Fractional flow reserve in patients with intermediate values of Duke Treadmill Score and borderline coronary lesions

Despite the wide usage of exercise ECG tests and Duke Treadmill Score (DTS) in clinical practice, no comparison between this scoring system and Fractional Flow Reserve (FFR) has yet been made, particularly in cases of angiographically verified borderline lesions. Thirty patients with single coronary lesions and angiographically assessed borderline stenosis (between 30-70%) and previously calculated intermediate values of DTS between -10 to +4 were examined using FFR. Adequate specificity and sensitivity (0.769 and 0.556, respectively) were in a more narrow range of -0.5 to -10. Sex and age did not have an influence on the DTS values. There was a correlation between the values of FFR and age (r=0.395, p=0.031) and between angiographic assessment of stenosis and quantitative coronary angiography (QCA) (r=0.648, p<0.0001). In the study population, a decision on revascularization could not be based solely on angiographic or QCA assessment of the artery or on the values of DTS

Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry

[Abstract] Aims. Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results. We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66±13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion. Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p&nbsp;&lt;.001. Over 24&nbsp;months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10&nbsp;ml/min/1.73&nbsp;m2 decrease), that was most notable in patients with eGFR &lt;30&nbsp;ml/min/1.73&nbsp;m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90&nbsp;ml/min/1.73&nbsp;m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P &lt;.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Fractional flow reserve of intermediate lesions on collateral donor coronary arteries after myocardial infarction

Fractional flow reserve (FFR) is the gold standard for the functional assessment of coronary arteries. The aim of this study was to evaluate the relation between angiography, QCA and FFR in borderline lesions on collateral donor coronary arteries. In addition, FFR is compared with the angiographic appearance of collaterals to infarction-related arteries and echocardiographically assessed viability of infarct related the LV wall. In 60 patients with previous IM and occluded IRA, functional assessment of borderline coronary stenosis (30-70% DS) on collaterals donor artery was performed. We have not found statistically significant differences in these parameters between groups with different angiographic appearances of collaterals and different viability of distal myocardium. However, we found higher FFR values in diabetic patients (p=0.018). Higher FFR values in diabetic patients reveal the negative effects of diabetes on collateral growth and myocardial viability

