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Outcome in Heart Failure with Preserved Ejection Fraction: The Role of Myocardial Structure and Right Ventricular Performance.

Goliasch G, Zotter-Tufaro C, Aschauer S, Duca F, Koell B, Kammerlander AA, Ristl R, Lang IM, Maurer G, Mascherbauer J, Bonderman D - PLoS ONE (2015)

Bottom Line: 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.The strongest risk factors were reduced right ventricular function (adj.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Correlation between the extent of left ventricular extracellular matrix and invasively measured stroke volume (r = -0.53; p = 0.04).Four patients with myocardial biopsy were not eligible for CMR study due to pacemakers.
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pone.0134479.g003: Correlation between the extent of left ventricular extracellular matrix and invasively measured stroke volume (r = -0.53; p = 0.04).Four patients with myocardial biopsy were not eligible for CMR study due to pacemakers.

Mentions: We detected significant correlations between left ventricular extracellular matrix and invasively measured stroke volume (r = -0.53; p = 0.04; Figs 2 and 3). Interestingly, we could not detect any significant correlations between left ventricular extracellular matrix and PAWP (r = -0.02; p = 0.99) or sPAP (r = 0.16; p = 0.52). Moreover, we did not observe a correlation between extracellular matrix and LV mass (r = 0.05, P = 0.89) by MRI or the thickness of the interventricular septum measured by MRI (0.36, P = 0.25), or echocardiography (r = 0.18, P = 0.49). Additionally, we did not detect substantial differences in baseline characteristics between patients with and without myocardial biopsy (data not shown).


Outcome in Heart Failure with Preserved Ejection Fraction: The Role of Myocardial Structure and Right Ventricular Performance.

Goliasch G, Zotter-Tufaro C, Aschauer S, Duca F, Koell B, Kammerlander AA, Ristl R, Lang IM, Maurer G, Mascherbauer J, Bonderman D - PLoS ONE (2015)

Correlation between the extent of left ventricular extracellular matrix and invasively measured stroke volume (r = -0.53; p = 0.04).Four patients with myocardial biopsy were not eligible for CMR study due to pacemakers.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4520449&req=5

pone.0134479.g003: Correlation between the extent of left ventricular extracellular matrix and invasively measured stroke volume (r = -0.53; p = 0.04).Four patients with myocardial biopsy were not eligible for CMR study due to pacemakers.
Mentions: We detected significant correlations between left ventricular extracellular matrix and invasively measured stroke volume (r = -0.53; p = 0.04; Figs 2 and 3). Interestingly, we could not detect any significant correlations between left ventricular extracellular matrix and PAWP (r = -0.02; p = 0.99) or sPAP (r = 0.16; p = 0.52). Moreover, we did not observe a correlation between extracellular matrix and LV mass (r = 0.05, P = 0.89) by MRI or the thickness of the interventricular septum measured by MRI (0.36, P = 0.25), or echocardiography (r = 0.18, P = 0.49). Additionally, we did not detect substantial differences in baseline characteristics between patients with and without myocardial biopsy (data not shown).

Bottom Line: 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.The strongest risk factors were reduced right ventricular function (adj.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus