Comorbidity and Ventricular and Vascular Structure and Function in Heart Failure With Preserved Ejection Fraction

Abstract

Background Patients with heart failure and preserved ejection fraction (HFpEF) display increased adiposity and multiple comorbidities, factors that in themselves may influence cardiovascular (CV) structure and function. This has sparked debate as to whether HFpEF represents a distinct disease or an amalgamation of comorbidities. We hypothesized that fundamental CV structural and functional alterations are characteristic of HFpEF, even after accounting for body size and comorbidities. Methods and Results Comorbidity adjusted CV structural and functional parameters scaled to independently generated and age appropriate allometric powers were compared in community-based cohorts of HFpEF patients (n=386) and age/gender-matched healthy (CON, n=193) and hypertensive (HTN, n=386) controls. Within HFpEF patients, body size and concomitant comorbidity adjusted CV structural and functional parameters and survival were compared in those with and without individual comorbidities. Among HFpEF patients, comorbidities (obesity, anemia, diabetes and renal dysfunction) were each associated with unique clinical, structural, functional and prognostic profiles. However, after accounting for age, gender, body size and comorbidities, greater concentric hypertrophy, atrial enlargement and systolic, diastolic and vascular dysfunction were consistently observed in HFpEF compared to CON and HTN. Conclusions Comorbidities influence ventricular-vascular properties and outcomes in HFpEF, yet fundamental disease-specific changes in cardiovascular structure and function underlie this disorder. These data support the search for mechanistically-targeted therapies in this disease.

Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community‐Dwelling Population

“…Preliminary cross‐sectional data in hypertensive patients suggested that sST2 levels could differentiate HFpEF from asymptomatic hypertension 20. We anticipated that sST2 could be a stronger prognostic factor for HFpEF than HFrEF, given that it has been hypothesized that HFpEF patients develop HF as a result of the overall burden of noncardiovascular comorbidities 43. sST2 levels may serve as a summation of the burden of comorbidities that contribute to HFpEF, particularly those observed in older adults.…”

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…The major effect of age on the vasculature is systolic hypertension with widening of the pulse pressure that results from age‐related increase in arterial stiffness and early wave reflections 43, 44. Arterial stiffening and early wave reflections are steady vascular features in HFpEF 45, 46, 47, 48, 49, 50, 51, 52. In the proximal arterial tree, vascular smooth cell loss of elastin increases systolic arterial pressure by lessening the “windkessel” effect 44, 45, 53.…”

Pulmonary Hypertension in Heart Failure Preserved Ejection Fraction

“…15,16,[19][20][21] Nonetheless, persistence of some degree of PH after acute hospital admission drives a worse clinical outcome and may represent a basic target of treatment. 22 Compared with PH attributable to HFrEF more pathogeneses account for PH-HFpEF with a high prevalence of hypertensive heart disease, diabetes mellitus, and obesity.…”