Acute heart failure congestion and perfusion status – impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry

none614siAims: Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC-EORP-HFA Heart Failure Long-Term Registry, we compared differences in baseline characteristics, in-hospital management and outcomes among congestion/perfusion profiles using this classification. Methods and results: We included 7865 AHF patients classified at admission as: ‘dry-warm’ (9.9%), ‘wet-warm’ (69.9%), ‘wet-cold’ (19.8%) and ‘dry-cold’ (0.4%). These groups differed significantly in terms of baseline characteristics, in-hospital management and outcomes. In-hospital mortality was 2.0% in ‘dry-warm’, 3.8% in ‘wet-warm’, 9.1% in ‘dry-cold’ and 12.1% in ‘wet-cold’ patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: ‘wet-warm’ vs. ‘dry-warm’ 1.78 (1.43–2.21) and ‘wet-cold’ vs. ‘wet-warm’ 1.33 (1.19–1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: ‘wet-warm’ vs. ‘dry-warm’ 1.46 (1.31–1.63) and ‘wet-cold’ vs. ‘wet-warm’ 2.20 (1.89–2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1-year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta-blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion. Conclusion: Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes.noneChioncel O.; Mebazaa A.; Maggioni A.P.; Harjola V.-P.; Rosano G.; Laroche C.; Piepoli M.F.; Crespo-Leiro M.G.; Lainscak M.; Ponikowski P.; Filippatos G.; Ruschitzka F.; Seferovic P.; Coats A.J.S.; Lund L.H.; Auer J.; Ablasser K.; Fruhwald F.; Dolze T.; Brandner K.; Gstrein S.; Poelzl G.; Moertl D.; Reiter S.; Podczeck-Schweighofer A.; Muslibegovic A.; Vasilj M.; Fazlibegovic E.; Cesko M.; Zelenika D.; Palic B.; Pravdic D.; Cuk D.; Vitlianova K.; Katova T.; Velikov T.; Kurteva T.; Gatzov P.; Kamenova D.; Antova M.; Sirakova V.; Krejci J.; Mikolaskova M.; Spinar J.; Krupicka J.; Malek F.; Hegarova M.; Lazarova M.; Monhart Z.; Hassanein M.; Sobhy M.; El Messiry F.; El Shazly A.H.; Elrakshy Y.; Youssef A.; Moneim A.A.; Noamany M.; Reda A.; Dayem T.K.A.; Farag N.; Halawa S.I.; Hamid M.A.; Said K.; Saleh A.; Ebeid H.; Hanna R.; Aziz R.; Louis O.; Enen M.A.; Ibrahim B.S.; Nasr G.; Elbahry A.; Sobhy H.; Ashmawy M.; Gouda M.; Aboleineen W.; Bernard Y.; Luporsi P.; Meneveau N.; Pillot M.; Morel M.; Seronde M.-F.; Schiele F.; Briand F.; Delahaye F.; Damy T.; Eicher J.-C.; de Groote P.; Fertin M.; Lamblin N.; Isnard R.; Lefol C.; Thevenin S.; Hagege A.; Jondeau G.; Logeart D.; Le Marcis V.; Ly J.