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SHR Neuro Cancer Cardio Lipid Metab Microb
Verheyen, N; Schmid, J; Kolesnik, E; Schwegel, N; Späth, J; Kattnig, L; Riepl, H; Zach, D; Santner, V; Höller, V; Pilz, S; Tomaschitz, A; Fuchsjäger, M; Fahrleitner-Pammer, A; Dimai, HP; Obermayer-Pietsch, B; Fruhwald, F; Scherr, D; Zirlik, A; von, Lewinski, D; Ablasser, K.
Prevalence and prognostic impact of bone disease in chronic heart failure with reduced ejection fraction.
ESC Heart Fail. 2024; 11(3):1730-1738
Doi: 10.1002/ehf2.14741
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- Leading authors Med Uni Graz
- Schmid Johannes
- Verheyen Nicolas Dominik
- von Lewinski Dirk
- Co-authors Med Uni Graz
- Ablasser Klemens
- Dimai Hans Peter
- Fahrleitner-Pammer Astrid
- Fruhwald Friedrich
- Fuchsjäger Michael
- Höller Viktoria
- Kolesnik Ewald
- Obermayer-Pietsch Barbara
- Pilz Stefan
- Riepl Hermann Stefan
- Santner Viktoria
- Scherr Daniel
- Schwegel Nora
- Tomaschitz Andreas
- Zach David
- Zirlik Andreas
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- Abstract:
- AIMS: Chronic heart failure is associated with a bone-catabolic state and increases the risk of osteoporosis and fractures. Prospective studies investigating the clinical relevance of bone disease in heart failure are lacking. We aimed to assess the prevalence and prognostic impact of osteoporosis and vertebral fractures (VFs) in chronic heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: Symptomatic outpatients with chronic heart failure and a previous diagnosis of overtly reduced left ventricular ejection fraction < 40% on stable, optimal HFrEF therapy and left ventricular ejection fraction < 50% at enrolment were included into a prospective single-centre study. Osteoporosis was determined with dual-energy X-ray absorptiometry and defined as a T-score ≤ 2.5 at any site. VFs were assessed using X-ray of both thoracic and lumbar spine applying the semiquantitative Genant score. We enrolled 205 patients (22% women), with a median age of 66 (IQR 58-74) years. Median left ventricular ejection fraction was 37 (IQR 30-43) % and median N-terminal pro B-type natriuretic peptide was 964 (IQR 363-2173) pg/mL. Osteoporosis, as defined by bone mineral density, and at least one VF were prevalent in 31 (15%) and 29 patients (14%). Osteoporosis or VF were present in 55 patients (27%) and 5 patients (2%) had both osteoporosis and a VF. During a median follow-up of 4.7 (IQR 4.0-5.3) years, 18 patients (9%) died due to cardiovascular (CV) cause, and 46 patients (22%) had a worsening heart failure (WHF) hospitalization. In multivariate Cox regression analyses, presence of VF independently predicted CV death (HR 2.82, 95% CI 1.04-7.65, P = 0.042), WHF hospitalizations (HR 2.39, 95% CI 1.18-4.82, P = 0.015), and a composite endpoint of CV death and WHF hospitalizations (HR 2.44, 95% CI 1.23-4.82, P = 0.011). Osteoporosis was not significantly associated with CV events. CONCLUSIONS: In a prospective study, bone disease affected every fourth patient with HFrEF, and patients with VF at baseline had a two-fold risk of subsequent CV death or WHF hospitalization. Prevalent bone disease, particularly VF, should be considered as a clinically relevant comorbidity in HFrEF.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Female - administration & dosage
- Male - administration & dosage
- Heart Failure - physiopathology, epidemiology, complications
- Stroke Volume - physiology
- Prospective Studies - administration & dosage
- Prevalence - administration & dosage
- Aged - administration & dosage
- Prognosis - administration & dosage
- Middle Aged - administration & dosage
- Osteoporosis - epidemiology, physiopathology
- Bone Density - physiology
- Ventricular Function, Left - physiology
- Follow-Up Studies - administration & dosage
- Absorptiometry, Photon - administration & dosage
- Risk Factors - administration & dosage
- Chronic Disease - administration & dosage
- Find related publications in this database (Keywords)
- Heart failure with reduced ejection fraction
- Mortality
- Osteoporosis
- Prospective cohort study
- Vertebral fractures
- Worsening heart failure hospitalization