Heart Failure，Congestive, Heart Failure, Diastolic
Conditions
Brief summary
Heart failure (HF) with preserved (HFpEF) or reduced (HFrEF) ejection fraction is associated with poor prognosis and quality of life. While the incidence of HFrEF is declining and HF treatment is effective, HFpEF is increasing, with no established therapy. PREFERS Stockholm is an epidemiological study with the aim of improving clinical care and research in HF and to find new targets for drug treatment in HFpEF starting with a cardiac biopsy study in elective CABG patiens.
Detailed description
Patients with new-onset HF (n = 2000) will be characterized at baseline and after 1-year follow-up by standardized protocols for clinical evaluation, echocardiography, and ECG. In one subset undergoing elective coronary bypass surgery (n = 100) and classified according to LV function, myocardial biopsies will be collected during surgery, and cardiac magnetic resonance (CMR) imaging will be performed at baseline and after 1 year. Blood and tissue samples will be stored in a biobank.We will characterize and compare new-onset HFpEF and HFrEF patients regarding clinical findings and cardiac imaging, genomics, proteomics, and transcriptomics from blood and cardiac biopsies, and by established biomarkers of fibrosis, inflammation, haemodynamics, haemostasis, and thrombosis. The data will be explored by state-of-the-art bioinformatics methods to investigate gene expression patterns, sequence variation, DNA methylation, and post-translational modifications, and using systems biology approaches including pathway and network analysis.In this epidemiological HF study with biopsy studies in a subset of patients, we aim to identify new biomarkers of disease progression and to find pathophysiological mechanisms to support explorations of new treatment regimens for HFpEF.
Interventions
DIAGNOSTIC_TESTCardiac imaging in the PREFERS and CABG PREFERS cohorts
performed at baseline and after 1 year
OTHERBiomarker analysis in the PREFERS and CABG PREFERS chorts
blood samples will be taken for biomarker analysis at baseline and after 1 year
PROCEDURECardiac biopsies in the CABG PREFERS cohort
myocardial biopsies from the right trium the left and right ventricles will be taken during elective CABG
Sponsors
The Swedish Research Council
Region Stockholm
Karolinska Institutet
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
CABG PREFERS Inclusion criteria: 1. Patients undergoing elective coronary bypass surgery 2. History of heart failure not required 3. Age \>18 years 4. Willingness to participate (written informed consent) 5. Possibility to obtain technically satisfactory echocardiography Inclusion criteria PREFERS: 1. New-onset heart failure according to ESC guidelines including NT-proBNP \>125 ng/L at heart failure clinic or \>300 ng/L at emergency department visit or hospital admission 2. Age \>18 years 3. Willingness to participate (written informed consent) 4. Possibility to obtain technically satisfactory echocardiography
Exclusion criteria
CABG PREFERS and PREFERS: 1. Cognitive impairment 2. Inability to understand Swedish language 3. Anaemia (haemoglobin level \<90 g/L) 4. Heart failure primarily due to valvular disease, primary right ventricular failure, pulmonary artery hypertension, hypertrophic obstructive cardiomyopathy Infiltrative cardiomyopathy (e.g. amyloidosis, sarcoidosis, or haemochromatosis) 5. Severe co-morbidity, severe COPD, severe renal dysfunction (eGFR \<30 mL/min/1.73m2). Any other co-morbid disease that will disable the ability to assess or treat heart failure.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in fibrotic biomarkers | 2 years | For the biopsies (CABG PREFERS), the sample size is based upon the number of patients undergoing elective CABG surgery. Investigators expect to discover mRNAs from genes of potential interest in this material with relevance to differences between preserved ejection fraction, reduced ejection fraction and normal groups by bioinformatics tools. These genes will be further investigated in the blood samples of the PREFERS study and potentially in future heart biopsies. for the PREFERS new onset heart failure study. Investigators calculated a 20% difference between HFrEF and HFpEF groups with regard to both PICP and CITP (higher PICP levels and lower CITP in HFpEF vs. HFrEF) as clinically meaningful. To detect a 20% difference between the HFpEF and the HFrEF groups with 80% power and with an estimated drop-out rate of 50 patients in each group, 250 patients in each group are needed to obtain samples from 200 per group. |
| Reverse remodeling | 2 years | diastolic function |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| cardiac magnetic resonance tomography imaging | 2 years | ECV by cMRI will be correlated to type of HF whether HFpEF or HFrEF and to echocardiographic findings |
Countries
Sweden
Outcome results
None listed