-F.; Coisne D.; Lequeux B.; Le Moal V.; Mascle S.; Lotton P.; Behar N.; Donal E.; Thebault C.; Ridard C.; Reynaud A.; Basquin A.; Bauer F.; Codjia R.; Galinier M.; Tourikis P.; Stavroula M.; Tousoulis D.; Stefanadis C.; Chrysohoou C.; Kotrogiannis I.; Matzaraki V.; Dimitroula T.; Karavidas A.; Tsitsinakis G.; Kapelios C.; Nanas J.; Kampouri H.; Nana E.; Kaldara E.; Eugenidou A.; Vardas P.; Saloustros I.; Patrianakos A.; Tsaknakis T.; Evangelou S.; Nikoloulis N.; Tziourganou H.; Tsaroucha A.; Papadopoulou A.; Douras A.; Polgar L.; Merkely B.; Kosztin A.; Nyolczas N.; Nagy A.C.; Halmosi R.; Elber J.; Alony I.; Shotan A.; Fuhrmann A.V.; Amir O.; Romano S.; Marcon S.; Penco M.; Di Mauro M.; Lemme E.; Carubelli V.; Rovetta R.; Metra M.; Bulgari M.; Quinzani F.; Lombardi C.; Bosi S.; Schiavina G.; Squeri A.; Barbieri A.; Di Tano G.; Pirelli S.; Ferrari R.; Fucili A.; Passero T.; Musio S.; Di Biase M.; Correale M.; Salvemini G.; Brognoli S.; Zanelli E.; Giordano A.; Agostoni P.; Italiano G.; Salvioni E.; Copelli S.; Modena M.G.; Reggianini L.; Valenti C.; Olaru A.; Bandino S.; Deidda M.; Mercuro G.; Dessalvi C.C.; Marino P.N.; Di Ruocco M.V.; Sartori C.; Piccinino C.; Parrinello G.; Licata G.; Torres D.; Giambanco S.; Busalacchi S.; Arrotti S.; Novo S.; Inciardi R.M.; Pieri P.; Chirco P.R.; Galifi M.A.; Teresi G.; Buccheri D.; Minacapelli A.; Veniani M.; Frisinghelli A.; Priori S.G.; Cattaneo S.; Opasich C.; Gualco A.; Pagliaro M.; Mancone M.; Fedele F.; Cinque A.; Vellini M.; Scarfo I.; Romeo F.; Ferraiuolo F.; Sergi D.; Anselmi M.; Melandri F.; Leci E.; Iori E.; Bovolo V.; Pidello S.; Frea S.; Bergerone S.; Botta M.; Canavosio F.G.; Gaita F.; Merlo M.; Cinquetti M.; Sinagra G.; Ramani F.; Fabris E.; Stolfo D.; Artico J.; Miani D.; Fresco C.; Daneluzzi C.; Proclemer A.; Cicoira M.; Zanolla L.; Marchese G.; Torelli F.; Vassanelli C.; Voronina N.; Erglis A.; Tamakauskas V.; Smalinskas V.; Karaliute R.; Petraskiene I.; Kazakauskaite E.; Rumbinaite E.; Kavoliuniene A.; Vysniauskas V.; Brazyte-Ramanauskiene R.; Petraskiene D.; Stankala S.; Switala P.; Juszczyk Z.; Sinkiewicz W.; Gilewski W.; Pietrzak J.; Orzel T.; Kasztelowicz P.; Kardaszewicz P.; Lazorko-Piega M.; Gabryel J.; Mosakowska K.; Bellwon J.; Rynkiewicz A.; Raczak G.; Lewicka E.; Dabrowska-Kugacka A.; Bartkowiak R.; Sosnowska-Pasiarska B.; Wozakowska-Kaplon B.; Krzeminski A.; Zabojszcz M.; Mirek-Bryniarska E.; Grzegorzko A.; Bury K.; Nessler J.; Zalewski J.; Furman A.; Broncel M.; Poliwczak A.; Bala A.; Zycinski P.; Rudzinska M.; Jankowski L.; Kasprzak J.D.; Michalak L.; Soska K.W.; Drozdz J.; Huziuk I.; Retwinski A.; Flis P.; Weglarz J.; Bodys A.; Grajek S.; Kaluzna-Oleksy M.; Straburzynska-Migaj E.; Dankowski R.; Szymanowska K.; Grabia J.; Szyszka A.; Nowicka A.; Samcik M.; Wolniewicz L.; Baczynska K.; Komorowska K.; Poprawa I.; Komorowska E.; Sajnaga D.; Zolbach A.; Dudzik-Plocica A.; Abdulkarim A.