scholarly journals Response by Di Tullio et al to Letter Regarding Article, “Left Ventricular Ejection Fraction and Risk of Stroke and Cardiac Events in Heart Failure: Data From the Warfarin Versus Aspirin in Reduced Ejection Fraction Trial”

Stroke ◽  
2016 ◽  
Vol 47 (12) ◽  
Author(s):  
Marco R. Di Tullio ◽  
John L.P. Thompson ◽  
Shunichi Homma
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Failure Data

scholarly journals Reduction in Left Ventricular Ejection Fraction is Associated with Subsequent Cardiac Events in Outpatients with Chronic Heart Failure

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yoshitaka Okuhara ◽  
Masanori Asakura ◽  
Yoshiyuki Orihara ◽  
Daisuke Morisawa ◽  
Yuki Matsumoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Operating Characteristics ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Significant Difference

AbstractLeft ventricular ejection fraction (LVEF) is critical for determining the prognosis and treatment of patients with heart failure (HF). However, the influence of serial LVEF changes in patients with stable chronic HF (CHF) has not yet been completely investigated. We analyzed data of 263 outpatients with CHF from the J-MELODIC study cohort and evaluated the frequency of cardiac events. We stratified patients into tertiles based on the relative difference in LVEF in 1 year and that at baseline. We found a significant difference in the cardiac event rate among the three groups (log-rank test, p = 0.042). We identified a relative 11% LVEF reduction as the optimal cutoff value based on the receiver operating characteristics analysis. LVEF (OR, 1.04; 95% CI, 1.01–1.07; p = 0.015) and E/e′ (OR, 1.06; 95% CI, 1.01–1.12; p = 0.023) at baseline were predictors of >11% LVEF reduction. After adjusting the variables including age and sex, >11% LVEF reduction was an independent predictor of subsequent cardiac events (HR, 5.79; 95% CI, 2.49–13.2; p < 0.001). In conclusion, patients with 1-year relative >11% LVEF reduction may have subsequent worsening outcomes. Such patients should be carefully followed-up as high risk population for development of cardiac events.

scholarly journals Updating The Accuracy of Administrative Claims for Identifying Left Ventricular Ejection Fraction Among Patients with Heart Failure

2021 ◽  
Author(s):  
Alexander Sandhu ◽  
Jimmy Zheng ◽  
Paul A Heidenreich
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Predictive Accuracy ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Administrative Claims ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction

Introduction: Left ventricular ejection fraction (EF) is an important factor for treatment decisions for heart failure. The EF is unavailable in administrative claims. We sought to evaluate the predictive accuracy of claims diagnoses for classifying heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF) with International Classification of Disease-Tenth Revision codes. Methods: We identified HF diagnoses for VA patients between 2017-2019 and extracted the EF from clinical notes and imaging reports using a VA natural language processing algorithm. We classified sets of codes as HFrEF-related, HFpEF-related, or non-specific based on the closest EF within 180 days. We selected a random heart failure diagnosis for each patient and tested the predictive accuracy of various algorithms for identifying HFrEF using the last 1 year of heart failure diagnoses. We performed sensitivity analyses on the EF thresholds, the cohort, and the diagnoses used. Results: Between 2017-2019, we identified 358,172 patients and 1,671,084 diagnoses with an EF recording within 180 days. After dividing diagnoses into HFrEF-related, HFpEF-related, or non-specific, we found using the proportion of specific diagnoses classified as HFrEF-related had an AUC of 0.76 for predicting EF≤40% and 0.80 for predicting EF<50%. However, 23.3% of patients could not be classified due to only having non-specific codes. Predictive accuracy increased among patients with ≥4 HF diagnoses over the preceding year. Discussion: In a VA cohort, administrative claims with ICD-10 codes had moderate accuracy for identifying reduced ejection fraction. This level of specificity is likely inadequate for performance measures. Administrative claims need to better align terminology with relevant clinical definitions.

scholarly journals Prognostic significance of cardiac 123I-MIBG SPECT imaging in patients with acute decompensated heart failure with preserved left ventricular ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Seo ◽  
T Yamada ◽  
T Watanabe ◽  
T Morita ◽  
Y Furukawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Spect Imaging ◽  
Left Ventricular Ejection ◽  
Mibg Imaging ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction

Abstract Background Cardiac sympathetic nerve dysfunction, which is assessed by I-123 metaiodobenzylguanidine (MIBG) imaging, is associated with the poor outcomes in patients with heart failure (HF). Most of the literature on the use of 123I-MIBG imaging is based on planar images in patients with chronic HF and reduced left ventricular ejection fraction (HFrEF), because It is technically challenging to conduct precise 123I-MIBG SPECT analysis in globally denervated heart, which is frequently observed in HFrEF patients. There was no information available on cardiac sympathetic nerve dysfunction evaluated by cardiac MIBG SPECT imaging in acute decompensated HF (ADHF) patients with preserved left ventricular ejection fraction (HFpEF). Purpose We aimed to clarify the prognostic significance of 123I-MIBG SPECT myocardial imaging in ADHF patients with HFpEF. Methods We enrolled 183 patients who were admitted for ADHF with HFpEF, discharged with survival. All patients underwent cardiac MIBG imaging at the timing of discharge. The cardiac MIBG heart to mediastinum ratio (H/M) was calculated on the early image and the delayed image (late H/M). We studied 156 patients after excluding 27 patients whose MIBG SPECT reconstruction was difficult due to too low MIBG uptake or extracardiac accumulation interference. SPECT analysis on the delayed image was conducted by using CardioBull, a fully automated software for the quantification of I-123 MIBG SPECT. All of 17 regional tracer uptake were compared with normal control database. A scoring algorithm for the evaluation of low uptake employs a 5-point scoring system as 0–4 for normal, mildly abnormal, moderately abnormal, severe abnormal, and perfusion defect, respectively. The summed severity (SSS) scores were obtained by summing the score for all segments. SSS could range from 0 to 68. The endpoint of this study is cardiac events defined as the composite of unplanned heart failure hospitalization and cardiac death. Results During a mean follow up period of 2.4±1.6 years, 60 patients reached cardiac events. SSS was significantly high in patients with than without cardiac events (20 [10–27] vs 7 [4–16], p&lt;0.0001). SSS (p&lt;0.0001) was significantly associated with cardiac events after multivariable Cox adjustment of age, sex, creatinine and log-transformed BNP level, although late H/M showed the significant association with the endpoint at the univariate Cox analysis. Kaplan-Meier analysis showed that patients with high SSS (&gt;10, defined by median) had significantly greater risk of cardiac event (56% vs 21%, Hazard ratio: 3.56 (2.00–6.33, p&lt;0.0001). ROC curve analysis showed that area under the curve (AUC) of SSS was 0.746 [95% CI:0.670, 0.812], which was significantly higher than that of late H/M (0.618 [95% CI:0.537, 0.695]) (p=0.0159). Conclusion Cardiac MIBG SPECT imaging was useful for risk stratification in ADHF patients with HFpEF. Funding Acknowledgement Type of funding source: None

scholarly journals Left Ventricular Ejection Fraction and Risk of Stroke and Cardiac Events in Heart Failure

Stroke ◽  
2016 ◽  
Vol 47 (8) ◽  
pp. 2031-2037 ◽  
Author(s):  
Marco R. Di Tullio ◽  
Min Qian ◽  
John L.P. Thompson ◽  
Arthur J. Labovitz ◽  
Douglas L. Mann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction
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