Impact of Reactive Oxidative Metabolites Among New Categories of Nonischemic Heart Failure

Figures

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  Figure 1. Flowchart showing the enrollment protocol. CAG indicates coronary angiography; CT, computed tomography; DROM, derivatives of reactive oxidative metabolites; EF, ejection fraction; HF, heart failure; HFmrEF, HF with midrange EF; HFnonrecEF, HF with nonrecovered EF; HFpEF, HF with preserved EF; HFrecEF, HF with recovered EF; HFrEF, HF with reduced EF; and UCG, ultrasonic echocardiography.

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  Figure 2. Follow‐up analysis in 201 patients with NIHF. A, Kaplan–Meier analysis of probability of HF‐related events in patients with NIHF with low or high DROM value. B, Serum DROM levels without or with HF‐related events. A, Using the median value of DROM (354 U.CARR), patients with HFrEF were divided into 2 groups. Kaplan–Meier analysis showed a significantly higher probability of HF‐related events in patients with NIHF in the high‐DROM group than in those in the low‐DROM group (P=0.001 by log‐rank test). B, DROM levels were significantly higher in patients with NIHF with HF‐related events than in those without HF‐related events (P<0.001 by Mann–Whitney U test). DROM indicates derivatives of reactive oxidative metabolites; HF, heart failure; and U.CARR, Carratelli unit.

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  Figure 3. Kaplan–Meier analysis of the probability of HF‐related events in patients with HFrEF, HFmrEF and HFpEF. Kaplan–Meier analysis revealed that there were no significant differences in the probability of HF‐related events among HF categories (P=0.796 by log‐rank test). EF indicates ejection fraction; HF, heart failure; HFmrEF, HF with midrange EF; HFpEF, HF with preserved EF; and HFrEF, HF with reduced EF.

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  Figure 4. Serum DROM levels between patients with and without HF‐related events in each HF category. A, HFrEF, (B) HFmrEF, (C) HFpEF. DROM levels in patients with HFrEF and HFpEF but not patients with HFmrEF with HF‐related events were significantly higher than those in patients without HF‐related events (P<0.003, P=0.820, and P<0.001, respectively, by Mann–Whitney U test). EF indicates ejection fraction; HF, heart failure; HFmrEF, HF with midrange EF; HFpEF, HF with preserved EF; and HFrEF, HF with reduced EF.

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  Figure 5. Kaplan–Meier analysis for the probability of HF‐related events in patients with HFrecEF and HFnonrecEF. Kaplan–Meier analysis revealed that patients with HFrecEF had a significantly lower probability of HF events than did patients with HFnonrecEF (P<0.001 by log‐rank test). HF indicates heart failure; HFnonrecEF, HF with nonrecovered EF; and HFrecEF, HF with recovered EF.

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  Figure 6. Receiver operating characteristic (ROC) analysis of DROM for the prediction of HFrecEF. ROC analysis showed that DROM values were significantly correlated with EF recovery, and the cutoff value for the prediction of HFrecEF was 347 U.CARR. The C‐statistic value for the DROM levels identified in patients with HFrEF was 0.703 (95% CI, 0.575–0.831; P=0.004). AUC indicates area under curve; HFrecEF, heart failure with recovered ejection fraction; and U.CARR, Carratelli unit.