-F.; Lauko-Rachocka A.; Kaminski L.; Kostka A.; Cichy A.; Ruszkowski P.; Splawski M.; Fitas G.; Szymczyk A.; Serwicka A.; Fiega A.; Zysko D.; Krysiak W.; Szabowski S.; Skorek E.; Pruszczyk P.; Bienias P.; Ciurzynski M.; Welnicki M.; Mamcarz A.; Folga A.; Zielinski T.; Rywik T.; Leszek P.; Sobieszczanska-Malek M.; Piotrowska M.; Kozar-Kaminska K.; Komuda K.; Wisniewska J.; Tarnowska A.; Balsam P.; Marchel M.; Opolski G.; Kaplon-Cieslicka A.; Gil R.J.; Mozenska O.; Byczkowska K.; Gil K.; Pawlak A.; Michalek A.; Krzesinski P.; Piotrowicz K.; Uzieblo-Zyczkowska B.; Stanczyk A.; Skrobowski A.; Ponikowski P.; Jankowska E.; Rozentryt P.; Polonski L.; Gadula-Gacek E.; Nowalany-Kozielska E.; Kuczaj A.; Kalarus Z.; Szulik M.; Przybylska K.; Klys J.; Prokop-Lewicka G.; Kleinrok A.; Aguiar C.T.; Ventosa A.; Pereira S.; Faria R.; Chin J.; De Jesus I.; Santos R.; Silva P.; Moreno N.; Queiros C.; Lourenco C.; Pereira A.; Castro A.; Andrade A.; Guimaraes T.O.; Martins S.; Placido R.; Lima G.; Brito D.; Francisco A.R.; Cardiga R.; Proenca M.; Araujo I.; Marques F.; Fonseca C.; Moura B.; Leite S.; Campelo M.; Silva-Cardoso J.; Rodrigues J.; Rangel I.; Martins E.; Correia A.S.; Peres M.; Marta L.; da Silva G.F.; Severino D.; Durao D.; Leao S.; Magalhaes P.; Moreira I.; Cordeiro A.F.; Ferreira C.; Araujo C.; Ferreira A.; Baptista A.; Radoi M.; Bicescu G.; Vinereanu D.; Sinescu C.-J.; Macarie C.; Popescu R.; Daha I.; Dan G.-A.; Stanescu C.; Dan A.; Craiu E.; Nechita E.; Aursulesei V.; Christodorescu R.; Otasevic P.; Seferovic P.M.; Simeunovic D.; Ristic A.D.; Celic V.; Pavlovic-Kleut M.; Lazic J.S.; Stojcevski B.; Pencic B.; Stevanovic A.; Andric A.; Iric-Cupic V.; Jovic M.; Davidovic G.; Milanov S.; Mitic V.; Atanaskovic V.; Antic S.; Pavlovic M.; Stanojevic D.; Stoickov V.; Ilic S.; Ilic M.D.; Petrovic D.; Stojsic S.; Kecojevic S.; Dodic S.; Adic N.C.; Cankovic M.; Stojiljkovic J.; Mihajlovic B.; Radin A.; Radovanovic S.; Krotin M.; Klabnik A.; Goncalvesova E.; Pernicky M.; Murin J.; Kovar F.; Kmec J.; Semjanova H.; Strasek M.; Iskra M.S.; Ravnikar T.; Suligoj N.C.; Komel J.; Fras Z.; Jug B.; Glavic T.; Losic R.; Bombek M.; Krajnc I.; Krunic B.; Horvat S.; Kovac D.; Rajtman D.; Cencic V.; Letonja M.; Winkler R.; Valentincic M.; Melihen-Bartolic C.; Bartolic A.; Vrckovnik M.P.; Kladnik M.; Pusnik C.S.; Marolt A.; Klen J.; Drnovsek B.; Leskovar B.; Anguita M.J.F.; Page J.C.G.; Martinez F.M.S.; Andres J.; Bayes-Genis A.; Mirabet S.; Mendez A.; Garcia-Cosio L.; Roig E.; Leon V.; Gonzalez-Costello J.; Muntane G.; Garay A.; Alcade-Martinez V.; Fernandez S.L.; Rivera-Lopez R.; Puga-Martinez M.; Fernandez-Alvarez M.; Serrano-Martinez J.L.; Crespo-Leiro M.; Grille-Cancela Z.; Marzoa-Rivas R.; Blanco-Canosa P.; Paniagua-Martin M.J.; Barge-Caballero E.; Cerdena I.L.; Baldomero I.F.H.; Padron A.L.; Rosillo S.O.; Gonzalez-Gallarza R.D.; Montanes O.S.; Manjavacas A.M.I.; Conde A.C.; Araujo A.; Soria T.; Garcia-Pavia P.; Gomez-Bueno M.; Cobo-Marcos M.; Alonso-Pulpon L.; Cubero J.S.; Sayago I.; Gonzalez-Segovia A.; Briceno A.; Subias P.E.; Hernandez M.V.; Cano M.J.R.; Sanchez M.A.G.; Jimenez J.F.D.; Garrido-Lestache E.B.; Pinilla J.M.G.; de la Villa B.G.; Sahuquillo A.; Marques R.B.; Calvo F.T.; Perez-Martinez M.T.; Gracia-Rodenas M.R.; Garrido-Bravo I.P.; Pastor-Perez F.; Pascual-Figal D.A.; Molina B.D.; Orus J.; Gonzalo F.E.; Bertomeu V.; Valero R.; Martinez-Abellan R.; Quiles J.; Rodrigez-Ortega J.A.; Mateo I.; ElAmrani A.; Fernandez-Vivancos C.; Valero D.B.; Almenar-Bonet L.; Sanchez-Lazaro I.J.; Marques-Sule E.; Facila-Rubio L.; Perez-Silvestre J.; Garcia-Gonzalez P.; Ridocci-Soriano F.; Garcia-Escriva D.; Pellicer-Cabo A.; de la Fuente Galan L.; Diaz J.L.; Platero A.R.; Arias J.C.; Blasco-Peiro T.; Julve M.S.; Sanchez-Insa E.; Aured-Guallar C.; Portoles-Ocampo A.; Melin M.; Hagglund E.; Stenberg A.; Lindahl I.-M.; Asserlund B.; Olsson L.; Dahlstrom U.; Afzelius M.; Karlstrom P.; Tengvall L.; Wiklund P.-A.; Olsson B.; Kalayci S.; Temizhan A.; Cavusoglu Y.; Gencer E.; Yilmaz M.B.; Gunes H.Chioncel, O.; Mebazaa, A.; Maggioni, A. P.; Harjola, V. -P.; Rosano, G.; Laroche, C.; Piepoli, M. F.; Crespo-Leiro, M. G.; Lainscak, M.; Ponikowski, P.; Filippatos, G.; Ruschitzka, F.; Seferovic, P.; Coats, A. J. S.; Lund, L. H.; Auer, J.; Ablasser, K.; Fruhwald, F.; Dolze, T.; Brandner, K.; Gstrein, S.; Poelzl, G.; Moertl, D.; Reiter, S.; Podczeck-Schweighofer, A.; Muslibegovic, A.; Vasilj, M.; Fazlibegovic, E.; Cesko, M.; Zelenika, D.; Palic, B.; Pravdic, D.; Cuk, D.; Vitlianova, K.; Katova, T.; Velikov, T.; Kurteva, T.; Gatzov, P.; Kamenova, D.; Antova, M.; Sirakova, V.; Krejci, J.; Mikolaskova, M.; Spinar, J.; Krupicka, J.; Malek, F.; Hegarova, M.; Lazarova, M.; Monhart, Z.; Hassanein, M.; Sobhy, M.; El Messiry, F.; El Shazly, A. H.; Elrakshy, Y.; Youssef, A.; Moneim, A. A.; Noamany, M.; Reda, A.; Dayem, T. K. A.; Farag, N.; Halawa, S. I.; Hamid, M. A.; Said, K.; Saleh, A.; Ebeid, H.; Hanna, R.; Aziz, R.; Louis, O.; Enen, M. A.; Ibrahim, B. S.; Nasr, G.; Elbahry, A.; Sobhy, H.; Ashmawy, M.; Gouda, M.; Aboleineen, W.; Bernard, Y.; Luporsi, P.; Meneveau, N.; Pillot, M.; Morel, M.; Seronde, M. -F.; Schiele, F.; Briand, F.; Delahaye, F.; Damy, T.; Eicher, J. -C.; de Groote, P.; Fertin, M.; Lamblin, N.; Isnard, R.; Lefol, C.; Thevenin, S.; Hagege, A.; Jondeau, G.; Logeart, D.; Le Marcis, V.; Ly, J. -F.; Coisne, D.; Lequeux, B.; Le Moal, V.; Mascle, S.; Lotton, P.; Behar, N.; Donal, E.; Thebault, C.; Ridard, C.; Reynaud, A.; Basquin, A.; Bauer, F.; Codjia, R.; Galinier, M.; Tourikis, P.; Stavroula, M.; Tousoulis, D.; Stefanadis, C.; Chrysohoou, C.; Kotrogiannis, I.; Matzaraki, V.; Dimitroula, T.; Karavidas, A.; Tsitsinakis, G.; Kapelios, C.; Nanas, J.; Kampouri, H.; Nana, E.; Kaldara, E.; Eugenidou, A.; Vardas, P.; Saloustros, I.; Patrianakos, A.; Tsaknakis, T.; Evangelou, S.; Nikoloulis, N.; Tziourganou, H.; Tsaroucha, A.; Papadopoulou, A.; Douras, A.; Polgar, L.; Merkely, B.; Kosztin, A.; Nyolczas, N.; Nagy, A. C.; Halmosi, R.; Elber, J.; Alony, I.; Shotan, A.; Fuhrmann, A. V.; Amir, O.; Romano, S.; Marcon, S.; Penco, M.; Di Mauro, M.; Lemme, E.; Carubelli, V.; Rovetta, R.; Metra, M.; Bulgari, M.; Quinzani, F.; Lombardi, C.; Bosi, S.; Schiavina, G.; Squeri, A.; Barbieri, A.; Di Tano, G.; Pirelli, S.; Ferrari, R.; Fucili, A.; Passero, T.; Musio, S.; Di Biase, M.; Correale, M.; Salvemini, G.; Brognoli, S.; Zanelli, E.; Giordano, A.; Agostoni, P.; Italiano, G.; Salvioni, E.; Copelli, S.; Modena, M. G.; Reggianini, L.; Valenti, C.; Olaru, A.; Bandino, S.; Deidda, M.; Mercuro, G.; Dessalvi, C. C.; Marino, P. N.; Di Ruocco, M. V.; Sartori, C.; Piccinino, C.; Parrinello, G.; Licata, G.; Torres, D.; Giambanco, S.; Busalacchi, S.; Arrotti, S.; Novo, S.; Inciardi, R. M.; Pieri, P.; Chirco, P. R.; Galifi, M. A.; Teresi, G.; Buccheri, D.; Minacapelli, A.; Veniani, M.; Frisinghelli, A.; Priori, S. G.; Cattaneo, S.; Opasich, C.; Gualco, A.; Pagliaro, M.; Mancone, M.; Fedele, F.; Cinque, A.; Vellini, M.; Scarfo, I.; Romeo, F.; Ferraiuolo, F.; Sergi, D.; Anselmi, M.; Melandri, F.; Leci, E.; Iori, E.; Bovolo, V.; Pidello, S.; Frea, S.; Bergerone, S.; Botta, M.; Canavosio, F. G.; Gaita, F.; Merlo, M.; Cinquetti, M.; Sinagra, G.; Ramani, F.; Fabris, E.; Stolfo, D.; Artico, J.; Miani, D.; Fresco, C.; Daneluzzi, C.; Proclemer, A.; Cicoira, M.; Zanolla, L.; Marchese, G.; Torelli, F.; Vassanelli, C.; Voronina, N.; Erglis, A.; Tamakauskas, V.; Smalinskas, V.; Karaliute, R.; Petraskiene, I.; Kazakauskaite, E.; Rumbinaite, E.; Kavoliuniene, A.; Vysniauskas, V.; Brazyte-Ramanauskiene, R.; Petraskiene, D.; Stankala, S.; Switala, P.; Juszczyk, Z.; Sinkiewicz, W.; Gilewski, W.; Pietrzak, J.; Orzel, T.; Kasztelowicz, P.; Kardaszewicz, P.; Lazorko-Piega, M.; Gabryel, J.; Mosakowska, K.; Bellwon, J.; Rynkiewicz, A.; Raczak, G.; Lewicka, E.; Dabrowska-Kugacka, A.; Bartkowiak, R.; Sosnowska-Pasiarska, B.; Wozakowska-Kaplon, B.; Krzeminski, A.; Zabojszcz, M.; Mirek-Bryniarska, E.; Grzegorzko, A.; Bury, K.; Nessler, J.; Zalewski, J.; Furman, A.; Broncel, M.; Poliwczak, A.; Bala, A.; Zycinski, P.; Rudzinska, M.; Jankowski, L.; Kasprzak, J. D.; Michalak, L.; Soska, K. W.; Drozdz, J.; Huziuk, I.; Retwinski, A.; Flis, P.; Weglarz, J.; Bodys, A.; Grajek, S.; Kaluzna-Oleksy, M.; Straburzynska-Migaj, E.; Dankowski, R.; Szymanowska, K.; Grabia, J.; Szyszka, A.; Nowicka, A.; Samcik, M.; Wolniewicz, L.; Baczynska, K.; Komorowska, K.; Poprawa, I.; Komorowska, E.; Sajnaga, D.; Zolbach, A.; Dudzik-Plocica, A.; Abdulkarim, A. -F.; Lauko-Rachocka, A.; Kaminski, L.; Kostka, A.; Cichy, A.; Ruszkowski, P.; Splawski, M.; Fitas, G.; Szymczyk, A.; Serwicka, A.; Fiega, A.; Zysko, D.; Krysiak, W.; Szabowski, S.; Skorek, E.; Pruszczyk, P.; Bienias, P.; Ciurzynski, M.; Welnicki, M.; Mamcarz, A.; Folga, A.; Zielinski, T.; Rywik, T.; Leszek, P.; Sobieszczanska-Malek, M.; Piotrowska, M.; Kozar-Kaminska, K.; Komuda, K.; Wisniewska, J.; Tarnowska, A.; Balsam, P.; Marchel, M.; Opolski, G.; Kaplon-Cieslicka, A.; Gil, R. J.; Mozenska, O.; Byczkowska, K.; Gil, K.; Pawlak, A.; Michalek, A.; Krzesinski, P.; Piotrowicz, K.; Uzieblo-Zyczkowska, B.; Stanczyk, A.; Skrobowski, A.; Ponikowski, P.; Jankowska, E.; Rozentryt, P.; Polonski, L.; Gadula-Gacek, E.; Nowalany-Kozielska, E.; Kuczaj, A.; Kalarus, Z.; Szulik, M.; Przybylska, K.; Klys, J.; Prokop-Lewicka, G.; Kleinrok, A.; Aguiar, C. T.; Ventosa, A.; Pereira, S.; Faria, R.; Chin, J.; De Jesus, I.; Santos, R.; Silva, P.; Moreno, N.; Queiros, C.; Lourenco, C.; Pereira, A.; Castro, A.; Andrade, A.; Guimaraes, T. O.; Martins, S.; Placido, R.; Lima, G.; Brito, D.; Francisco, A. R.; Cardiga, R.; Proenca, M.; Araujo, I.; Marques, F.; Fonseca, C.; Moura, B.; Leite, S.; Campelo, M.; Silva-Cardoso, J.; Rodrigues, J.; Rangel, I.; Martins, E.; Correia, A. S.; Peres, M.; Marta, L.; da Silva, G. F.; Severino, D.; Durao, D.; Leao, S.; Magalhaes, P.; Moreira, I.; Cordeiro, A. F.; Ferreira, C.; Araujo, C.; Ferreira, A.; Baptista, A.; Radoi, M.; Bicescu, G.; Vinereanu, D.; Sinescu, C. -J.; Macarie, C.; Popescu, R.; Daha, I.; Dan, G. -A.; Stanescu, C.; Dan, A.; Craiu, E.; Nechita, E.; Aursulesei, V.; Christodorescu, R.; Otasevic, P.; Seferovic, P. M.; Simeunovic, D.; Ristic, A. D.; Celic, V.; Pavlovic-Kleut, M.; Lazic, J. S.; Stojcevski, B.; Pencic, B.; Stevanovic, A.; Andric, A.; Iric-Cupic, V.; Jovic, M.; Davidovic, G.; Milanov, S.; Mitic, V.; Atanaskovic, V.; Antic, S.; Pavlovic, M.; Stanojevic, D.; Stoickov, V.; Ilic, S.; Ilic, M. D.; Petrovic, D.; Stojsic, S.; Kecojevic, S.; Dodic, S.; Adic, N. C.; Cankovic, M.; Stojiljkovic, J.; Mihajlovic, B.; Radin, A.; Radovanovic, S.; Krotin, M.; Klabnik, A.; Goncalvesova, E.; Pernicky, M.; Murin, J.; Kovar, F.; Kmec, J.; Semjanova, H.; Strasek, M.; Iskra, M. S.; Ravnikar, T.; Suligoj, N. C.; Komel, J.; Fras, Z.; Jug, B.; Glavic, T.; Losic, R.; Bombek, M.; Krajnc, I.; Krunic, B.; Horvat, S.; Kovac, D.; Rajtman, D.; Cencic, V.; Letonja, M.; Winkler, R.; Valentincic, M.; Melihen-Bartolic, C.; Bartolic, A.; Vrckovnik, M. P.; Kladnik, M.; Pusnik, C. S.; Marolt, A.; Klen, J.; Drnovsek, B.; Leskovar, B.; Anguita, M. J. F.; Page, J. C. G.; Martinez, F. M. S.; Andres, J.; Bayes-Genis, A.; Mirabet, S.; Mendez, A.; Garcia-Cosio, L.; Roig, E.; Leon, V.; Gonzalez-Costello, J.; Muntane, G.; Garay, A.; Alcade-Martinez, V.; Fernandez, S. L.; Rivera-Lopez, R.; Puga-Martinez, M.; Fernandez-Alvarez, M