Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction

Abstract

BackgroundComorbidities negatively affect prognosis more strongly in heart failure with preserved (HFpEF) than with reduced (HFrEF) ejection fraction. Their comparative impact on physical impairment in HFpEF and HFrEF has not been evaluated so far.Methods and resultsThe frequency of 12 comorbidities and their impact on NYHA class and SF-36 physical functioning score (SF-36 PF) were evaluated in 1,294 patients with HFpEF and 2,785 with HFrEF. HFpEF patients had lower NYHA class (2.0 ± 0.6 vs. 2.4 ± 0.6, p < 0.001) and higher SF-36 PF score (54.4 ± 28.3 vs. 54.4 ± 27.7, p < 0.001). All comorbidities were significantly (p < 0.05) more frequent in HFrEF, except hypertension and obesity, which were more frequent in HFpEF (p < 0.001). Adjusting for age and gender, COPD, anemia, hyperuricemia, atrial fibrillation, renal dysfunction, cerebrovascular disease and diabetes had a similar (p for interaction > 0.05) negative effect in both groups. Obesity, coronary artery disease and peripheral arterial occlusive disease exerted a significantly (p < 0.05) more adverse effect in HFpEF, while hypertension and hyperlipidemia were associated with fewer (p < 0.05) symptoms in HFrEF only. The total impact of comorbidities on NYHA (AUC for prediction of NYHA III/IV vs. I/II) and SF-36 PF (r2) in multivariate analyses was approximately 1.5-fold higher in HFpEF, and also much stronger than the impact of a 10% decrease in ejection fraction in HFrEF or a 5 mm decrease in left ventricular end-diastolic diameter in HFpEF.ConclusionThe impact of comorbidities on physical impairment is higher in HFpEF than in HFrEF. This should be considered in the differential diagnosis and in the treatment of patients with HFpEF.

Myocardial Titin Hypophosphorylation Importantly Contributes to Heart Failure With Preserved Ejection Fraction in a Rat Metabolic Risk Model

“…17 The current model, however, closely resembles clinical HFPEF where metabolic risk is highly prevalent as evident from numerous HFPEF registries or large outcome trials. 3,18,19 The HFPEF presentation observed in this metabolic risk model also shares characteristic features with clinical HFPEF presentation. After 18 weeks, during closed chest echocardiographic evaluation, the E/E′ ratio was diagnostic of diastolic LV dysfunction 20 (ZSF1-Obese, 17.2±0.8; ZSF1-Obese+HFD, 15.8±1.1).…”

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…Though abnormal relaxation is the first mechanical manifestation of myocardial ischemia,194, 195, 196 acute coronary artery syndromes seldom precipitate HFpEF decompensation or present as HFpEF 100, 197. The prevalence of CAD ranges from 35% to 53% in large HFpEF registries 34, 35, 198. The prevalence of CAD in HFpEF varies with the ethnic background of patients.…”

“…In contrast, the prevalence of myocardial ischemia is less than 4% in a multiethnic population of patients presenting with shortness of breath and without wall motion abnormalities 200. Not surprisingly, patients with HFpEF and CAD experience a greater deterioration of LV function and a worse prognosis than patients with only HFpEF 198, 201, 202, 203. However, a fatal outcome does not appear to be related to the presence of CAD in patients hospitalized for a first episode of HFpEF decompensation 203.…”

Impact of Peripheral Artery Disease on Prognosis in Hospitalized Heart Failure Patients

“…The major findings of this study were that (1) the prevalence of PAD defined according to the PAD management guideline in hospitalized HF patients was 26.0% (clinical PAD, 6.7%; 26 Impaired physical function may relate to skeletal muscle abnormalities or a mixture of central and peripheral hemodynamic abnormalities. 27, 28 In contrast, elevated circulating TNF-α and troponins are correlated with HF severity and adverse allcause mortality in HF patients.…”