Characterization of subgroups of heart failure patients with preserved ejection fraction with possible implications for prognosis and treatment response

Kao, David; Lewsey, James; Anand, Inder S.; Massie, Barry M.; Zile, Michael R.; Carson, Peter E.; McKelvie, Robert S.; Komajda, Michel; McMurray, John J.V.; Lindenfeld, JoAnn

doi:10.1002/ejhf.327

Cited by 214 publications

(247 citation statements)

References 35 publications

(39 reference statements)

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“…A prospective study is needed to determine whether the same medical therapies (renin‐angiotensin aldosterone system inhibitors and beta‐blockers) that have efficacy for reducing progression to symptomatic HF in patients with asymptomatic LV systolic dysfunction would also have comparable efficacy in patients with malignant LVH. Recently, it has been suggested that it is possible to subgroup HFpEF into different phenotypes using machine learning or other algorithms 23, 24. It remains to be determined whether the malignant LVH phenotype may be also able to identify specific patient phenotypes that would be at greater risk to progress to HFpEF among the overall heterogeneous HFpEF cohort.…”

Section: Discussionmentioning

confidence: 99%

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)

Peters

Seliger

Christenson

et al. 2018

JAHA

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BackgroundAs heart failure (HF)‐associated morbidity and mortality continue to escalate, enhanced focus on prevention is increasingly important. “Malignant” left ventricular (LV) hypertrophy (LVH): LVH combined with an elevated cardiac biomarker reflecting either injury (high‐sensitivity cardiac troponin T), or strain (amino‐terminal pro‐B‐type natriuretic peptide) has predicted accelerated progression to HF. We sought to determine whether malignant LVH identified community‐dwelling adults initially free of cardiovascular disease at high risk of asymptomatic decline in LV ejection fraction or a clinical cardiovascular event.Methods and ResultsA total of 4985 of 6814 individuals without prevalent cardiovascular disease underwent baseline cardiac magnetic resonance for LVH in combination with measurement of plasma high‐sensitivity cardiac troponin T and amino‐terminal pro‐B‐type natriuretic peptide as part of MESA (Multi‐Ethnic Study of Atherosclerosis) and were subsequently divided into 4 groups: (1) No LVH, no elevated biomarkers (n=2206; 44.3%); (2) No LVH, ≥1 elevated biomarkers (n=2275; 45.7%); (3) LVH, no elevated biomarkers (n=153; 3.0%); and (4) LVH, ≥1 elevated biomarkers (malignant LVH; n=351; 7.0%). Cardiac magnetic resonance was repeated 10 years later (n=2831) for assessment of LV ejection fraction <50%. Median follow‐up was 12.2 years. Malignant LVH was associated with 7.0‐, 3.5‐, and 2.6‐fold adjusted increases in incidence of HF, cardiovascular death, and asymptomatic LV dysfunction, respectively, versus group 1. New‐onset HF was predominately HF with reduced ejection fraction (9.5‐fold increase).ConclusionsMalignant LVH is predictive of progression to asymptomatic LV dysfunction, HF (particularly HF with reduced ejection fraction), and cardiovascular death. Consequently, malignant LVH represents a high‐risk phenotype among individuals without known cardiovascular disease, which should be targeted for increased surveillance and more‐aggressive therapies.

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Section: Discussionmentioning

confidence: 99%

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)

Peters

Seliger

Christenson

et al. 2018

JAHA

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“…Furthermore, as expected, CKD was associated with considerably increased risk of anemia, which was minimally attenuated on adjustment. These data suggest that multiple comorbidities independently are associated with and may drive anemia and contribute to one another, and are consistent with the hypothesis of a constellation of comorbidities driving HFpEF [134][135][136] .…”

Section: Anemia and Hfmref And Hfpef (Paper Iii)supporting

confidence: 85%

How to create and analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life

Jönsson¹

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“…In a recently published exploratory study of patients enrolled in the Irbesartan in Heart Failure with Preserved Ejection Fraction Study (I-PRESERVE), a statistical approach was used to identify HFPEF subgroups and validated using the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved study, which may potentially differ in prognosis. 16 Clinical profiles and prognosis of the 6 predefined subgroups were similar in the CHARM-Preserved study. The 2 subgroups with the worst event-free survival in both studies were characterized by a high prevalence of obesity, hyperlipidemia, diabetes mellitus, anemia, or renal insufficiency and by female predominance, advanced age, lower body mass index, high rates of atrial fibrillation, valvular disease, renal insufficiency, or anemia, respectively.…”

