LV remodelling.

Authors+Show Affiliations

Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada.Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada.Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32592541

Citation

Howlett, Jonathan G., et al. "Circulating Troponin and Further Left Ventricular Ejection Fraction Improvement in Patients With Previously Recovered Left Ventricular Ejection Fraction." ESC Heart Failure, 2020.
Howlett JG, Sharma N, Alemayehu WG, et al. Circulating troponin and further left ventricular ejection fraction improvement in patients with previously recovered left ventricular ejection fraction. ESC Heart Fail. 2020.
Howlett, J. G., Sharma, N., Alemayehu, W. G., Dyck, J. R. B., Anderson, T., Fine, N., Becker, H., White, J. A., Paterson, D. I., Thompson, R. B., Oudit, G. Y., Haykowsky, M. J., & Ezekowitz, J. A. (2020). Circulating troponin and further left ventricular ejection fraction improvement in patients with previously recovered left ventricular ejection fraction. ESC Heart Failure. https://doi.org/10.1002/ehf2.12863
Howlett JG, et al. Circulating Troponin and Further Left Ventricular Ejection Fraction Improvement in Patients With Previously Recovered Left Ventricular Ejection Fraction. ESC Heart Fail. 2020 Jun 27; PubMed PMID: 32592541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Circulating troponin and further left ventricular ejection fraction improvement in patients with previously recovered left ventricular ejection fraction. AU - Howlett,Jonathan G, AU - Sharma,Nakul, AU - Alemayehu,Wendimagegn G, AU - Dyck,Jason R B, AU - Anderson,Todd, AU - Fine,Nowell, AU - Becker,Harald, AU - White,James A, AU - Paterson,D Ian, AU - Thompson,Richard B, AU - Oudit,Gavin Y, AU - Haykowsky,Mark J, AU - Ezekowitz,Justin A, Y1 - 2020/06/27/ PY - 2020/05/25/received PY - 2020/06/09/accepted PY - 2020/6/28/entrez KW - Biomarkers KW - Heart failure KW - Left ventricular remodelling KW - Troponin JF - ESC heart failure JO - ESC Heart Fail N2 - AIMS: The aim of this study is to determine factors associated with long-term recovery of left ventricular ejection fraction (LVEF) in patients with heart failure with reduced EF (HFrEF) and if further recovery also occurs in this group. METHODS AND RESULTS: Among 621 participants enrolled in the Alberta Heart Failure Etiology and Analysis Team (HEART) Study, 316 with Stage C HF underwent comprehensive imaging and biomarker testing at enrolment and at 1-year follow up. Using pre-enrolment data, HF with recovered EF (HFrecEF) was defined as an absolute improvement ≥5% in LVEF from the prior lowest LVEF value, with a final LVEF value > 35% at or prior to study baseline. Participants with all LVEF > 40% were included for comparison. Hospitalization-free survival to 5 years was performed. The median cohort age was 66 years, and time from diagnosis was 4 years; 82% were male patients. Of the 316 patients, 95 (30%) patients had HFrecEF and 56 (18%) patients pHFrEF. On multivariate analysis, only shorter duration of HF was predictive of HFrecEF status. Over 1 year, LVEF increased in the HFrecEF group 4.0% (0.15-7.90, P = 0.042) as compared with persistent HFrEF, who in turn demonstrated higher baseline serum high sensitivity Troponin-T with further increase at follow up 0.55(0.33-0.86, P = 0.011). No change in any parameter in the HFpEF/HFmrEF group at follow up was observed. CONCLUSIONS: Patients with HFrecEF demonstrate evidence of additional late improvement in LVEF and unchanged troponin levels, in contrast to those with persistent HFrEF, where LVEF does not improve and serum troponin rises over time. These data help to inform mechanisms relating to late LV remodelling. SN - 2055-5822 UR - https://www.unboundmedicine.com/medline/citation/32592541/Circulating_troponin_and_further_left_ventricular_ejection_fraction_improvement_in_patients_with_previously_recovered_left_ventricular_ejection_fraction L2 - https://doi.org/10.1002/ehf2.12863 DB - PRIME DP - Unbound Medicine ER -
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