scholarly journals Predictive Value of HFA-PEFF Score in Patients With Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuxi Sun ◽  
Jinping Si ◽  
Jiaxin Li ◽  
Mengyuan Dai ◽  
Emma King ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Ejection Fraction ◽  
Roc Analysis ◽  
Cox Regression ◽  
Nyha Class ◽  
Area Under The Curve ◽  
Heart Association ◽  
Preserved Ejection Fraction ◽  
All Cause Mortality

Aims: HFA-PEFF score has been proposed for diagnosing heart failure with preserved ejection fraction (HFpEF). Currently, there are only a limited number of tools for predicting the prognosis. In this study, we evaluated whether the HFA-PEFF score can predict mortality in patients with HFpEF.Methods: This single-center, retrospective observational study enrolled patients diagnosed with HFpEF at the First Affiliated Hospital of Dalian Medical University between January 1, 2015, and April 30, 2018. The subjects were divided according to their HFA-PEFF score into low (0–2 points), intermediate (3–4 points), and high (5–6 points) score groups. The primary outcome was all-cause mortality.Results: A total of 358 patients (mean age: 70.21 ± 8.64 years, 58.1% female) were included. Of these, 63 (17.6%), 156 (43.6%), and 139 (38.8%) were classified into the low, intermediate, and high score groups, respectively. Over a mean follow-up of 26.9 months, 46 patients (12.8%) died. The percentage of patients who died in the low, intermediate, and high score groups were 1 (1.6%), 18 (11.5%), and 27 (19.4%), respectively. A multivariate Cox regression identified HFA-PEFF score as an independent predictor of all-cause mortality [hazard ratio (HR):1.314, 95% CI: 1.013–1.705, P = 0.039]. A Cox analysis demonstrated a significantly higher rate of mortality in the intermediate (HR: 4.912, 95% CI 1.154–20.907, P = 0.031) and high score groups (HR: 5.291, 95% CI: 1.239–22.593, P = 0.024) than the low score group. A receiver operating characteristic (ROC) analysis indicated that the HFA-PEFF score can effectively predict all-cause mortality after adjusting for age and New York Heart Association (NYHA) class [area under the curve (AUC) 0.726, 95% CI 0.651–0.800, P = 0.000]. With an HFA-PEFF score cut-off value of 3.5, the sensitivity and specificity were 78.3 and 54.8%, respectively. The AUC on ROC analysis for the biomarker component of the score was similar to that of the total score.Conclusions: The HFA-PEFF score can be used both to diagnose HFpEF and predict the prognosis. The higher scores are associated with higher all-cause mortality.

scholarly journals Effects of Sacubitril-Valsartan in Heart Failure With Preserved Ejection Fraction in Patients Undergoing Peritoneal Dialysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Sha Fu ◽  
Zhenjian Xu ◽  
Baojuan Lin ◽  
Junzhe Chen ◽  
Qiuyan Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Peritoneal Dialysis ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Heart Association ◽  
Signs And Symptoms ◽  
Preserved Ejection Fraction ◽  
Nyha Classification ◽  
Neprilysin Inhibitor

Aims: The effect of the angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril-valsartan in patients with heart failure with preserved ejection fraction (HFpEF) remains unclear, and data on ARNI treatment in peritoneal dialysis (PD) patients are lacking. The present study was designed to assess the efficacy and safety of sacubitril-valsartan in patients with HFpEF undergoing peritoneal dialysis.Methods and Results: End-stage kidney disease (ESKD) patients undergoing PD for 3 months with New York Heart Association (NYHA) class II–IV heart failure, ejection fraction of 50% or higher, and elevated levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP) were assigned to receive sacubitril-valsartan. Patients were followed up regularly after medication treatment. The alterations in clinical and biochemical parameters before and after taking sacubitril-valsartan (generally 50–100 mg b.i.d) were investigated, and safety was also assessed. Twenty-one patients were recruited in this study. Compared with baseline levels, NT-proBNP levels [9769.0 (3093.5–21941.0) vs. 3034.0 (1493.2–6503.0), P = 0.002], and heart rate [80.0 (74.5–90.5) vs. 75.0 (70.3–87.0), P = 0.031] were markedly decreased after treatment with sacubitril-valsartan. Signs and symptoms of heart failure (21/21 vs. 15/21, P = 0.021) were obviously alleviated, NYHA classification and E/e' ratio showed a notable trend of improvement after 3–12 months of follow-up. None of the patients showed adverse drug reactions.Conclusions: The present data suggested that sacubitril-valsartan treatment in patients with HFpEF undergoing PD was effective and safe.

