Clinical characteristics and factors associated with death from acute decompensated heart failure

Aim. To assess the diagnostic significance of clinical indicators and left ventricle ejection fraction (LV EF) for predicting the probability of death from acute decompensated heart failure (ADHF) in patients with chronic heart failure with a reduced LV EF (HFrEF) within one year after implantation of cardioverter defibrillator (ICD).

Methods. The study included 384 patients with heart failure NYHA 3-4 functional class with LV EF ≤ 35%, undergoing ICD implantation for the purpose of primary prevention of sudden cardiac death. After ICD implantation the patients included in the study were prospectively observed during one year (visits to the clinic after 3, 6, 12 months). The primary end point - a case of ADHF was registered.

Results. In a one-year observation, the primary endpoint was recorded in 38 patients (10 per cent). Single factor logistic regression analysis showed 5 factors with the greatest predictive potential (p<0.1), related to the occurrence of the investigated endpoint. These included: history of arterial hypertension (AH) and obesity, LV EF based on the biplane Simpson’s method, LV EF ≤ 28% and systolic blood pressure. Based on the results of the multi-factor regression analysis, a predictive model was developed, which included three factors with the highest levels of statistical significance: the presence of AH, obesity and LV EF ≤ 28%. The diagnostic efficiency of the model was 69.5% (sensitivity 78.9%; specificity 68.5%).

Conclusion. The results of the research indicate that the main predictor of one-year mortality due to ADHF in the studied cohort of HFrEF patients with NYHA class 3-4 is LV EF ≤ 28%. The presence in the history of AH and obesity was associated with the best prognosis for life.

1. 2020 Clinical practice guidelines for Chronic heart failure. Russ J Cardiol. 2020;25: 4083. (In Russ.)]. https://doi.org/10.15829/15604071-2020-4083.

2. Packer M. What causes sudden death in patients with chronic heart failure and a reduced ejection fraction? Eur Heart J. 2020;41: 1757-63. https://doi.org/10.1093/eurheartj/ehz553.

3. Shlyakhto EV, Arutyunov GP, Belenkov YuN, et al. National recommendations on risk estimation and sudden cardiac death prevention (2-nd edition). М.:«MedPraktika-М». 2018:247. (In Russ.)]. ISBN 978-5-98803-397-4.

4. Ilov NN, Palnikova OV, Stompel DR, et al. Risk stratification of sudden cardiac death in heart failure patients: is left ventricular ejection fraction alone sufficient? Russ J Cardiol. 2021;26(1): 3959. (In Russ.)]. https://doi.org/10.15829/1560-4071-2021-3959.

5. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal (2021) 42, 3599-3726. https://doi.org/10.1093/eurheartj/ehab368

6. Lebedeva VK, Lebedev DS. Implantable cardioverter defibrillator: decision-making on turning off in patients with end-stage heart failure. Russ J Cardiol. 2020;25: 3868. (In Russ.)]. https:// doi.org/10.15829/1560-4071-2020-3868.

7. Tymińska A, Ozierański K, Balsam P, et al. Ischemic Cardiomyopathy versus Non-Ischemic Dilated Cardiomyopathy in Patients with Reduced Ejection Fraction - Clinical Characteristics and Prognosis Depending on Heart Failure Etiology (Data from European Society of Cardiology Heart Failure Registries). Biology (Basel). 2022;11:341. https://doi.org/10.3390/biology11020341.

8. Tkacheva ON, Kotovskaya Y V., Krylov KY, et al. Malnutrition as a factor aggravating the heart failure course in the elderly and senile age. Russ J Cardiol. 2022;27: 4583. (In Russ.)]. https://doi.org/10.15829/1560-4071-2022-4583.

9. Feng Z, Akinrimisi OP, Gornbein JA, Truong QA, et al. Combination Biomarkers for Risk Stratification in Patients With Chronic Heart Failure Biomarkers Prognostication in HF. J Card Fail. 2021;27: 1321-7. https://doi.org/10.1016/j.cardfail.2021.05.028.

10. Çinier G, Hayıroğlu Mİ, Çınar T, Pet al. Predictors for early mortality in patients with implantable cardiac defibrillator for heart failure with reduced ejection fraction. Indian Heart J. 2022;74: 127-30. https://doi.org/10.1016/j.ihj.2022.01.003.

11. Britton KA, Gaziano JM, Djoussé L. Normal systolic blood pressure and risk of heart failure in US male physicians. Eur J Heart Fail. 2009;11: 1129-34. https://doi.org/10.1093/eurjhf/hfp141.

12. Shen L, Claggett BL, Jhund PS, et al. Development and external validation of prognostic models to predict sudden and pump-failure death in patients with HFrEF from PARADIGM-HF and ATMOSPHERE. Clin Res Cardiol. 2021;110: 1334-49. https://doi.org/10.1007/s00392021-01888-x.

13. Ather S, Chan W, Chillar A, et al. Association of systolic blood pressure with mortality in patients with heart failure with reduced ejection fraction: A complex relationship. Am Heart J. 2011;161: 567-73. https://doi.org/10.1016/j.ahj.2010.12.009.

14. Polyakov DS, Fomin IV. Badin YV, et al. Effects of systolic and diastolic blood pressure and its changes between successive hospitalizations on prognosis for patients with acute decompensated CHF. Russ Hear Fail J 2017;17: 178-84. (In Russ.)]. https://doi.org/10.18087/rhfj.2017.3.2357.

15. Ventura HO, Messerli FH, Lavie CJ. Observations on the blood pressure paradox in heart failure. Eur J Heart Fail. 2017;19: 843-5. https://doi.org/10.1002/ejhf.818.

16. Carbone S, Lavie CJ, Elagizi A, Arena R, Ventura HO. The Impact of Obesity in Heart Failure. Cardiol Clin. 2022;40: 209-18. https://doi.org/10.1016/j.ccl.2021.12.009.

17. Oreopoulos A, Padwal R, Kalantar-Zadeh K, et al. Body mass index and mortality in heart failure: A meta-analysis. Am Heart J. 2008;156: 13-22. https://doi.org/10.1016/j.ahj.2008.02.014.

18. Shpagina OV, Bondarenko IZ. Obesity Paradox - another look at the problem of cardiovascular disease. Obe Metab. 2013;10: 3-9. (In Russ.)]. https://doi.org/10.14341/omet201343-9.

19. Miklisanskaya SV, Mazur NA, Solomasova LV, et.al The «obesity paradox» and its degree of proof. Ter Arkh. 2020;92: 84-90. (In Russ.)]. https://doi.org/10.26442/00403660.2020.04.000421.

20. Kalantar-Zadeh K, Block G, Horwich T, et al. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol. 2004;43: 1439-44. https://doi.org/10.1016/j.jacc.2003.11.039.