Combined assessment of myocardial damage and electrical disturbance in chronic heart failure

doi:10.4330/wjc.v9.i5.457

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World Journal of Cardiology

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World J Cardiol. May 26, 2017; 9(5): 457-465
Published online May 26, 2017. doi: 10.4330/wjc.v9.i5.457

Table 1 Comparison of the clinical characteristics of patients with and without cardiac events

	All patients (n = 322)	Event-free (n = 205)	Cardiac event (n = 117)	P value
Age, yr	69 ± 13	67 ± 14	72 ± 11	0.0041
Female, n (%)	140 (43)	92 (45)	48 (41)	0.5024
NYHA functional class, II/III/IV	175/105/42	125/53/27	50/52/15	0.002
Etiology, n (%)				0.5273
Dilated cardiomyopathy	80 (25)	56 (27)	24 (21)
Hypertensive heart disease	14 (4)	10 (5)	4 (3)
Hypertrophic cardiomyopathy	21 (7)	15 (7)	6 (5)
Ischemic heart disease	65 (20)	36 (18)	29 (25)
Valvular heart disease	80 (25)	52 (25)	28 (24)
Arrhythmia	24 (7)	14 (7)	10 (8)
Others	38 (12)	22 (11)	16 (14)
Atrial fibrillation, n (%)	109 (34)	64 (31)	45 (38)	0.1866
Diabetes mellitus, n (%)	117 (36)	71 (35)	44 (38)	0.5923
Dyslipidemia, n (%)	87 (26)	56 (26)	31 (27)	0.8732
Hypertension, n (%)	217 (67)	137 (67)	80 (68)	0.7758
Blood biomarkers
BNP, pg/mL (IQR)	397 (135-853)	314 (101-710)	625 (280-1147)	0.0326
H-FABP, ng/mL (IQR)	4.7 (3.3-7.6)	4.0 (2.9-6.3)	6.0 (4.2-10.0)	< 0.0001
eGFR, mL/min per 1.73 m²	65 ± 22	69 ± 23	58 ± 19	< 0.0001
Echocardiographic data
LV end-diastolic diameter, mm	55 ± 10	54 ± 9	55 ± 12	0.6018
LV ejection fraction, %	49 ± 18	50 ± 18	47 ± 18	0.1472
Electrocardiogram
Heart rate, beat/min	77 ± 22	78 ± 21	74 ± 19	0.0841
QRS duration, ms	107 ± 20	106 ± 18	109 ± 22	0.0989
QRS prolongation, n (%)	61 (19)	28 (17)	33 (28)	0.0014
Medications, n (%)
ACE inhibitors and/or ARBs, n (%)	213 (66)	138 (67)	75 (64)	0.5577
β-blockers, n (%)	170 (53)	106 (52)	64 (55)	0.6048
Ca channel blockers, n (%)	66 (21)	41 (21)	25 (20)	0.77
Diuretics, n (%)	202 (63)	111 (54)	91 (78)	< 0.0001
Statins, n (%)	83 (26)	54 (26)	29 (25)	0.759

Data are presented as mean ± SD or % unless otherwise indicated. ACE: Angiotensin-converting enzyme; ARB: Angiotensin receptor blocker; BNP: Brain natriuretic peptide; eGFR: Estimated glomerular filtration rate; H-FABP: Heart-type fatty acid-binding protein; LV: Left ventricular; NYHA: New York Heart Association.

Table 2 Univariate and multivariate analyses for cardiovascular events

	HR	95%CI	P value
Univariate analysis
Age, per 10-yr increase	1.297	1.105-1.524	0.0016
Female gender	0.829	0.573-1.199	0.3183
NYHA functional class II and III vs IV	1.960	1.381-2.747	0.0003
Atrial fibrillation	1.256	0.865-1.824	0.2304
Diabetes mellitus	1.103	0.758-1.605	0.6062
Dyslipidemia	0.958	0.635-1.447	0.8417
Hypertension	0.986	0.667-1.457	0.9459
BNP, per 1SD increase	1.166	1.019-1.334	0.0249
eGFR, per 1SD increase	0.589	0.467-0.733	< 0.0001
LV end-diastolic diameter, per 1SD increase	1.062	0.877-1.280	0.5272
LV ejection fraction, per 1SD increase	0.881	0.734-1.074	0.1998
Heart rate, per 1SD increase	0.869	0.724-1.062	0.1724
High H-FABP (> 4.5 ng/mL)	2.994	1.996-4.504	< 0.0001
QRS prolongation (≥ 120 ms)	1.897	1.264-2.832	0.0019
Multivariate analysis
Age, per 10-yr increase	1.093	0.921-1.298	0.3055
NYHA functional class II and III vs IV	1.55	1.055-2.309	0.0262
BNP, per 1SD increase	0.948	0.811-1.151	0.7003
eGFR, per 1SD increase	0.733	0.571-0.938	0.0144
High H-FABP (> 4.5 ng/mL)	1.745	1.088-2.793	0.0210
QRS prolongation (≥ 120 ms)	1.612	1.060-2.451	0.0258

HR: Hazard ratio; SD: Standard deviation; BNP: Brain natriuretic peptide; eGFR: Estimated glomerular filtration rate; NYHA: New York Heart Association.