scholarly journals H2FPEF score predicts 1-year rehospitalisation of patients with heart failure with preserved ejection fraction

2020 ◽  
pp. postgradmedj-2019-137434
Author(s):  
Yifei Tao ◽  
Wenjing Wang ◽  
Jing Zhu ◽  
Tao You ◽  
Yi Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Support Vector ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Non Invasive ◽  
Patients With Heart Failure

BackgroundHeart failure with preserved ejection fraction (HFpEF) has received widespread attention in recent years. There is currently a lack of valuable predictors for the prognosis of this disease. Here, we aimed to identify a non-invasive scoring system that can effectively predict 1-year rehospitalisation for patients with HFpEF.MethodsWe included 151 consecutive patients with HFpEF in a prospective cohort study and investigated the association between H2FPEF score and 1-year readmission for heart failure using multivariate Cox regression analysis.ResultsOur findings indicated that obesity, age >70 years, treatment with ≥2 antihypertensives, echocardiographic E/e’ ratio >9 and pulmonary artery pressure >35 mm Hg were independent predictors of 1-year readmission. Three models (support vector machine, decision tree in R and Cox regression analysis) proved that H2FPEF score could effectively predict 1-year readmission for patients with HFpEF (area under the curve, 0.910, 0.899 and 0.771, respectively; p<0.001).ConclusionOur study demonstrates that the H2FPEF score has excellent predictive value for 1-year rehospitalisation of patients with HFpEF.

scholarly journals MMMELD-XI Score Is Associated With Short-Term Adverse Events in Patients With Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 8 ◽  
Author(s):  
Sunying Wang ◽  
Yuwei Wang ◽  
Manqing Luo ◽  
Kaiyang Lin ◽  
Xiaoxu Xie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Adverse Events ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Cardiovascular Mortality ◽  
Nyha Class ◽  
Preserved Ejection Fraction ◽  
Short Term ◽  
All Cause Mortality ◽  
Discriminatory Capacity

Aim: Accumulating evidence suggests that MELD-XI score holds the ability to predict the prognosis of congestive heart failure. However, most of the evidence is based on the end-stage heart failure population; thus, we aim to explore the association between the MELD-XI score and the prognosis in heart failure with preserved ejection fraction (HFpEF).Methods: A total of 30,096 patients hospitalized for HFpEF in Fujian Provincial Hospital between January 1, 2014 and July 17, 2020 with available measures of creatinine and liver function were enrolled. The primary endpoint was 60-day in-hospital all-cause mortality. Secondary endpoints were 60-day in-hospital cardiovascular mortality and 30-day rehospitalization for heart failure.Results: A total of 222 patients died within 60 days after admission, among which 75 deaths were considered cardiogenic. And 73 patients were readmitted for heart failure within 30 days after discharge. Generally, patients with an elevated MELD-XI score tended to have more comorbidities, higher NYHA class, and higher inflammatory biomarkers levels. Meanwhile, the MELD-XI score was positively correlated with NT-pro BNP, left atrial diameter, E/e' and negatively correlated with LVEF. After adjusting for conventional risk factors, the MELD-XI score was independently associated with 60-day in-hospital all-cause mortality [hazard ratio(HR) = 1.052, 95% confidential interval (CI) 1.022–1.083, P = 0.001], 60-day in-hospital cardiovascular mortality (HR = 1.064, 95% CI 1.013–1.118, P = 0.014), and 30-day readmission for heart failure (HR = 1.061, 95% CI 1.015–1.108, P = 0.009). Furthermore, the MELD-XI score added an incremental discriminatory capacity to risk stratification models developed based on this cohort.Conclusion: The MELD-XI score was associated with short-term adverse events and provided additional discriminatory capacity to risk stratification models in patients hospitalized for HFpEF.

scholarly journals High Plasma Docosahexaenoic Acid Associated to Better Prognoses of Patients with Acute Decompensated Heart Failure with Preserved Ejection Fraction

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 371
Author(s):  
Naoaki Matsuo ◽  
Toru Miyoshi ◽  
Atsushi Takaishi ◽  
Takao Kishinoue ◽  
Kentaro Yasuhara ◽  
...  
Keyword(s):  
Heart Failure ◽  
Docosahexaenoic Acid ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
Cox Regression ◽  
Risk Index ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Nutritional Risk Index ◽  
All Cause Mortality

