{
  "abstract": "Background The restrictive filling pattern of transmitral inflow has been shown to be associated with a poor prognosis in patients with heart failure (HF) with reduced ejection fraction or myocardial infarction. We aimed to investigate the significance of restrictive filling pattern in patients with HF with preserved ejection fraction (HFpEF).Methods Among 4056 patients with acute decompensated HF in the Kyoto Congestive Heart Failure registry, we analysed 830 patients with HFpEF who had transmitral inflow data available in echocardiography. Patients whose early to late diastolic transmitral flow velocity (E/A ratio) ≥2 were classified as having a restrictive filling pattern of transmitral inflow. The main outcome measures were all-cause death and HF hospitalisation at 1 year.Results Among 830 patients, a restrictive filling pattern was observed in 144 (17.3%) patients, who had higher prevalence of a history of atrial fibrillation and supranormal left ventricular ejection fraction (>65%), and higher brain natriuretic peptide level at discharge. The cumulative 1-year incidence of HF hospitalisation was significantly higher in patients with restrictive filling pattern than those without (31.0% vs 18.1%, p<0.001), while the cumulative 1-year incidence of all-cause death was not different between the two groups (14.2% vs 14.4%, p=0.93). After adjusting for confounding factors, the excess risk of restrictive filling pattern relative to non-restrictive filling pattern remained significant for HF hospitalisation (HR=1.58, 95% CI 1.10 to 2.27, p=0.01), but not for all-cause death (HR=0.92, 95% CI 0.60 to 1.42, p=0.70).Conclusions A restrictive filling pattern of transmitral inflow was associated with an increased risk for HF hospitalisation, but not for all-cause death, in patients with acute decompensated HFpEF.",
  "authors": [
    {
      "affiliations": [
        "Kyoto University Graduate School of Medicine Department of Cardiovascular Medicine, Kyoto, Kyoto Prefecture, Japan"
      ],
      "name": "Yutaro Miyoshi"
    },
    {
      "affiliations": [
        "Kyoto University Graduate School of Medicine Department of Cardiovascular Medicine, Kyoto, Kyoto Prefecture, Japan"
      ],
      "name": "Takao Kato"
    },
    {
      "affiliations": [
        "Department of Data Science, Hyogo Medical University, Nishinomiya, Hyogo Prefecture, Japan"
      ],
      "name": "Takeshi Morimoto"
    },
    {
      "affiliations": [
        "Kyoto University Graduate School of Medicine Department of Cardiovascular Medicine, Kyoto, Kyoto Prefecture, Japan"
      ],
      "name": "Neiko Ozasa"
    },
    {
      "affiliations": [
        "Kyoto University Graduate School of Medicine Department of Cardiovascular Medicine, Kyoto, Kyoto Prefecture, Japan",
        "Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Hidenori Yaku"
    },
    {
      "affiliations": [
        "Cardiology, Shiga Medical Center for Adults, Moriyama, Japan"
      ],
      "name": "Yasutaka Inuzuka"
    },
    {
      "affiliations": [
        "Cardiology, Tenri Hospital, Tenri, Japan"
      ],
      "name": "Yodo Tamaki"
    },
    {
      "affiliations": [
        "Kyoto University Graduate School of Medicine Department of Cardiovascular Medicine, Kyoto, Kyoto Prefecture, Japan"
      ],
      "name": "Erika Yamamoto"
    },
    {
      "affiliations": [
        "Kyoto University Graduate School of Medicine Department of Cardiovascular Medicine, Kyoto, Kyoto Prefecture, Japan",
        "Department of Data Science, Hyogo Medical University, Nishinomiya, Hyogo Prefecture, Japan"
      ],
      "name": "Yusuke Yoshikawa"
    },
    {
      "affiliations": [
        "Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"
      ],
      "name": "Takeshi Kitai"
    },
    {
      "affiliations": [
        "Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan"
      ],
      "name": "Moritake Iguchi"
    },
    {
      "affiliations": [
        "Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan"
      ],
      "name": "Kazuya Nagao"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Okayama Prefecture, Japan"
      ],
      "name": "Yuichi Kawase"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka Prefecture, Japan"
      ],
      "name": "Takashi Morinaga"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan"
      ],
      "name": "Yutaka Furukawa"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka Prefecture, Japan"
      ],
      "name": "Kenji Ando"
    },
    {
      "affiliations": [
        "Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo Prefecture, Japan"
      ],
      "name": "Yukihito Sato"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Shinshu Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Matsumoto, Nagano, Japan"
      ],
      "name": "Koichiro Kuwahara"
    },
    {
      "affiliations": [
        "Kyoto University Graduate School of Medicine Department of Cardiovascular Medicine, Kyoto, Kyoto Prefecture, Japan"
      ],
      "name": "Koh Ono"
    },
    {
      "affiliations": [
        "Kyoto University Graduate School of Medicine Department of Cardiovascular Medicine, Kyoto, Kyoto Prefecture, Japan",
        "Cardiology, Hirakata Kosai Hospital, Hirakata, Japan"
      ],
      "name": "Takeshi Kimura"
    }
  ],
  "title": "Restrictive filling pattern of transmitral inflow in acute decompensated heart failure with preserved ejection fraction: insights from the KCHF registry",
  "uid": "31fe4f25-e744-5dee-9f23-b57b1733dee1"
}