Heart failure & cardiomyopathies
Prognoses and Risk Stratification of Thrombus-Associated Events in Heart Failure Patients Without Atrial Fibrillation
Authors' conclusion
In HF without AF, TAE during follow-up was associated with adverse prognoses. The independent risk factors of TAE or TAE-D improved CHA2DS2-VASc predictive ability, especially in patients with HFrEF.
Study context
- Population
- Patients hospitalised for heart failure (HF) without atrial fibrillation (AF) or atrial flutter, left ventricular ejection fraction (LVEF) ≤ 55%, New York Heart Association (NYHA) class III–IV
- Participants
- 450 patients
- Exposure
- ACE andACEN vs CHA2DS2VASc for predicting thrombus-associated events (TAE)
- Outcome
- Prediction of 5-year TAE and TAE-D (composite of TAE and death)
- Follow-up
- 5 years
Methodological detailsMedian follow-up 47 months
- Median follow-up 47 months
Main finding
As reported in the abstract
AUC
0.694 vs. 0.660
P = 0.018
TAE
AUC
0.708 vs. 0.639
P < 0.001
TAE and death (TAE-D)
CHA2DS2VASc
- AUC TAE
- 0.660
- AUC TAE-D
- 0.639
(C)ACE
- AUC TAE
- 0.694
- AUC TAE-D
- 0.708
AUC TAE
CHA2DS2VASc0.660
(C)ACE0.694
AUC TAE-D
CHA2DS2VASc0.639
(C)ACE0.708
Observational data: associations, not effects.
Further findings
Prognosis associated with TAE during follow-up (adjusted) · median follow-up 47 months
| HR (95% CI) | P value | ||
|---|---|---|---|
| TAEAll-cause death | 1.756 (1.324–2.328) | P < 0.001 | |
| TAEReadmission for HF | 1.574 (1.122–2.208) | P = 0.009 | |
| 0.512Hazard ratio (log scale) |
Independent predictors of TAE
| HR (95% CI) | P value | ||
|---|---|---|---|
| Hypertension | 1.573 (1.018–2.429) | P = 0.041 | |
| AAexAF | 2.041 (1.066–3.908) | P = 0.031 | |
| Previous ischaemic stroke | 2.469 (1.576–3.869) | P < 0.001 | |
| Vascular disease | 1.658 (1.074–2.562) | P = 0.023 | |
| 0.20.5125Hazard ratio (log scale) |
Independent predictors of TAE-D
| HR (95% CI) | P value | ||
|---|---|---|---|
| Age | 1.021 (1.008–1.033) | P = 0.001 | |
| Previous ischaemic stroke | 1.685 (1.248–2.274) | P = 0.001 | |
| Ccr | 0.991 (0.986–0.996) | P = 0.001 | |
| 0.512Hazard ratio (log scale) |
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Independent predictors of TAE-DLVEF [10, 25]vs LVEF [40, 55] | 1.925 (1.311–2.826) | P = 0.001 | |
| Independent predictors of TAE-DLVEF (25, 40]vs LVEF (40, 55] | 1.084 (0.825–1.424) | P = 0.563 | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | CHA2DS2VASc | (C)ACE | (C)ACEN | P value |
|---|---|---|---|---|
| Prediction of 5-year TAE and TAE-D in HFrEF (subgroup) · 5 years(C)ACE vs CHA2DS2VASc · TAE | P = 0.013 | |||
| AUC TAE | 0.649 | 0.700 | 0.707 | |
| AUC TAE-D | 0.622 | 0.712 | 0.713 | |
| Prediction of 5-year TAE and TAE-D in HFrEF (subgroup) · 5 years(C)ACEN vs CHA2DS2VASc · TAE | 0.030 | |||
| Prediction of 5-year TAE and TAE-D in HFrEF (subgroup) · 5 years(C)ACE vs CHA2DS2VASc · TAE-D | P < 0.001 | |||
| Prediction of 5-year TAE and TAE-D in HFrEF (subgroup) · 5 years(C)ACEN vs CHA2DS2VASc · TAE-D | <0.001 | |||
| Prediction of 5-year TAE and TAE-D in HFrEF (subgroup) · 5 years(C)ACEN vs (C)ACE · TAE; no statistical improvement | P = 0.600 | |||
| Prediction of 5-year TAE and TAE-D in HFrEF (subgroup) · 5 years(C)ACEN vs (C)ACE · TAE-D; no statistical improvement | P = 0.917 |
Original publication
Prognoses and Risk Stratification of Thrombus-Associated Events in Heart Failure Patients Without Atrial Fibrillation. ESC Heart Fail. Published 9 July 2024. doi:10.
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