The clinical relevance of polyunsaturated fatty acids (PUFAs) in heart failure remains unclear. The aim of this study was to investigate the association between PUFA levels and the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). This retrospective study included 140 hospitalized patients with acute decompensated HFpEF (median age 84.0 years, 42.9% men). The patients’ nutritional status was assessed, using the geriatric nutritional risk index (GNRI), and their plasma levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), and dihomo-gamma-linolenic acid (DGLA) were measured before discharge. The primary outcome was all-cause mortality. During a median follow-up of 23.3 months, the primary outcome occurred in 37 patients (26.4%). A Kaplan–Meier analysis showed that lower DHA and DGLA levels, but not EPA or AA levels, were significantly associated with an increase in all-cause death (log-rank; p < 0.001 and p = 0.040, respectively). A multivariate Cox regression analysis also revealed that DHA levels were significantly associated with the incidence of all-cause death (HR: 0.16, 95% CI: 0.06–0.44, p = 0.001), independent of the GNRI. Our results suggest that low plasma DHA levels may be a useful predictor of all-cause mortality and potential therapeutic target in patients with acute decompensated HFpEF.

Plasma urocortin in human systolic heart failure

2004 ◽  
Vol 106 (4) ◽  
pp. 383-388 ◽  
Author(s):  
Leong L. NG ◽  
Ian W. LOKE ◽  
Russell J. O'BRIEN ◽  
Iain B. SQUIRE ◽  
Joan E. DAVIES
Keyword(s):  
Heart Failure ◽  
New York ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Area Under The Curve ◽  
Logistic Models ◽  
Heart Association ◽  
Roc Curves ◽  
Relative Increase ◽  
And Gender

Urocortin (UCN), a member of the corticotrophin-releasing factor family, is expressed in heart, brain and gut. UCN has potent cardiostimulatory, cardioprotective, vasodilator and diuretic/natriuretic effects, and cardiac UCN expression is increased in heart failure (HF). In the present study, we investigated plasma levels of UCN in 119 patients with HF and 212 age- and gender-matched controls to clarify its relationship with gender and disease severity. UCN was elevated in HF [normal males, 19.5 (3.9–68.8) pmol/l and HF males, 50.2 (6.9–108.2) pmol/l, P<0.0005; normal females, 14.2 (3.9–53.5) pmol/l and HF females, 21.8 (3.9–112.5) pmol/l, P<0.001; values are medians (range)]. The relative increase was greater in males than females (P<0.03). UCN fell with increasing age, especially in HF patients (rs=-0.56, P<0.0005) and with increasing New York Heart Association (NYHA) class (rs=-0.55, P<0.0005). The fall in UCN levels with increasing NYHA class was reinforced by a significant correlation between UCN and ejection fraction (rs=0.45, P<0.0005) in HF patients. Although receiver operating characteristic (ROC) curves for diagnosis of all HF cases yielded an area under the curve (AUC) of 0.76, ROC AUCs for patients with early HF (NYHA class I and II) were better (0.91). ROC AUCs for logistic models incorporating N-terminal probrain natriuretic peptide (N-BNP) and UCN were better than either peptide alone. In conclusion, plasma UCN is elevated in HF, especially in its early stages. Its decline with increasing HF severity may expedite disease progression due to diminished cardioprotective/anti-inflammatory effects. UCN measurement may also complement N-BNP in the diagnosis of early HF.

scholarly journals The Effects of Sacubitril/Valsartan on Clinical, Biochemical and Echocardiographic Parameters in Patients with Heart Failure with Reduced Ejection Fraction: The “Hemodynamic Recovery”

2019 ◽  
Vol 8 (12) ◽  
pp. 2165 ◽  
Author(s):  
Giuseppe Romano ◽  
Giuseppe Vitale ◽  
Laura Ajello ◽  
Valentina Agnese ◽  
Diego Bellavia ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Ejection Fraction ◽  
Nyha Class ◽  
Heart Association ◽  
Class Iii ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Echocardiographic Parameters ◽  
The Impact

