Am J Cardiovasc Dis 2011;1(2):167-175
Original Article
Influence of myocardial ischemia on outcomes in patients with systolic
versus non-systolic heart failure
Thomas E. Vanhecke, Barry A. Franklin, Prem Soman, Avijit Lahiri, Jennifer H. Mieres, Tina Sias, Dennis A. Calnon, David
Wolinsky, James E. UdelsonI, Peter A. McCullough
Genesys Regional Medical Center/Ascension Health System, Grand Blanc, MI, USA; William Beaumont Hospital, Royal
Oak, MI, USA; The University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Wellington Hospital, London, UK; New
York University School of Medicine, New York, NY, USA; Marshall University School of Medicine, Huntington, WV, USA;
MidWest Cardiology Research Foundation, Columbus, OH, USA; Albany Associates in Cardiology, Albany, NY, USA; Tufts
Medical Center, Boston MA, USA; St. John Providence Health System/Ascension Health System, Providence Park Heart
Institute, Novi, MI, USA.
Received June 30, 2011; accepted July , 2011; Epub July , 2011; published July 30, 2011
Abstract: Background: Heart failure (HF) is a leading cause of adult hospitalization, morbidity, and mortality. We evaluated
the influence of myocardial ischemia and left ventricular ejection fraction (LVEF) on outcomes in patients who were
hospitalized with new onset HF. Methods: We prospectively recruited 201 consecutive patients hospitalized for a first
episode of HF from 17 medical centers across Europe and North America. All patients received gated single-photon
emission computed tomographic testing with standardized study interpretations by trained core laboratory investigators.
Predefined data from routine care were collected and aggregated. Computerized scoring was performed at the core
laboratory and participants with a summed difference score ≥4 were defined as having myocardial ischemia. Participants
were categorized as having systolic heart failure (SHF) (LVEF<40%) or nonsystolic heart failure (NS-HF) (LVEF≥40%). A
proportional hazards model was used to assess the impact of clinical predictors on the outcomes of mortality, cardiac
rehospitalization and a combined outcome within 2 years of study enrollment. Results: 180 patients (mean age was 65.5
± 14.6 years and 57.2% male) fulfilled study criteria and were included. Myocardial ischemia was present in 45 (41.2%)
patients with SHF and 19 (27.5%) patients with NS-HF (p <0.01). During the follow-up period, 11.1% (n=20) died and
42.2% (n=76) experienced a recurrent hospitalization. Patients with NS-HF and ischemia had the highest (73.7%) event
rate compared with the other cohorts (multivariate OR=3.29, 95% CI 1.69-6.42, p=0.001). Conclusions: In new-onset HF,
those with NS-HF and myocardial ischemia are at the highest risk for poor outcomes. (AJCD1106006).
Keywords: heart failure, new onset heart failure, myocardial ischemia, recurrent hospitalizations, outcomes
Full Text PDF
Address all correspondence to:
Thomas E. Vanhecke, MD
Department of Cardiovascular Medicine
Genesys Regional Medical Center/Ascension Health System
1 Genesys Parkway
Grand Blanc, MI 48439
Phone: 248-259-6025
Fax: 248-551-8880
E-mail: tvanhecke@gmail.com
Original Article
Influence of myocardial ischemia on outcomes in patients with systolic
versus non-systolic heart failure
Thomas E. Vanhecke, Barry A. Franklin, Prem Soman, Avijit Lahiri, Jennifer H. Mieres, Tina Sias, Dennis A. Calnon, David
Wolinsky, James E. UdelsonI, Peter A. McCullough
Genesys Regional Medical Center/Ascension Health System, Grand Blanc, MI, USA; William Beaumont Hospital, Royal
Oak, MI, USA; The University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Wellington Hospital, London, UK; New
York University School of Medicine, New York, NY, USA; Marshall University School of Medicine, Huntington, WV, USA;
MidWest Cardiology Research Foundation, Columbus, OH, USA; Albany Associates in Cardiology, Albany, NY, USA; Tufts
Medical Center, Boston MA, USA; St. John Providence Health System/Ascension Health System, Providence Park Heart
Institute, Novi, MI, USA.
Received June 30, 2011; accepted July , 2011; Epub July , 2011; published July 30, 2011
Abstract: Background: Heart failure (HF) is a leading cause of adult hospitalization, morbidity, and mortality. We evaluated
the influence of myocardial ischemia and left ventricular ejection fraction (LVEF) on outcomes in patients who were
hospitalized with new onset HF. Methods: We prospectively recruited 201 consecutive patients hospitalized for a first
episode of HF from 17 medical centers across Europe and North America. All patients received gated single-photon
emission computed tomographic testing with standardized study interpretations by trained core laboratory investigators.
Predefined data from routine care were collected and aggregated. Computerized scoring was performed at the core
laboratory and participants with a summed difference score ≥4 were defined as having myocardial ischemia. Participants
were categorized as having systolic heart failure (SHF) (LVEF<40%) or nonsystolic heart failure (NS-HF) (LVEF≥40%). A
proportional hazards model was used to assess the impact of clinical predictors on the outcomes of mortality, cardiac
rehospitalization and a combined outcome within 2 years of study enrollment. Results: 180 patients (mean age was 65.5
± 14.6 years and 57.2% male) fulfilled study criteria and were included. Myocardial ischemia was present in 45 (41.2%)
patients with SHF and 19 (27.5%) patients with NS-HF (p <0.01). During the follow-up period, 11.1% (n=20) died and
42.2% (n=76) experienced a recurrent hospitalization. Patients with NS-HF and ischemia had the highest (73.7%) event
rate compared with the other cohorts (multivariate OR=3.29, 95% CI 1.69-6.42, p=0.001). Conclusions: In new-onset HF,
those with NS-HF and myocardial ischemia are at the highest risk for poor outcomes. (AJCD1106006).
Keywords: heart failure, new onset heart failure, myocardial ischemia, recurrent hospitalizations, outcomes
Full Text PDF
Address all correspondence to:
Thomas E. Vanhecke, MD
Department of Cardiovascular Medicine
Genesys Regional Medical Center/Ascension Health System
1 Genesys Parkway
Grand Blanc, MI 48439
Phone: 248-259-6025
Fax: 248-551-8880
E-mail: tvanhecke@gmail.com
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