Clinical Utility of Overlap Time for Incomplete Relaxation to Predict Cardiac Events in Heart Failure
Section snippets
Study Population
We designed a single-center prospective study (Fig. 1). A total of 272 patients first hospitalized with HF who underwent echocardiographic studies after HF stabilization were enrolled initially. The study covered the period between January 2013 and December 2017. Exclusion criteria were as follows: post valve replacement (n = 22), severe valvular disease (n = 4), pacemaker implantation (n = 6), active cancer (n = 4), or severe chronic obstructive pulmonary disease (n = 4). We also removed
Clinical Backgrounds
Table 1 shows patients’ baseline characteristics at discharge. A total of 153 hospitalized patients with HF (mean age 68 ± 15 years; 63% male) were enrolled. Patients had been treated with angiotensin converting enzymes and angiotensin converting enzyme inhibitors (67%), beta-blockers (79%) and diuretics (73%). Table 2 shows the comparison of characteristics and echocardiographic variables between 2 groups, with or without overlap of the E-A wave. In this analysis, heart rate (P = 0.01),
Discussion
Our study sought to assess the clinical meaning of E-A overlap as an association between overlap time and CV events in HF. Our study brings several insights into the interpretation of E-A overlap: (1) overlap time was related to heart rate, DFL/CCL and LV systolic and diastolic function; (2) patients with overlap of the E-A wave had a significantly higher event rate compared to patients without overlap of the E-A wave; and (3) the association between the overlap time and the primary outcome
Limitations
The present study has several limitations. First, this was a single-center study with a small sample size. Therefore, the subgroup analysis was limited (eg, HFpEF and HFrEF). On the other hand, we thought that the advantage of a single-center study outweighed the limitation of small sample size in the hypothesis-generating study because of the least number of biases, such as differences in treatment quality or diversity of causes. The sample size was small, and there were relatively few events,
Conclusions
This preliminary study suggests that overlap time may have some potential for predicting readmission and cardiac mortality risk as a marker of incomplete relaxation in HF.
Funding
This work was supported by the Takeda Science Foundation and Public Trust Cardiovascular Research Fund (to KK). The funding source had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, the preparation, review or approval of the manuscript, or the decision to submit the manuscript for publication.
Contributions
KK and MA designed the work; RZ, YH, SN, TI, KY, DF, SY, HY, TS, and TW conducted the work and acquired data; KK and MA analyzed and interpreted the data; KK, MA and MS drafted the work; all authors reviewed the work, provided input and gave final approval of the manuscript.
Conflicts of Interest
None.
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The first 2 authors contributed equally to this work (KK, MA).