MedUni Vienna RESEARCHER OF THE MONTH, July 2017
Functional Status, Pulmonary Artery Pressure and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction - Journal of the American College of Cardiology (IF 17.759) [1]
Background. Patients with heart failure and preserved ejection fraction (HFpEF) have functional impairment resulting in reduced quality of life. Specific pathological mechanisms underlying symptoms have not yet been defined.
Methods and Results. Between January 2011 and February 2015, 193 patients with confirmed HFpEF were enrolled. Those in more advanced New York Heart Association (NYHA) functional classes (III/IV, n=136) were older (p=0.008), had higher body mass indexes (BMI, p=0.004) and higher levels of NT-pro-brain natriuretic peptide (NT-proBNP, p=0.001) compared with less symptomatic patients (NYHA II, n=57). Furthermore, parameters reflecting left ventricular (LV) diastolic dysfunction were more pronounced in advanced NYHA classes (early mitral inflow velocity/early diastolic mitral annular velocity: p=0.023) as well as parameters reflecting right ventricular (RV) afterload (diastolic pulmonary artery pressure (dPAP), p<0.001). By multivariable regression analysis, age (p=0.007), BMI (p=0.002), NT-proBNP (p<0.001) as well as early mitral inflow velocity/ mitral peak velocity of late filling (p=0.031) and dPAP (p<0.001) were independently associated with advanced NYHA class.
After 21.9 ± 13.1 months of follow-up, 64 patients (33.2%) reached the combined endpoint defined as hospitalization due to HF and/ or cardiac death. By multivariate Cox analysis NYHA functional class was independently associated with outcome (HR 2.133, p=0.040) as well as NT-proBNP (HR 1.655, p<0.001) and impaired RV function (HR 2.360, p=0.001).
Conclusion. Symptoms of breathlessness in patients with HFpEF are multi-factorial and largely related to BMI, diastolic dysfunction, and the pulmonary vasculature. Clinically meaningful therapeutic interventions should target body weight, LV stiffness, and concomitant pulmonary vascular disease.
Selected literature
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