Abstract 18532: New Prognostic Factors in Heart Failure With Preserved Ejection Fraction: The KaRen Study
KaRen was a prospective multicentre study identifying predictors of outcome in patients with Heart Failure and preserved Ejection Fraction (HFpEF).
Method: 539 patients were included following an acute HF presentation accompanied with BNP> 100 pg/mL or NT-proBNP>300 pg/mL and LVEF > 45%. 438 patients were reassessed after 4 -8 weeks clinically, biologically and by ECG and echocardiography. ECG (18 variables) and echo (117 variables) were analysed in core centres. Patients were followed for vital status and hospitalisation every 6 months during a minimum of 18 months. The primary endpoint was time to all-cause death or first HF hospitalisation. A Cox proportional hazard modelling was applied. The multivariable model included univariable covariates at and below the significance level p=0.15 added by age and gender.
Patients: The mean age was 76± 9 years and 57% were women. A history of HF was found in 40.4 %. Patients′ history included hypertension in 78.5%, atrial tachyarrhythmia in 58%, anemia in 47.2%, diabetes in 31.3%, renal dysfunction in 37.9%. At the acute event, LVEF was 56±7 %. Of the patients 6.1 % had first degree AV block and 14.9% had QRS width > 120 ms. Right bundle branch block (BBB) was present in 6.6% and Left BBB in 3.7%.
Results: During a mean follow-up time of 21.6 months a primary outcome event occurred in 204 patients (46.5%), consisting of 101 deaths (23%) and 142 HF-hospitalizations (32.5%). Candidate predictors of outcome are: First degree AV block was the only dyssynchrony criteria independently predicting outcome (p=0.04); tricuspid regurgitation (mean±standard deviation = 2.87±0.64 m/s, p=0.0009) and mean e’ velocity > 5.5cm/s (mean±standard deviation = 7.95±2.58, p=0.0009) were the two echocardiographic predictors. Ongoing ACE (ARB) treatment was the only positive predictor of outcome.
CONCLUSION: The KaRen study recruited a representative population of HFpEF patients with a high rate of clinical events (23% deaths).First degree atrio-ventricular block and increased pulmonary arterial pressures and left ventricular diastolic dysfunction were independently associated with outcome. These novel data may provide new information improving the management of HFpEF patients.
- © 2013 by American Heart Association, Inc.