.; Serrano-Martinez, J. L.; Crespo-Leiro, M.; Grille-Cancela, Z.; Marzoa-Rivas, R.; Blanco-Canosa, P.; Paniagua-Martin, M. J.; Barge-Caballero, E.; Cerdena, I. L.; Baldomero, I. F. H.; Padron, A. L.; Rosillo, S. O.; Gonzalez-Gallarza, R. D.; Montanes, O. S.; Manjavacas, A. M. I.; Conde, A. C.; Araujo, A.; Soria, T.; Garcia-Pavia, P.; Gomez-Bueno, M.; Cobo-Marcos, M.; Alonso-Pulpon, L.; Cubero, J. S.; Sayago, I.; Gonzalez-Segovia, A.; Briceno, A.; Subias, P. E.; Hernandez, M. V.; Cano, M. J. R.; Sanchez, M. A. G.; Jimenez, J. F. D.; Garrido-Lestache, E. B.; Pinilla, J. M. G.; de la Villa, B. G.; Sahuquillo, A.; Marques, R. B.; Calvo, F. T.; Perez-Martinez, M. T.; Gracia-Rodenas, M. R.; Garrido-Bravo, I. P.; Pastor-Perez, F.; Pascual-Figal, D. A.; Molina, B. D.; Orus, J.; Gonzalo, F. E.; Bertomeu, V.; Valero, R.; Martinez-Abellan, R.; Quiles, J.; Rodrigez-Ortega, J. A.; Mateo, I.; Elamrani, A.; Fernandez-Vivancos, C.; Valero, D. B.; Almenar-Bonet, L.; Sanchez-Lazaro, I. J.; Marques-Sule, E.; Facila-Rubio, L.; Perez-Silvestre, J.; Garcia-Gonzalez, P.; Ridocci-Soriano, F.; Garcia-Escriva, D.; Pellicer-Cabo, A.; de la Fuente Galan, L.; Diaz, J. L.; Platero, A. R.; Arias, J. C.; Blasco-Peiro, T.; Julve, M. S.; Sanchez-Insa, E.; Aured-Guallar, C.; Portoles-Ocampo, A.; Melin, M.; Hagglund, E.; Stenberg, A.; Lindahl, I. -M.; Asserlund, B.; Olsson, L.; Dahlstrom, U.; Afzelius, M.; Karlstrom, P.; Tengvall, L.; Wiklund, P. -A.; Olsson, B.; Kalayci, S.; Temizhan, A.; Cavusoglu, Y.; Gencer, E.; Yilmaz, M. B.; Gunes, H

Acute heart failure congestion and perfusion status – impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry

Aims: Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC-EORP-HFA Heart Failure Long-Term Registry, we compared differences in baseline characteristics, in-hospital management and outcomes among congestion/perfusion profiles using this classification. Methods and results: We included 7865 AHF patients classified at admission as: ‘dry-warm’ (9.9%), ‘wet-warm’ (69.9%), ‘wet-cold’ (19.8%) and ‘dry-cold’ (0.4%). These groups differed significantly in terms of baseline characteristics, in-hospital management and outcomes. In-hospital mortality was 2.0% in ‘dry-warm’, 3.8% in ‘wet-warm’, 9.1% in ‘dry-cold’ and 12.1% in ‘wet-cold’ patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: ‘wet-warm’ vs. ‘dry-warm’ 1.78 (1.43–2.21) and ‘wet-cold’ vs. ‘wet-warm’ 1.33 (1.19–1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: ‘wet-warm’ vs. ‘dry-warm’ 1.46 (1.31–1.63) and ‘wet-cold’ vs. ‘wet-warm’ 2.20 (1.89–2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1-year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta-blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion. Conclusion: Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiolog