Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction

Zile, M.R., Gottdiener, J.S., Hetzel, S.J., McMurray, J.J.V. , Komajda, M., McKelvie, R., Baicu, C.F., Massie, B.M. and Carson, P.E. (2011) Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation, 124(23), pp. 2491-2501. (doi: 10.1161/CIRCULATIONAHA.110.011031)

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Publisher's URL: http://dx.doi.org/10.1161/CIRCULATIONAHA.110.011031

Abstract

<p><b>Background:</b> The purpose of this study was to examine the prevalence of abnormalities in cardiac structure and function present in patients with heart failure and a preserved ejection fraction (HFPEF) and to determine whether these alterations in structure and function were associated with cardiovascular morbidity and mortality.</p> <p><b>Methods and Results:</b> The Irbesartan in HFPEF trial (I-PRESERVE) enrolled 4128 patients; echocardiographic determination of left ventricular (LV) volume, mass, left atrial (LA) size, systolic function, and diastolic function were made at baseline in 745 patients. The primary end point was death or protocol-specific cardiovascular hospitalization. A secondary end point was the composite of heart failure death or heart failure hospitalization. Associations between baseline structure and function and patient outcomes were examined using univariate and multivariable Cox proportional hazard analyses. In this substudy, LV hypertrophy or concentric remodeling was present in 59%, LA enlargement was present in 66%, and diastolic dysfunction was present in 69% of the patients. Multivariable analyses controlling for 7 clinical variables (including log N-terminal pro-B–type natriuretic peptide) indicated that increased LV mass, mass/volume ratio, and LA size were independently associated with an increased risk of both primary and heart failure events (all P<0.05).</p> <p><b>Conclusions:</b> Left ventricular hypertrophy or concentric remodeling, LA enlargement, and diastolic dysfunction were present in the majority of patients with HFPEF. Left ventricular mass and LA size were independently associated with an increased risk of morbidity and mortality. The presence of structural remodeling and diastolic dysfunction may be useful additions to diagnostic criteria and provide important prognostic insights in patients with HFPEF.</p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Zile, M.R., Gottdiener, J.S., Hetzel, S.J., McMurray, J.J.V., Komajda, M., McKelvie, R., Baicu, C.F., Massie, B.M., and Carson, P.E.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Circulation
Publisher:American Heart Association
ISSN:0009-7322
ISSN (Online):1524-4539
Published Online:07 November 2011
Copyright Holders:Copyright © 2011 American Heart Association
First Published:First published in Circulation 124(23):2491-2501
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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