Outcome in Heart Failure with Preserved Ejection Fraction: The Role of Myocardial Structure and Right Ventricular PerformanceReport as inadecuate




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Background

Heart failure with preserved ejection fraction HFpEF is recognized as a major cause of cardiovascular morbidity and mortality. Thus, a profound understanding of the pathophysiologic changes in HFpEF is needed to identify risk factors and potential treatment targets in this specific patient population. Therefore, we aimed to comprehensively assess the impact of left- and right-ventricular function and hemodynamics on long-term mortality and morbidity in order to improve risk prediction in patients with HFpEF.

Methods and Results

We prospectively included 142 consecutive patients with HFpEF into our observational, non-interventional registry. Echocardiography, cardiac magnetic resonance imaging and invasive hemodynamic assessments including myocardial biopsy were performed at baseline. We detected significant correlations between left ventricular extracellular matrix and left ventricular end-diastolic diameter r = -0.64;p = 0.03 and stroke volume r = -0.53;p = 0.04. Hospitalization for heart failure and-or cardiac death was observed over a median follow up of 10 months. The strongest risk factors were reduced right ventricular function adj. HR 6.62;95%CI 3.12- 14.02;p<0.001, systolic pulmonary arterial pressure adj. HR per 1-SD 1.55;95%CI 1.15- 2.09;p = 0.004 and the pulmonary artery wedge pressure adj. HR per 1-SD 1.51;95%CI 1.09–2.08; p = 0.012. The area under the ROC curve for right ventricular function was 0.63, for systolic pulmonary arterial pressure 0.75, and for pulmonary artery wedge pressure 0.68.

Conclusion

The current study emphasizes the importance of right ventricular function and pulmonary pressures on outcome in patients with HFpEF providing pathophysiological insights into the hemodynamic changes in HFpEF.



Author: Georg Goliasch , Caroline Zotter-Tufaro, Stefan Aschauer, Franz Duca, Benedikt Koell, Andreas A. Kammerlander, Robin Ristl, Irene

Source: http://plos.srce.hr/



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