Clinical Predictors of Outcomes in HFpEF Patients
In patients with heart failure and preserved ejection fraction (HFpEF), what parameters predict clinical outcomes?
This was a single-center prospective, observational cohort study investigating hemodynamic and other patient-level variables associated with New York Heart Association (NYHA) functional class and outcomes in patients with HFpEF. A total of 193 patients were enrolled and clinical parameters by physical examination, transthoracic echocardiography (TTE), lung function tests, labwork, and hemodynamics by right heart catheterization were collected. The primary endpoint was hospitalization for HF and/or cardiac death. Patients with significant valvular heart disease, prior valve surgery, significant coronary artery disease, or left ventricular (LV) regional wall motion abnormalities were excluded. LVEF was >50%.
Patients with more advanced NYHA class were older (p = 0.008), had higher body mass index (p = 0.004), more often had pulmonary arterial hypertension (p = 0.002), and had more abnormal parameters of LV diastolic dysfunction. After a follow-up of 21.9 ± 13.1 months, 64 patients (33.2%) reached the combined endpoint. Patients with higher NYHA class had shorter event-free survival compared to patients with NYHA class II/III (log-rank, p < 0.001) and higher all cause-mortality (log-rank, p = 0.01). In multivariate analysis, NYHA class was an independent predictor of outcome (p = 0.008); atrial fibrillation, diabetes mellitus, higher N-terminal pro–B-type natriuretic peptide (NT-proBNP), and lower hemoglobin were also predictive of outcome. TTE parameters predictive of worse outcomes were larger right ventricular (RV) end-diastolic dimension, visually impaired RVEF, and tricuspid annular plane excursion <16 mm. Higher systolic pulmonary artery pressure was also predictive of worse outcomes in multivariate analysis. By multivariate Cox regression, only NYHA class (p = 0.040), NT-proBNP (p < 0.01), and visually impaired RV function on TTE (p = 0.001) remained significantly associated with the primary outcome.
The authors concluded that NYHA functional class and RV function are important predictors of outcome in patients with HFpEF.
This study underscores the importance of NYHA functional class and pulmonary vasculature parameters on outcomes in HFpEF. Symptoms of HFpEF are related to impaired LV filling, RV function, and pulmonary vascular disease, in addition to age and BMI. Future studies and treatments should focus on both the LV and RV and the pulmonary vasculature to better understand the pathophysiology of and treatment for HFpEF.
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