Relationship between UACR and echocardiographic indexes (E/A, E/E’ and LAVI).

<p><b>A)</b> UACR was negatively correlated to E/A ratio. <b>B</b>) UACR was positively correlated to LAVI. <b>C</b>) UACR was also positively correlated to E/E’ ratio. UACR, urinary albumin-to-creatinine ratio; LAVI, left atrial volume index.</p

Characteristics of participants according to presence and absence of LVDD.

<p>Values of creatinine, urea-to-creatinine ratio, eGFR, UACR and NT-proBNP are median (interquartile), other values are mean ± SD or %.</p><p>HR, heart rate; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; CHD, coronary heart disease; eGFR, estimated glomerular filtration rate; UACR, urinary albumin-to-creatininie ratio; FBG, fasting blood glucose; TC, total cholesterol; TG, triglycerides; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; NT-proBNP, N-terminal pro-B type natriuretic peptide; LVEF, left ventricular ejection fraction.</p><p><b>*</b>Compared between subjects with and without LVDD.</p

Relationship between urea-to-creatinine ratio and echocardiographic indexes (E/A and LAVI).

<p><b>A</b>) Urea-to-creatinine ratio was negatively correlated to E/A ratio. <b>B</b>) Urea-to-creatinine ratio was positively correlated to LAVI. LAVI, left atrial volume index.</p

Prevalence of LVDD according to serum urea, urea-to-creatinine ratio, and UACR.

<p>The prevalence of LVDD is 36.9%, 37.6% and 44.6% in tertile 1, 2 and 3 of serum urea respectively. It is 33.8%, 40.5% and 45.1% for urea-to-creatinine ratio and 35.1%, 39.7% and 44.5% for UACR, respectively. LVDD, left ventricular diastolic dysfunction; UACR, urinary albumin-to-creatinine ratio.</p

The association of biochemical renal parameters with NT-proBNP.

<p>Abbreviations as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0088638#pone-0088638-t001" target="_blank">Table 1</a>.</p><p>*r, Spearman correlation coefficient.</p

The association of renal parameters with LVDD in subpopulation with eGFR > 60 ml/min/1.73 m².

<p>OR, odds ratio; CI, confidence interval.</p><p>*Adjusted for age, gender, heart rate, BMI, SBP, smoking status, presence or absence of hypertension, diabetes mellitus, CHD, and atrial fibrillation; FBG, NT-proBNP and LVEF. NT-proBNP is log transformed before entering models. Abbreviations as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0088638#pone-0088638-t001" target="_blank">Table 1</a>.</p><p>**OR is per 1 unit increase in urea values; per 1 log unit increase in creatinine, urea-to-creatinine ratio, eGFR and UACR values.</p

The association of biochemical renal parameters with LVDD and severity of LVDD.

<p>OR, odds ratio; CI, confidence interval. Other abbreviations as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0088638#pone-0088638-t001" target="_blank">Table 1</a>.</p><p>*Adjusted for age, gender, heart rate, BMI, SBP, smoking status, presence or absence of hypertension, diabetes mellitus, CHD, and atrial fibrillation; FBG, NT-proBNP and LVEF. NT-proBNP is log transformed before entering models.</p><p>**Adjusted the same parameters except NT-proBNP.</p><p>***Per 1 unit increase in urea values; per 1 log unit increase in creatinine, urea-to-creatinine ratio, eGFR and UACR values.</p

Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity

BackgroundHeart failure with preserved ejection fraction is increasing in prevalence and is associated with a high symptom burden and functional impairment, especially in persons with obesity. No therapies have been approved to target obesity-related heart failure with preserved ejection fraction.MethodsWe randomly assigned 529 patients who had heart failure with preserved ejection fraction and a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or higher to receive once-weekly semaglutide (2.4 mg) or placebo for 52 weeks. The dual primary end points were the change from baseline in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range from 0 to 100, with higher scores indicating fewer symptoms and physical limitations) and the change in body weight. Confirmatory secondary end points included the change in the 6-minute walk distance; a hierarchical composite end point that included death, heart failure events, and differences in the change in the KCCQ-CSS and 6-minute walk distance; and the change in the C-reactive protein (CRP) level.ResultsThe mean change in the KCCQ-CSS was 16.6 points with semaglutide and 8.7 points with placebo (estimated difference, 7.8 points; 95% confidence interval [CI], 4.8 to 10.9; PConclusionsIn patients with heart failure with preserved ejection fraction and obesity, treatment with semaglutide (2.4 mg) led to larger reductions in symptoms and physical limitations, greater improvements in exercise function, and greater weight loss than placebo. (Funded by Novo Nordisk; STEP-HFpEF ClinicalTrials.gov number, NCT04788511.)