CLINICAL RESEARCH: HEART FAILURE
Cardiovascular Features of Heart Failure With Preserved Ejection Fraction Versus Nonfailing Hypertensive Left Ventricular Hypertrophy in the Urban Baltimore Community
The Role of Atrial Remodeling/Dysfunction
Vojtech Melenovsky, MD*, , ,1,
Barry A. Borlaug, MD*,
Boaz Rosen, MD*,
Ilan Hay, MD*,
Luigi Ferruci, MD, PhD ,
Christopher H. Morell, PhD,
Edward G. Lakatta, MD,
Samer S. Najjar, MD and
David A. Kass, MD*,*
* Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
Clinical Research Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
Department of Mathematical Sciences, Loyola College in Maryland, Baltimore, Maryland.
Manuscript received January 18, 2006;
revised manuscript received August 8, 2006,
accepted August 14, 2006.
* Reprint requests and correspondence: Dr. David A. Kass, Ross 835, Division of Medicine, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Baltimore, Maryland 21205. (Email: dkass{at}jhmi.edu).
OBJECTIVES: The purpose of this study was to identify cardiovascular features of patients with heart failure with preserved ejection fraction (HFpEF) that differ from those in individuals with hypertensive left ventricular hypertrophy (HLVH) of similar age, gender, and racial background but without failure.
BACKGROUND: Heart failure with preserved ejection fraction often develops in HLVH patients and involves multiple abnormalities. Clarification of changes most specific to HFpEF may help elucidate underlying pathophysiology.
METHODS: A cross-sectional study comparing HFpEF patients (n = 37), HLVH subjects without HF (n = 40), and normotensive control subjects without LVH (n = 56). All subjects had an EF of >50%, sinus rhythm, and insignificant valvular or active ischemic disease, and groups were matched for age, gender, and ethnicity. Comprehensive echo-Doppler and pressure analysis was performed.
RESULTS: The HFpEF patients were predominantly African-American women with hypertension, LVH, and obesity. They had vascular and systolic-ventricular stiffening and abnormal diastolic function compared with the control subjects. However, most of these parameters either individually or combined were similarly abnormal in the HLVH group and poorly distinguished between these groups. The HFpEF group had quantitatively greater concentric LVH and estimated mean pulmonary artery wedge pressure (20 mm Hg vs. 16 mm Hg) and shorter isovolumic relaxation time than the HLVH group. They also had left atrial dilation/dysfunction unlike in HLVH and greater total epicardial volume. The product of LV mass index and maximal left atrial (LA) volume best identified HFpEF patients (84% sensitivity, 82% specificity).
CONCLUSIONS: In an urban, principally African American, cohort, HFpEF patients share many abnormalities of systolic, diastolic, and vascular function with nonfailing HLVH subjects but display accentuated LVH and LA dilation/failure. These latter factors may help clarify pathophysiology and define an important HFpEF population for clinical trials.
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Abbreviations and Acronyms
| | Ea
= arterial elastance | | Ees
= end-systolic elastance | | HF = heart failure | | HFpEF = heart failure with preserved ejection fraction | | HLVH = hypertensive left ventricular hypertrophy | | LA = left atrial | | LV = left ventricular | | LVH = left ventricular hypertrophy | | PAWP = pulmonary artery wedge pressure |
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