Table 3 Clinical characteristics of the 4 subgroups of chronic heart failure patients

	Normal (n = 136)	QRS prolongation (n = 20)	High H-FABP (n = 125)	High H-FABP and QRS prolongation (n = 41)
Age, yr	65 ± 13	59 ± 11	74 ± 11^a^b	71 ± 13^b
Female, n (%)	58 (42)	10 (50)	55 (45)	17 (41)
NYHA functional class, II/III/IV	97/30/9	3/4/2013	51/54/20	14/18/9^e
Etiology, n (%)
Dilated cardiomyopathy	33 (24)	8 (40)	24 (19)	15 (37)
Hypertensive heart disease	8 (6)	1 (5)	5 (4)	1 (2)
Hypertrophic cardiomyopathy	11 (8)	3 (15)	6 (5)	0 (0)
Ischemic heart disease	21 (15)	3 (15)	31 (24)	10 (24)
Valvular heart disease	40 (30)	3 (15)	29 (24)	8 (20)
Arrhythmia	12 (9)	0 (0)	8 (7)	4 (10)
Others	11 (8)	2 (10)	22 (17)	3 (7)
Atrial fibrillation, n (%)	48 (35)	7 (35)	41 (33)	13 (32)
Diabetes mellitus, n (%)	46 (33)	6 (28)	46 (37)	17 (41)
Dyslipidemia, n (%)	39 (28)	4 (20)	32 (26)	12 (29)
Hypertension, n (%)	92 (67)	11 (55)	89 (72)	25 (61)
Blood biomarkers
BNP, pg/mL (IQR)	347 (69-453)	389 (213-855)	700 (311-1257)^a	628 (328-1075)^a
H-FABP, ng/mL (IQR)	3.2 (2.4-3.9)	3.6 (2.8-4.2)	7.6 (5.7-11.0)^a^b	7.6 (5.7-9.8)^a^b
eGFR, mL/min per 1.73 m²	75 ± 20	71 ± 26	57 ± 20^a	52 ± 17^a^d
Echocardiographic data
LV end-diastolic diameter, mm	52 ± 10	65 ± 9^a^d	54 ± 9^b	60 ± 10^a^c
LV ejection fraction, %	55 ± 18	35 ± 15^a	49 ± 17^b	38 ± 14^a^d
Electrocardiogram
Heart rate, beat/min	78 ± 19	72 ± 13	79 ± 22	72 ± 20
QRS duration, ms	100 ± 10	143 ± 23^a^d	100 ± 10	138 ± 14^a^d
Medications, n (%)
ACE inhibitors and/or ARBs, n (%)	86 (62)	13 (65)	85 (69)	29 (71)
β-blockers, n (%)	65 (47)	15 (75)	64 (52)	26 (63)
Ca channel blockers, n (%)	36 (26)	0 (0)	24 (20)	6 (15)
Diuretics, n (%)	72 (52)	14 (70)	82 (67)	34 (83)^e
Statins, n (%)	40 (29)	5 (25)	28 (23)	10 (24)

^aP < 0.01 vs normal;

^bP < 0.01 vs QRS prolongation; and

^cP < 0.05 and

^dP < 0.01 vs High H-FABP by analysis of variance with the Scheffe post hoc test.

^eP < 0.01 by χ² test. Normal group (n = 136): H-FABP ≤ 4.5 ng/mL and QRS duration < 120 ms, QRS prolongation group (n = 20): H-FABP ≤ 4.5 ng/mL and QRS duration ≥ 120 ms, High H-FABP group (n = 123): H-FABP > 4.5 ng/mL and QRS duration < 120 ms, and High H-FABP and QRS prolongation group (n = 41): H-FABP > 4.5 ng/mL and QRS duration ≥ 120 ms. ACE: Angiotensin-converting enzyme; ARB: Angiotensin receptor blocker; BNP: Brain natriuretic peptide; eGFR: Estimated glomerular filtration rate; H-FABP: Heart-type fatty acid-binding protein; LV: Left ventricular; NYHA: New York Heart Association.

Table 4 Statistics for model fit and improvement with the addition of high heart-type fatty acid-binding protein and QRS prolongation predicted on the prediction of cardiac events

	Group 1	Group 2	P value
AUC of ROC curve	0.668	0.706	0.029
NRI (95%CI)	Ref	0.223 (0.073-0.372)	0.003
IDI (95%CI)	Ref	0.036 (0.015-0.056)	0.016

AUC: Area under the curve; CI: Confidence interval; IDI: Integrated discrimination improvement; NRI: Net reclassification improvement; ROC: Receiver operator characteristics. Group 1: Age + BNP + NYHA + eGFR; Group 2: Group 1 + H-FABP > 4.5 ng/mL + QRS duration ≥ 120 ms. BNP: Brain natriuretic peptide; eGFR: Estimated glomerular filtration rate; H-FABP: Heart-type fatty acid-binding protein; NYHA: New York Heart Association.

Citation: Kadowaki S, Watanabe T, Otaki Y, Narumi T, Honda Y, Takahashi H, Arimoto T, Shishido T, Miyamoto T, Kubota I. Combined assessment of myocardial damage and electrical disturbance in chronic heart failure. World J Cardiol 2017; 9(5): 457-465
URL: https://www.wjgnet.com/1949-8462/full/v9/i5/457.htm
DOI: https://dx.doi.org/10.4330/wjc.v9.i5.457