Background: Sacubitril/valsartan has been shown to be superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF). However, knowledge of the impact on cardiac performance remains limited. We sought to evaluate the effects of sacubitril/valsartan on clinical, biochemical and echocardiographic parameters in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Sacubitril/valsartan was administered to 205 HFrEF patients. Results: Among 230 patients (mean age 59 ± 10 years, 46% with ischemic heart disease) 205 (89%) completed the study. After a follow-up of 10.49 (2.93 ± 18.44) months, the percentage of patients in New York Heart Association (NYHA) class III changed from 40% to 17% (p < 0.001). Median N–Type natriuretic peptide (Nt-proBNP) decreased from 1865 ± 2318 to 1514 ± 2205 pg/mL, (p = 0.01). Furosemide dose reduced from 131.3 ± 154.5 to 120 ± 142.5 (p = 0.047). Ejection fraction (from 27± 5.9% to 30 ± 7.7% (p < 0.001) and E/A ratio (from 1.67 ± 1.21 to 1.42 ± 1.12 (p = 0.002)) improved. Moderate to severe mitral regurgitation (from 30.1% to 17.4%; p = 0.002) and tricuspid velocity decreased from 2.8 ± 0.55 m/s to 2.64 ± 0.59 m/s (p < 0.014). Conclusions: Sacubitril/valsartan induce “hemodynamic recovery” and, consistently with reduction in Nt-proBNP concentrations, improve NYHA class despite diuretic dose reduction.

scholarly journals HUBUNGAN KELAS NYHA DENGAN FRAKSI EJEKSI PADA PASIEN GAGAL JANTUNG KRONIK DI BLU/RSUP PROF. DR. R.D. KANDOU MANADO

e-CliniC ◽  
2013 ◽  
Vol 1 (2) ◽  
Author(s):  
Patricia Ratna Sari ◽  
Starry H. Rampengan ◽  
Agnes Lucia Panda
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Heart Function ◽  
Nyha Class ◽  
Heart Association ◽  
Cross Sectional ◽  
New York Heart Association ◽  
Spearman Test

Abstract: The functional status of patients with chronic heart failure (CHF) has been standardized by the classification of NYHA [New York Heart Association] class I-IV. One of the parameters to assess the ability of the heart function is the ejection fraction (LVEF) were assessed using echocardiography parameters. The purpose of this study was to determine the relationship of NYHA class with ejection fraction in patients with chronic heart failure in the BLU/Prof. Dr. R. D. Kandou Manado. Methodology: This research method is analytic cross sectional study approach. The sample was CHF patients in BLU/Prof. Dr. R. D. Manado Kandou 30 people held during November-December 2012. Results: The distribution of patients according to NYHA class most are in NYHA II (43%), while the lowest are in NYHA IV (7%). Distribution according to the ejection fraction is at most 30-39% LVEF is 12 and there are at least LVEF <30%, is 6 people. The results obtained using the Spearman test (p = 0.177), indicating that there was no statistically significant association between NYHA class with ejection fraction in patients with chronic heart failure in the BLU/Prof. Dr. R. D. Kandou Manado.Conclusion: No significant relationship was found between NYHA class with ejection fraction. Keywords: Chronic Heart Failure, ejection fraction, NYHA class   Abstrak: Status fungsional penderita gagal jantung kronik (GJK) ini telah dibakukan berdasarkan klasifikasi NYHA [New York Heart Association] kelas I-IV. Salah satu parameter untuk menilai kemampuan fungsi jantung adalah fraksi ejeksi (LVEF) yang dinilai menggunakan parameter ekokardiografi. Tujuan penelitian ini adalah untuk mengetahui hubungan kelas NYHA dengan fraksi ejeksi pada penderita gagal jantung kronik di BLU/RSUP Prof. Dr. R. D. Kandou Manado. Metodologi: Metode penelitian ini bersifat analitik dengan pendekatan studi cross sectional.  Sampel penelitian ini adalah pasien GJK  di BLU/RSUP. Prof. Dr. R. D. Kandou Manado sebanyak 30 orang yang berlangsung selama bulan November – Desember 2012. Hasil : Distribusi pasien GJK menurut kelas NYHA terbanyak berada pada NYHA II (43%), sedangkan yang paling rendah berada pada NYHA IV (7%). Distribusi  menurut Fraksi Ejeksi terbanyak berada pada LVEF 30-39 % yaitu 12 orang dan paling rendah terdapat pada LVEF <30 % yaitu 6 orang. Hasil penelitian ini menggunakan uji Spearman diperoleh (p= 0,177), menunjukkan bahwa secara statistik tidak terdapat hubungan bermakna antara NYHA kelas dengan fraksi ejeksi pada pasien gagal jantung kronik di BLU/RSUP Prof. Dr. R. D. Kandou Manado. Kesimpulan:Tidak ditemukan hubungan yang signifikan antara kelas NYHA dengan fraksi ejeksi. Kata kunci : Fraksi ejeksI, Gagal Jantung Kronik, Kelas NYHA [New York Heart Association]

scholarly journals Sex Differences in the Outcomes of Elderly Patients With Heart Failure With Preserved Ejection Fraction 

