PP.22.13: PROGNOSIS IN DIASTOLIC HEART FAILURE. (June 2015)

• Record Type: Journal Article
• Authors: Stanojevic, D.; Apostolovic, S.; Salinger-Martinovic, S.; Djordjevic-Radojkovic, D.; Kutlesic-Kurtovic, D.; Jankovic-Tomasevic, R.; Pavlovic, M.; Tahirovic, E.; Dungen, Hd
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000468402.33584.30
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Community surveys on chronic heart failure (HF) have shown that the distribution of left ventricular ejection fraction (LVEF) is bell-shaped, and that 40% to 50% of patients present with a LVEF higher than 50%. Arterial hypertension is the leading cause of HFpEF. Prognosis of HFpEF is worse than originally believed. We still do not have guidelines for therapy in HFpEF. Beta blockers are cornerstone in management of HF with reduced LVEF (HFrEF), however theirs' role in HFpEF is less known. Aim of our study was to investigate the role of BB therapy on 2 years prognosis in patients with HFpEF included in CIBIS ELD study. Design and method: In CIBIS ELD study 876 patients with HF were enrolled. Prior to randomization participants had to be clinically stable and to be beta blocker (BB) naive or on less or equal of 25% of the guideline-recommended target or equivalent dose. Over three months, we up-titrated BB (bisoprolol or carvedilol) up to maximum tolerated dose. After 24 months we found that 75.7% of patients were alive (80.2% with HFpEF), 20.9% died (18.5% with HFpEF) and 3.3% (1.3% of those with HFpEF) were lost to follow up. Results: Among 876 patients included in the CIBIS ELD study, 250 had HFpEF (mean age 73.42 ± 5.99 years, female 65.6%). LVEF in patients with "diastolic HF" was 60.63% ± 7.76 at the inclusion in the study, and significantly lower (54.48% ± 11.46), after 24 months of follow up (p < 0.001). We found no difference in the LVEF between patients who had BB in therapy 24 months after inclusion in the study (54.47% ± 11.39) and those who stopped to take BB during 2 years of follow up (54.47% ± 11.21), p = 0.4. Conclusions: Mortality rate in patients with HFpEF was not significantly different (p = 0.053) than in those with HFrEF. We found that LVEF significantly decreased in HFpEF patients during 2 years and that it was not associated with BB therapy. We need more studies on "diastolic" HF and on view that HFpEF and HFrEF are mere extremes in a spectrum of overlapping HF phenotypes, and hence not distinct disease entities.