Characteristics of Heart Failure With Preserved Ejection Fraction Across the Range of Left Ventricular Ejection Fraction. Issue 7 (8th July 2022)
- Record Type:
- Journal Article
- Title:
- Characteristics of Heart Failure With Preserved Ejection Fraction Across the Range of Left Ventricular Ejection Fraction. Issue 7 (8th July 2022)
- Main Title:
- Characteristics of Heart Failure With Preserved Ejection Fraction Across the Range of Left Ventricular Ejection Fraction
- Authors:
- Rosch, Sebastian
Kresoja, Karl-Patrik
Besler, Christian
Fengler, Karl
Schöber, Anne Rebecca
von Roeder, Maximilian
Lücke, Christian
Gutberlet, Matthias
Klingel, Karin
Thiele, Holger
Rommel, Karl-Philipp
Lurz, Philipp - Abstract:
- Abstract : Background: Recent trial data suggest that stratification of patients with heart failure with preserved ejection fraction (HFpEF) according to left ventricular ejection fraction (LVEF) provides a means for dissecting different treatment responses. However, the differential pathophysiologic considerations have rarely been described. Methods: This prospective, single-center study analyzed consecutive symptomatic patients with HFpEF diagnosed according to the 2016 European Society of Cardiology heart failure guidelines. Patients were grouped into LVEF 50% to 60% and LVEF >60% cohorts. All patients underwent cardiac magnetic resonance imaging. Transfemoral cardiac catheterization was performed to derive load-dependent and load-independent left ventricular (LV) properties on pressure–volume loop analyses. Results: Fifty-six patients with HFpEF were enrolled and divided into LVEF 50% to 60% (n=21) and LVEF >60% (n=35) cohorts. On cardiac magnetic resonance imaging, the LVEF >60% cohort showed lower LV end-diastolic volumes ( P =0.019) and end-systolic volumes ( P =0.001) than the LVEF 50% to 60% cohort; stroke volume ( P =0.821) did not differ between the cohorts. Extracellular volume fraction was higher in the LVEF 50% to 60% cohort than in the LVEF >60% cohort (0.332 versus 0.309; P =0.018). Pressure-volume loop analyses demonstrated higher baseline LV contractility (end-systolic elastance, 1.85 vs 1.33 mm Hg/mL; P <0.001) and passive diastolic stiffness (β constant,Abstract : Background: Recent trial data suggest that stratification of patients with heart failure with preserved ejection fraction (HFpEF) according to left ventricular ejection fraction (LVEF) provides a means for dissecting different treatment responses. However, the differential pathophysiologic considerations have rarely been described. Methods: This prospective, single-center study analyzed consecutive symptomatic patients with HFpEF diagnosed according to the 2016 European Society of Cardiology heart failure guidelines. Patients were grouped into LVEF 50% to 60% and LVEF >60% cohorts. All patients underwent cardiac magnetic resonance imaging. Transfemoral cardiac catheterization was performed to derive load-dependent and load-independent left ventricular (LV) properties on pressure–volume loop analyses. Results: Fifty-six patients with HFpEF were enrolled and divided into LVEF 50% to 60% (n=21) and LVEF >60% (n=35) cohorts. On cardiac magnetic resonance imaging, the LVEF >60% cohort showed lower LV end-diastolic volumes ( P =0.019) and end-systolic volumes ( P =0.001) than the LVEF 50% to 60% cohort; stroke volume ( P =0.821) did not differ between the cohorts. Extracellular volume fraction was higher in the LVEF 50% to 60% cohort than in the LVEF >60% cohort (0.332 versus 0.309; P =0.018). Pressure-volume loop analyses demonstrated higher baseline LV contractility (end-systolic elastance, 1.85 vs 1.33 mm Hg/mL; P <0.001) and passive diastolic stiffness (β constant, 0.032 versus 0.018; P =0.004) in the LVEF >60% cohort. Ventriculo-arterial coupling (end-systolic elastance/arterial elastance) at rest was in the range of optimized stroke work in the LVEF >60% cohort but was impaired in the LVEF 50% to 60% cohort (1.01 versus 0.80; P =0.005). During handgrip exercise, patients with LVEF >60% had higher increases in end-systolic elastance (1.85 versus 0.82 mm Hg/mL; P =0.023), attenuated increases in indexed end-systolic volume (−1 versus 7 mL/m²; P <0.004), and more exaggerated increases in LV filling pressures (8 vs 5 mm Hg; P =0.023). LV stroke volume decreased in the LVEF >60% cohort ( P =0.007) under exertion. Conclusions: Patients with HFpEF in whom LVEF ranged from 50% to 60% demonstrated reduced contractility, impaired ventriculo-arterial coupling, and higher extracellular volume fraction. In contrast, patients with HFpEF and a LVEF >60% demonstrated a hypercontractile state with excessive LV afterload and diminished preload reserve. A LVEF-based stratification of patients with HFpEF identified distinct morphologic and pathophysiologic subphenotypes. … (more)
- Is Part Of:
- Circulation. Volume 146:Issue 7(2022)
- Journal:
- Circulation
- Issue:
- Volume 146:Issue 7(2022)
- Issue Display:
- Volume 146, Issue 7 (2022)
- Year:
- 2022
- Volume:
- 146
- Issue:
- 7
- Issue Sort Value:
- 2022-0146-0007-0000
- Page Start:
- 506
- Page End:
- 518
- Publication Date:
- 2022-07-08
- Subjects:
- fibrosis -- heart failure, diastolic -- hemodynamics
Blood -- Circulation -- Periodicals
Cardiovascular system -- Periodicals
Cardiology -- Periodicals
Heart -- Diseases -- Periodicals
Blood Circulation
Cardiovascular System
Vascular Diseases
616.1 - Journal URLs:
- http://ovidsp.tx.ovid.com/sp-3.4.2a/ovidweb.cgi?&S=HFFJFPCLPODDKOLGNCALDCMCIACKAA00&Browse=Toc+Children%7cNO%7cS.sh.1384_1326796138_84.1384_1326796138_96.1384_1326796138_97%7c66%7c50 ↗
http://www.circulationaha.org ↗
http://circ.ahajournals.org/ ↗
http://journals.lww.com ↗ - DOI:
- 10.1161/CIRCULATIONAHA.122.059280 ↗
- Languages:
- English
- ISSNs:
- 0009-7322
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 3265.200000
British Library DSC - BLDSS-3PM
British Library HMNTS - ELD Digital store - Ingest File:
- 23128.xml