J Am Coll Cardiol, 2007; 49:972-981, doi:10.1016/j.jacc.2006.10.061 (Published online 16 February 2007). © 2007 by the American College of Cardiology Foundation

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CLINICAL RESEARCH: HEART FAILURE

Ventricular Structure and Function in Hypertensive Participants With Heart Failure and a Normal Ejection Fraction

The Cardiovascular Health Study

Clinical Cardiovascular Research Laboratory for the Elderly, Columbia University, College of Physicians and Surgeons, Allen Pavilion of New York Presbyterian Hospital, New York, New York.

Manuscript received June 2, 2006; revised manuscript received October 12, 2006, accepted October 24, 2006.

^_* Reprint requests and correspondence: Dr. Mathew S. Maurer, Clinical Cardiovascular Research Laboratory for the Elderly, Columbia University, College of Physicians & Surgeons, Allen Pavilion of New York Presbyterian Hospital, 5141 Broadway, 3 Field West Room 035, New York, New York 10034. (Email: msm10{at}columbia.edu).

Objectives: The purpose of this study was to evaluate left ventricular (LV) size and structure in elderly subjects with hypertension (HTN) and heart failure who have a normal ejection fraction (HFNEF) in a large population-based sample.

Background: The pathophysiology of HFNEF is incompletely understood but is generally attributed to LV diastolic dysfunction with normal or reduced LV diastolic chamber size despite greater than normal filling pressures.

Methods: In the Cardiovascular Health Study (n = 5,888), demographic and clinical characteristics and ventricular structure and function were compared in healthy normal subjects (healthy; n = 499), subjects with HTN but not heart failure (HTN; n = 2,184), and subjects with HTN and HFNEF (HFNEF; n = 167).

Results: Subjects with HFNEF were older, more obese, and more often African American than healthy and HTN subjects and had a higher prevalence of diabetes, coronary heart disease, and anemia than HTN subjects. Serum creatinine and cystatin-C were increased in HFNEF subjects. Average LV diastolic dimension was significantly increased in HFNEF subjects (5.2 ± 0.8 cm) compared with healthy (4.8 ± 0.6 cm) and HTN (4.9 ± 0.6 cm) subjects. As a result, average calculated stroke volume (89 ± 25 ml vs. 78 ± 20 ml and 80 ± 20 ml) and cardiac output (6.0 ± 2.0 l/min vs. 4.8 ± 1.3 l/min and 5.1 ± 1.4 l/min) were increased in HFNEF compared with healthy and HTN subjects, respectively.

Conclusions: As a group, HFNEF subjects have increased LV diastolic diameter and increased calculated stroke volume. They also have increased prevalence of multiple comorbidities, including anemia, renal dysfunction, and obesity, that can cause volume overload. These data suggest that extracardiac factors, via volume overload, may contribute to the pathophysiology of HFNEF in the elderly.

Abbreviations and Acronyms   CHS = Cardiovascular Health Study   CO = cardiac output   EF = ejection fraction   HFNEF = heart failure with normal ejection fraction   HTN = hypertension   LV = left ventricle   SV = stroke volume

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