2021 ◽  
Author(s):  
Jiaxing Sun ◽  
Shi Tai ◽  
Guo Yanan ◽  
Liang Tang ◽  
Hui Yang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sex Differences ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Primary Outcome ◽  
Cox Regression ◽  
Baseline Characteristic ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
All Cause Mortality

Abstract Background: It has been shown the impacts of sex on patients' outcomes with preserved ejection fraction (HFpEF), but little is known about the impacts of sex on elderly patients with HFpEF.Methods: A secondary analysis was conducted to evaluate the impacts of sex on outcomes of patients who were ≥70 years of age with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT). The primary outcome was composed of cardiovascular (CV) mortality, HF hospitalization. Secondary outcomes included all-cause mortality and all-cause hospitalization. Cox regression models were used to determine sex differences in outcomes.Results: A total of 1619 patients were included: 898 (55.5%) women and 721 (44.5%) men. Their age ranged from 70 to 94 years, similar between women and men. Women had fewer comorbidities than men. The rate of primary outcome was lower in women than in men (18.9% vs. 28.1%, p=0.002), including CV mortality (10.6% vs. 15.4%, p=0.039) and HF hospitalization (13.5% vs. 19.0%, p=0.033). After adjustment for baseline characteristic, the Cox regression analysis showed that woman was a protective factor for CV mortality (hazard ratio [HR] 0.53, 95% confidence interval [CI] 0.40-0.73), HF hospitalization (HR 0.71, 95% CI 0.55-0.93) and all-cause mortality (HR 0.59, 95% CI 0.47-0.75). Although a significant reduction in all-cause mortality associated with spironolactone in women was observed even after adjustment (HR: 0.68; 95% CI: 0.48-0.96; p=0.028), there is not a significant multivariate sex-treatment interaction (p interaction=0.190).Conclusion: Among elderly patients with HFpEF, women had fewer comorbidities and better outcomes. Clinical trial registration: NCT00094302 (TOPCAT). Registered 15 October 2004, https://www.clinicaltrials.gov/ct2/show/NCT00094302

scholarly journals Restoration of sinus rhythm by pulmonary vein isolation improves heart failure with preserved ejection fraction in atrial fibrillation patients

EP Europace ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. 1328-1336 ◽  
Author(s):  
Manuel Rattka ◽  
Alexander Pott ◽  
Anna Kühberger ◽  
Karolina Weinmann ◽  
Dominik Scharnbeck ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
New York ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Treatment Strategies ◽  
Heart Association ◽  
Preserved Ejection Fraction

Abstract Aims Atrial fibrillation (AF) in patients suffering from heart failure with preserved ejection fraction (HFpEF) is associated with increased symptoms and higher morbidity and mortality. Effective treatment strategies for this patient population have not yet been established. Methods and results We analysed clinical outcomes and echocardiographic parameters of patients with AF and HFpEF who underwent pulmonary vein isolation (PVI). Out of 374 PVI patients, we identified 35 patients suffering from concomitant HFpEF. Freedom from atrial tachyarrhythmia (AT) after 1 year was 80%. Heart failure symptoms assessed by New York Heart Association class significantly improved from 2.7 ± 0.7 to 1.7 ± 0.9 (P &lt; 0.001). We observed regression of diastolic dysfunction by echocardiography 12 months after the index procedure. Moreover, 15 patients (42.9%) experienced complete resolution of HFpEF after a single ablation procedure. Multivariate logistic regression revealed absence of AT recurrence as an independent predictor of recovery from HFpEF (hazard ratio 11.37, 95% confidence interval 1.70–75.84, P = 0.009). Furthermore, resolution of HFpEF by achieving freedom from AT recurrence by PVI, including multiple procedures, led to a significant reduction of hospitalizations. Conclusion Our results suggest that restoration of sinus rhythm by PVI in HFpEF patients with concomitant AF induces reverse remodelling, improvement of symptoms, resolution of HFpEF and subsequently decrease of hospitalizations. Randomized controlled trials are warranted to confirm our results.

Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Huang ◽  
C Liu
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: &lt;120mmHg, ≥120mmHg and &lt;130mmHg, ≥130mmHg and &lt;140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of &lt;120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of &lt;120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

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