Etiologies and predictors of mortality in an all-comer population of patients with non-ischemic heart failure

Sebastian Göbel (Mainz)1, A.-S. Braun (Mainz)1, O. Hahad (Mainz)1, U. von Henning (Mainz)1, M. Brandt (Mainz)1, K. Keller (Mainz)1, M. Gaida (Mainz)2, T. Gori (Mainz)3, H.-P. Schultheiss (Berlin)4, F. Escher (Berlin)5, T. Münzel (Mainz)1, P. Wenzel (Mainz)3

1Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; 2Universitätsmedizin Mainz Institut für Allgemeine Pathologie Mainz, Deutschland; 3Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie Mainz, Deutschland; 4IKDT - Institut Kardiale Diagnostik und Therapie GmbH Berlin, Deutschland; 5Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin, CVK Berlin, Deutschland


Background: Despite progress in diagnosis and therapy of heart failure (HF), etiology and risk stratification remain elusive in many patients.

Methods: The My Biopsy HF-Study (German clinical trials register number: DRKS22178) is a retrospective monocentric study investigating an all-comer population of patients with unexplained HF based on a thorough workup including endomyocardial biopsy (EMB).

Results: 655 patients (70.9% men, median age 55.0 [45.0/66.0] years) with non-ischemic, non-valvular HF were included in the analyses. 489 patients were diagnosed with HF with reduced ejection fraction (HFrEF), 52 patients with HF with mildly reduced ejection fraction (HFmrEF) and 114 patients with HF with preserved ejection fraction (HFpEF). After a median follow up of 4.6 (2.5/6.6) years of follow up, 94 deaths were enumerated (HFrEF: 68; HFmrEF: 8; HFpEF: 18), equating to mortality rates of 3.3% and 11.6% for patients with HFrEF, 7.7% and 15.4% for patients with HFmrEF and 5.3% and 11.4% for patients with HFpEF after 1 and 5 years, respectively. In EMB, we detected a variety of putative etiologies of HF, including incidental cardiac amyloidosis (CA, 5.8%). In multivariate logistic regression analysis adjusting for age, sex and comorbidities only CA, age and NYHA functional class remained independently associated with all-cause mortality (CA: HRperui 3.13, 95% CI, 1.5-6.51; p=0.002).

Conclusions: In an all-comer population of patients presenting with HF of unknown etiology, incidental finding of CA stands out as to be independently associated with all-cause mortality. Our findings suggest that prospective trials would be helpful to test the added value of a systematic and holistic work-up of HF of unknown etiology

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