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confidence: 77%

“…The 2 subgroups with the worst event-free survival in both studies were characterized by a high prevalence of obesity, hyperlipidemia, diabetes mellitus, anemia, or renal insufficiency and by female predominance, advanced age, lower body mass index, high rates of atrial fibrillation, valvular disease, renal insufficiency, or anemia, respectively. 16 These data, together with the findings of Brzyżkiewicz et al, 2 highlight the need for active searching for the signs and symptoms of HF in patients with certain clinical characteristics and confirmation in further laboratory tests and imaging evaluation. The diagnosis of HFPEF provides information on poor prognosis; however, no treatment has yet been shown to convincingly reduce morbidity and mortality in patients with diastolic HF.…”

mentioning

confidence: 91%

“…The diagnosis of HFPEF provides information on poor prognosis; however, no treatment has yet been shown to convincingly reduce morbidity and mortality in patients with diastolic HF. 2,16 That it is why, an adequate treatment of hypertension and myocardial ischemia is considered to be important, as is control of the ventricular rate in patients with atrial fibrillation. 2 The neccessity of proper treatment of obesity, diabetes, and hyperlipidemia should be also kept in mind.…”

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Heart failure with preserved ejection fraction

Rajzer¹,

Wojciechowska²,

Mikołajczyk³

2016

Polish Archives of Internal Medicine

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of the endocardium without the use of intravenous contrast is lacking, 5 the cut-off value of 50% for LVEF to dichotomize HFPEF from HF with reduced ejection fraction (HFREF) is somewhat arbitrary. Maybe the simultaneous use of 2 methods, namely, echocardiography, which is more precise for LV diastolic dysfunction assessment, and cardiac magnetic resonance (CMR), which is better for systolic dysfunction evaluation, is the optimal solution, as proposed by Leong et al. 6 What is established for now, the characterization of HF patients should be as wide as possible, including (except for certain clinical examinations) additional tests described by Brzyżkiewicz et al 1 such as echocardiography, chest X-ray, and laboratory tests with special attention to HF-specific natriuretic peptides. A wide spectrum of diagnostic tests not only dedicated to HF is especially important in patients with HFPEF, where differential diagnosis is pivotal.The above considerations lead to a conclusion that diagnosis and, in consequence, the real prevalence of HFPEF are not so easy to establish. The estimate indicates that the prevalence of HFPEF among patients with HF might be about 54%, ranging from 40% to 71%, 7 which is in agreement with the results of one of the largest trials, the Copenhagen Hospital Heart Failure Study, in which the prevalence of HFPEF was 61%.8 Data from the National Health and Nutrition Examination Survey (NHANES) suggest an increase of 46% in the prevalence of HFPEF by 2030. 9 In clinical practice, an echocardiographic examination is crucial for the determination of the fourth condition in HFPEF, namely, "relevant structural heart disease (LV hypertrophy/left atrial enlargement) and/or diastolic dysfunction". 2 The recommendations of American and European echocardiography societies 10 as well as the ESC guidelines for the diagnosis and treatment of acute and chronic HF 2 agree that a good definition of LV diastolic dysfunction needs to evaluate more than 1 group of indices. The echocardiographic techniques to assess LV systolic and diastolic function have evolved rapidly over the past years. New techniques of tissue Doppler Diastolic heart failure is a disorder characterized by impaired left ventricular (LV) relaxation and increased LV stiffness. Heart failure with preserved ejection fraction (HFPEF) accounts for 40% to 50% of all HF cases and has a prognosis that is as dangerous as that of systolic HF. 1,2 Nowadays, HF is growing into a major health problem, so that recent HF guidelines have placed special emphasis on the detection of LV systolic and diastolic dysfunction and the timely identification of risk factors for HF.1 Therefore, the issue addressed in the article of Brzyżkiewicz et al 1 is particularly important. The authors aimed to evaluate the prevalence of HF diagnosis in hypertensive patients with the first stage of diastolic dysfunction, namely, impaired relaxation. They based the diagnosis of HFPEF on the 2012 European Society of Cardiology (ESC) guidelines, 2 which require 4 conditions to be ful...

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Characterization of subgroups of heart failure patients with preserved ejection fraction with possible implications for prognosis and treatment response

Cited by 214 publications

References 35 publications

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)

How to create and analyze a Heart Failure Registry with emphasis on Anemia and Quality of Life

Heart failure with preserved ejection fraction

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