Journal of Cardiac Failure最新文献

Objectives: N-terminal pro brain natriuretic peptide (NT-proBNP) is a biomarker for myocardial stress used in diagnosing and prognosticating heart failure (HF). However, its interpretation is complicated by clinical factors. This study aims to clarify the prognostic value of NT-proBNP in patients with heart failure with preserved ejection fraction (HFpEF), and risk-prediction cutoffs considering various clinical factors.

Methods: The study utilized data of prospective multicenter observational Asian HFpEF registry. Patients with acute decompensated HF and left ventricular ejection fraction ≥ 50% were included. NT-proBNP levels were measured at discharge. The primary endpoint was a composite of all-cause death and hospitalization for HF within 1 year after discharge.

Results: A total of 1,231 patients (83 [77, 87] years, 551 (45%) male) were enrolled, with 916 eligible patients analyzed. The median NT-proBNP level was 1,060 pg/m. In multivariable logistic regression model, NT-proBNP was significantly associated with the primary endpoint (adjusted OR for log-transformed NT-proBNP:2.71, 95%CI:1.78-4.18, p<0.001). Subgroup analysis revealed varying NT-proBNP distributions and differential safety cutoffs (329-929 pg/mL) at sensitivity of 0.8 based on factors like atrial fibrillation and chronic kidney disease, maintaining its discriminatory performance (Area under the curve: 0.587-0.734).

Conclusions: NT-proBNP at discharge is a significant prognostic marker for HFpEF. Although NT-proBNP showed different distributions in various subgroups and cutoff values were distinctive for each, the prognostic utility was found to be equivalent in almost all subgroups with similar moderate discriminative performance. The study highlights the necessity of personalized NT-proBNP cutoffs for better management and prognostication of HFpEF.

Background: There is increasing interest in predicting heart failure (HF), a major cause of morbidity and mortality with a significant financial burden. The role of coronary artery calcium (CAC), an accessible and inexpensive test, in predicting long-term HF mortality amongst asymptomatic adults remains unknown. We aim to determine if CAC burden is associated with HF-related mortality in the CAC Consortium.

Methods and results: The study included 66,636 primary prevention patients from the CAC Consortium. Multivariable competing risks regression was used to assess the association between CAC and HF-related mortality adjusting for demographics and traditional risk factors. The mean age was 54.4 years, 67% male, 89% white, and 55% had CAC >0. 260 HF-related mortality events were observed during a median follow up of 12.5 years, 75.3% occurred among those with a baseline CAC score >100. Compared with CAC = 0, there was a stepwise higher risk (P < 0.005) of HF mortality for CAC 1-100 (subdistribution hazard ratio [SHR]: 2.27; 95% CI: 1.3-3.99), 100-400 (SHR: 3.68; 95% CI 2.1-6.43), and >400 (SHR: 7.05; 95% CI 4.05-12.29). This increasing risk of HF mortality across higher CAC scores persisted across age groups, sex, and in the intermediate and high-risk groups as calculated by the pooled cohort (PCE) and PREVENT equations.

Conclusions: Higher CAC is associated with increasing incidence of long-term HF-related mortality in the primary prevention population, particularly intermediate and high-risk patients. Early preventive approaches in patients with high CAC must focus on preventing heart failure and ASCVD with lifestyle changes and medications.

Background: While recent guidelines have noted the deleterious effects of poor sleep on cardiovascular health, the upstream impact of cardiac arrest-induced psychological distress on sleep health metrics among families of cardiac arrest survivors remains unknown.

Methods: Sleep health of close family members of consecutive patients with cardiac arrest admitted to an academic center (August 16, 2021-June 28, 2023) was self-reported using the Pittsburgh Sleep Quality Index (PSQI). The baseline PSQI, focused on sleep in the month before cardiac arrest, was administered during hospitalization and repeated 1 month after cardiac arrest alongside the Patient Health Questionnaire-8 (PHQ-8) to assess depression severity. Multivariable linear regressions analyzed associations between total PHQ-8 scores and changes in global PSQI scores between baseline and 1 month, with higher scores indicating deterioration. A prioritization exercise explored potential interventions categorized into the family's information and well-being needs to reduce psychological distress.

Results: In our sample of 102 close family members (mean age 52 ± 15 years, 70% female, 21% Black, 33% Hispanic), mean global PSQI scores showed a significant decline between baseline and 1 month after cardiac arrest (6.2 ± 3.8 vs. 7.4 ± 4.1; P < .01). This deterioration was notable for sleep quality, duration, and daytime dysfunction. Higher PHQ-8 scores were significantly associated with higher change in PSQI scores after adjusting for family members' age, sex, race/ethnicity, prior psychiatric history, and patient's discharge disposition (B = 0.4 [95% CI 0.24-0.48]; P < .01, β = 0.5). Most families expressed a higher priority for information-based interventions over well-being needs to help alleviate psychological distress during the first month following cardiac arrest (76% vs. 34%, P < .01).

Conclusions: A significant sleep health decline was observed among close family members of cardiac arrest survivors during the acute period, with psychological distress associated with this disruption. Understanding these temporal associations will help guide the development of targeted interventions to support families during this uncertain time.