Impact of left ventricular ejection fraction on the effect of renin-angiotensin system blockers after an episode of acute heart failure: From the KCHF Registry

• Yoshikawa, Yusuke

• Tamaki, Yodo

• Morimoto, Takeshi

• Yaku, Hidenori

• Yamamoto, Erika

• Inuzuka, Yasutaka

• Ozasa, Neiko

• Kitai, Takeshi

• Nagao, Kazuya

• Sato, Yukihito

• Kondo, Hirokazu

• Tamura, Toshihiro

• Nakagawa, Yoshihisa

• Kuwahara, Koichiro

• Kato, Takao

• Kimura, Takeshi

Abstract

Objective: This observational study aimed to examine the prognostic association of angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARB) in different left ventricular ejection fraction (LVEF) categories. Methods: In 3717 patients enrolled in the KCHF Registry, a multicentre registry including consecutive patients hospitalized for acute heart failure (HF), we assessed patient characteristics and association between ACE-I/ARB and clinical outcomes according to LVEF. In the three LVEF categories (reduced LVEF [HFrEF], mid-range LVEF [HFmrEF] and preserved LVEF [HFpEF]), we compared the patients with ACE-I/ARB as discharge medication and those without, and assessed their 1-year clinical outcomes. We defined the primary outcome measure as a composite of all-cause death and HF hospitalization. Results: The 1-year cumulative incidences of the primary outcome measure were 36.3% in HFrEF, 30.1% in HFmrEF and 33.8% in HFpEF (log-rank P = 0.07). The adjusted risks of the ACE-I/ARB group relative to the no ACE-I/ARB group for the primary outcome measure were significantly lower in HFrEF and HFmrEF (HR 0.66 [95%CI 0.54–0.79], P<0.001, and HR 0.61 [0.45–0.82], P = 0.001, respectively), but not in HFpEF (HR 0.95 [0.80–1.14], P = 0.61). There was a significant interaction between the LVEF category and the ACE-I/ARB use on the primary outcome measure (Pinteraction = 0.01). Conclusions: ACE-I/ARB for patients who were hospitalized for acute HF was associated with significantly lower risk for a composite of all-cause death and HF hospitalization in HFrEF and HFmrEF, but not in HFpEF. ACE-I/ARB might be a potential treatment option in HFmrEF as in HFrEF.

Journal

• PLOS ONE

  PLOS ONE 15 (9), 2020-09

  Public Library of Science (PLoS)

Details

• CRID: 1051975833353236608
• NII Article ID: 120006954100
• ISSN: 19326203
• HANDLE: 2433/261139
• Text Lang: en
• Article Type: journal article
• Data Source:
  • IRDB
  • CiNii Articles