Automated Interpretation Of Systolic And Diastolic Function On The Echocardiogram
HFSA ePoster Library. Tromp J. 09/10/21; 343504; 268
Jasper Tromp
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Abstract
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Introduction: A small subset of patients with heart failure with reduced ejection fraction (HFrEF) will have favorable reverse remodeling and improved left ventricular (LV) function. Patients with improved HFrEF have markedly better outcomes than other HFrEF patients, but the mechanisms that mediate reverse remodeling are poorly understood. Loss of microvascular endothelial cells have been associated with heart failure, as have perturbations in angiokines, a family of molecules involved in angiogenesis. It is not known if baseline or relative changes in angiokine levels are associated with improvement in LV function and outcomes over time.
Methods: Using data from the GUIDE-IT Echo sub-study, we analyzed blood samples from 99 patients, assessing levels of 24 angiokines at baseline and 12 months. Using univariable logistic regression modeling, we then identified angiokines associated with reverse remodeling, defined as a reduction of > 10ml/m2 in indexed LV end-systolic volume from 0 to 12 months. Using survival analysis, we then assessed the relationship between angiokine levels and time to death or heart failure hospitalization (HHF) over the following 12 months.
Results: Of the angiokines surveyed (Figure), we found that relative changes in angiopoietin 2 (ANGPT2) were significantly associated with reverse remodeling, with every 50% decrease of baseline ANGPT2 level corresponding to a 6.02ml/m2 decrease in LVESVi (p=0.009). Furthermore, event rates between tertiles of ANGPT2 levels were significantly different, with markedly higher rates of death (p=0.001) or HHF (p<0.001), and with a composite rate of death or HHF that was over 5 times higher in the highest vs lowest tertile of ANGPT2 (0.603 vs 0.112 events per patient year, p=0.001 between tertiles).
Conclusions: In patients with HFrEF, baseline levels of ANGPT2 are predictive of death or hospitalization for heart failure. Decreases in ANGPT2 are associated with improvement in ventricular function. ANGPT2 is a potential biomarker for predicting both clinical outcomes and reverse remodeling in HFrEF.
Methods: Using data from the GUIDE-IT Echo sub-study, we analyzed blood samples from 99 patients, assessing levels of 24 angiokines at baseline and 12 months. Using univariable logistic regression modeling, we then identified angiokines associated with reverse remodeling, defined as a reduction of > 10ml/m2 in indexed LV end-systolic volume from 0 to 12 months. Using survival analysis, we then assessed the relationship between angiokine levels and time to death or heart failure hospitalization (HHF) over the following 12 months.
Results: Of the angiokines surveyed (Figure), we found that relative changes in angiopoietin 2 (ANGPT2) were significantly associated with reverse remodeling, with every 50% decrease of baseline ANGPT2 level corresponding to a 6.02ml/m2 decrease in LVESVi (p=0.009). Furthermore, event rates between tertiles of ANGPT2 levels were significantly different, with markedly higher rates of death (p=0.001) or HHF (p<0.001), and with a composite rate of death or HHF that was over 5 times higher in the highest vs lowest tertile of ANGPT2 (0.603 vs 0.112 events per patient year, p=0.001 between tertiles).
Conclusions: In patients with HFrEF, baseline levels of ANGPT2 are predictive of death or hospitalization for heart failure. Decreases in ANGPT2 are associated with improvement in ventricular function. ANGPT2 is a potential biomarker for predicting both clinical outcomes and reverse remodeling in HFrEF.
Introduction: A small subset of patients with heart failure with reduced ejection fraction (HFrEF) will have favorable reverse remodeling and improved left ventricular (LV) function. Patients with improved HFrEF have markedly better outcomes than other HFrEF patients, but the mechanisms that mediate reverse remodeling are poorly understood. Loss of microvascular endothelial cells have been associated with heart failure, as have perturbations in angiokines, a family of molecules involved in angiogenesis. It is not known if baseline or relative changes in angiokine levels are associated with improvement in LV function and outcomes over time.
Methods: Using data from the GUIDE-IT Echo sub-study, we analyzed blood samples from 99 patients, assessing levels of 24 angiokines at baseline and 12 months. Using univariable logistic regression modeling, we then identified angiokines associated with reverse remodeling, defined as a reduction of > 10ml/m2 in indexed LV end-systolic volume from 0 to 12 months. Using survival analysis, we then assessed the relationship between angiokine levels and time to death or heart failure hospitalization (HHF) over the following 12 months.
Results: Of the angiokines surveyed (Figure), we found that relative changes in angiopoietin 2 (ANGPT2) were significantly associated with reverse remodeling, with every 50% decrease of baseline ANGPT2 level corresponding to a 6.02ml/m2 decrease in LVESVi (p=0.009). Furthermore, event rates between tertiles of ANGPT2 levels were significantly different, with markedly higher rates of death (p=0.001) or HHF (p<0.001), and with a composite rate of death or HHF that was over 5 times higher in the highest vs lowest tertile of ANGPT2 (0.603 vs 0.112 events per patient year, p=0.001 between tertiles).
Conclusions: In patients with HFrEF, baseline levels of ANGPT2 are predictive of death or hospitalization for heart failure. Decreases in ANGPT2 are associated with improvement in ventricular function. ANGPT2 is a potential biomarker for predicting both clinical outcomes and reverse remodeling in HFrEF.
Methods: Using data from the GUIDE-IT Echo sub-study, we analyzed blood samples from 99 patients, assessing levels of 24 angiokines at baseline and 12 months. Using univariable logistic regression modeling, we then identified angiokines associated with reverse remodeling, defined as a reduction of > 10ml/m2 in indexed LV end-systolic volume from 0 to 12 months. Using survival analysis, we then assessed the relationship between angiokine levels and time to death or heart failure hospitalization (HHF) over the following 12 months.
Results: Of the angiokines surveyed (Figure), we found that relative changes in angiopoietin 2 (ANGPT2) were significantly associated with reverse remodeling, with every 50% decrease of baseline ANGPT2 level corresponding to a 6.02ml/m2 decrease in LVESVi (p=0.009). Furthermore, event rates between tertiles of ANGPT2 levels were significantly different, with markedly higher rates of death (p=0.001) or HHF (p<0.001), and with a composite rate of death or HHF that was over 5 times higher in the highest vs lowest tertile of ANGPT2 (0.603 vs 0.112 events per patient year, p=0.001 between tertiles).
Conclusions: In patients with HFrEF, baseline levels of ANGPT2 are predictive of death or hospitalization for heart failure. Decreases in ANGPT2 are associated with improvement in ventricular function. ANGPT2 is a potential biomarker for predicting both clinical outcomes and reverse remodeling in HFrEF.
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