Clinical profile of patients presenting with heart failure with preserved ejection fraction

Authors

  • Neil B. Palkhiwala Department of General Medicine, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Rushin P. Patel Intern, GCS Medical College, Ahmedabad, Gujarat, India
  • Ruchi T. Jani Student, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Jinal R. Pandya Department of Physiology, Dr. M. K. Shah Medical College, Ahmedabad, Gujarat, India
  • Chinmay T. Jani Department of Internal Medicine, Mount Auburn Hospital-Harvard Medical School, Boston, Massachusetts, USA
  • Ami P. Parikh Department of General Medicine, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20203099

Keywords:

Diastolic dysfunction heart failure, Diastolic heart failure, Heart failure, Heart failure with a normal EF, Heart failure with normal systolic function, Preserved ejection fraction

Abstract

Background: Evaluate the clinical profile of patients presenting with heart failure having normal or preserved ejection fraction and to determine the prevalence of comorbid illnesses in these patients.

Methods: The study was carried out on patients that presented with heart failure at the Vadilal Sarabhai hospital, Ahmedabad between September 2014-2016. Heart failure patients with normal ejection fraction (>50%) were selected. Socio-demographic, vital signs, data of 2D Echocardiography and Tissue Doppler study were collected. The patients were classified as per the Echocardiographic study into four categories. Different laboratory parameters were compared in patients with respect to (a) grade of Hypertension (b), grade of anemia (c), HbA1c levels. Statistical analysis was done using the SPSS software v20. Mann-Whitney and Kruskal-Wallis tests were performed to compare the means between different study groups.

Results: Out of the 70 patients, a majority (47%) belonged to the Grade 2 (pseudo-normalized) group of diastolic dysfunctions with most of them having only dyspnea and pedal edema (33%). 58.6% patients required intensive care for at least one day. Regarding co-morbidities 27 (38.6%) had hypertension, 34 (48.6%) were diabetic and 49(70%) had anemia. Patients with higher grade of dysfunction had higher HbA1c (p=0.023) and worsening anemia (p=0.003).

Conclusions: Authors concluded that it is of prime importance to find, prevent and treat the comorbidities along with targeted therapies for HFpEF. Further evaluation can be done for clinical applicability of different markers including HbA1c and U.ACR for renal dysfunction in HFpEF.

References

Little WC, Zile MR. HFpEF: cardiovascular abnormalities not just comorbidities. Circ Heart Fail. 2012;5(6):669-71.

Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251-9.

Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):1977-2016.

Konstam MA, Kramer DG, Patel AR, Maron MS, Udelson JE. Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment. JACC Cardiovasc Imaging. 2011;4(1):98-108.

Kitzman DW, Higginbotham MB, Cobb FR, Sheikh KH, Sullivan MJ. Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-Starling mechanism. J Am Coll Cardiol. 1991;17(5):1065-72.

Sanderson JE. HFNEF, HFpEF, HF-PEF, DHF. what is in an acronym? JACC Heart Fail. 2014;2(1):93-4.

Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355(3):260-9.

Lam CS, Roger VL, Rodeheffer RJ, Bursi F, Borlaug BA, Ommen SR, et al. Cardiac structure and ventricular-vascular function in persons with heart failure and preserved ejection fraction from Olmsted County, Minnesota. Circulation. 2007;115(15):1982-90.

Kitzman DW, Little WC. Left ventricle diastolic dysfunction and prognosis. Circulation. 2012;125(6):743-5.

Iwano H, Little WC. Heart failure: what does ejection fraction have to do with it? J Cardiol. 2013;62(1):1-3.

Little WC, Zile MR, Klein A, Appleton CP, Kitzman DW, Wesley-Farrington DJ. Effect of losartan and hydrochlorothiazide on exercise tolerance in exertional hypertension and left ventricular diastolic dysfunction. Am J Cardiol. 2006;98(3):383-5.

Rector TS, Carson PE, Anand IS, McMurray JJ, Zile MR, McKelvie RS, et al. Assessment of long-term effects of irbesartan on heart failure with preserved ejection fraction as measured by the minnesota living with heart failure questionnaire in the irbesartan in heart failure with preserved systolic function (I-PRESERVE) trial. Circ Heart Fail. 2012;5(2):217-25.

McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285(26):1441-6.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72.

Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. WHO; Available at: http://www.who.int/vmnis/indicators/haemoglobin.

Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010;33(Supplement 1):S62-S9.

Abhayaratna WP, Marwick TH, Smith WT, Becker NG. Characteristics of left ventricular diastolic dysfunction in the community: an chocardiographic survey. Heart. 2006;92(9):1259-64.

Mohammed SF, Borlaug BA, Roger VL, Mirzoyev SA, Rodeheffer RJ, Chirinos JA, et al. Comorbidity and ventricular and vascular structure and function in heart failure with preserved ejection fraction: a community-based study. Circ Heart Fail. 2012;5(6):710-9.

Lam CS, Little WC. Sex and cardiovascular risk: are women advantaged or men disadvantaged? Circulation. 2012;126(8):913-5.

Aljaroudi W, Halley C, Houghtaling P, Agarwal S, Menon V, Rodriguez L, et al. Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction. Nutr Diabetes. 2012;2:e39.

Hermann F, Ruschitzka FT, Schiffrin EL. Clinical trials report. CHARM-Added Trial. Curr Hypertens Rep. 2004;6(1):47.

Trimarco B, Rosei EA. [The I-PRESERVE study]. G Ital Cardiol (Rome). 2009;10(8):495-8.

Gheorghiade M, Pitt B. Digitalis Investigation Group (DIG) trial: a stimulus for further research. Am Heart J. 1997;134(1):3-12.

Patil VC, Patil HV, Shah KB, Vasani JD, Shetty P. Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. J Cardiovasc Dis Res. 2011;2(4):213-22.

Shemirani H, Khosravi A, Hemmati R, Gharipour M. Body Mass Index or Microalbuminuria, Which One is More Important for the Prediction and Prevention of Diastolic Dysfunction in Non-diabetic Hypertensive Patients? Int J Prev Med. 2012;3(3):211-20.

Katz DH, Burns JA, Aguilar FG, Beussink L, Shah SJ. Albuminuria is independently associated with cardiac remodeling, abnormal right and left ventricular function, and worse outcomes in heart failure with preserved ejection fraction. JACC Heart Fail. 2014;2(6):586-96.

Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol. 2006;47(10):1987-96.

Tschope C, Kasner M, Westermann D, Gaub R, Poller WC, Schultheiss HP. The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements. Eur Heart J. 2005;26(21):2277-84.

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Published

2020-07-24

How to Cite

Palkhiwala, N. B., Patel, R. P., Jani, R. T., Pandya, J. R., Jani, C. T., & Parikh, A. P. (2020). Clinical profile of patients presenting with heart failure with preserved ejection fraction. International Journal of Research in Medical Sciences, 8(8), 2753–2760. https://doi.org/10.18203/2320-6012.ijrms20203099

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Original Research Articles