Comorbidity and ventricular and vascular structure and function in heart failure with preserved ejection fraction: a community-based study

Abstract

Background: Patients with heart failure and preserved ejection fraction (HFpEF) display increased adiposity and multiple comorbidities, factors that in themselves may influence cardiovascular structure and function. This has sparked debate as to whether HFpEF represents a distinct disease or an amalgamation of comorbidities. We hypothesized that fundamental cardiovascular structural and functional alterations are characteristic of HFpEF, even after accounting for body size and comorbidities.

Methods and results: Comorbidity-adjusted cardiovascular structural and functional parameters scaled to independently generated and age-appropriate allometric powers were compared in community-based cohorts of HFpEF patients (n=386) and age/sex-matched healthy n=193 and hypertensive, n=386 controls. Within HFpEF patients, body size and concomitant comorbidity-adjusted cardiovascular structural and functional parameters and survival were compared in those with and without individual comorbidities. Among HFpEF patients, comorbidities (obesity, anemia, diabetes mellitus, and renal dysfunction) were each associated with unique clinical, structural, functional, and prognostic profiles. However, after accounting for age, sex, body size, and comorbidities, greater concentric hypertrophy, atrial enlargement and systolic, diastolic, and vascular dysfunction were consistently observed in HFpEF compared with age/sex-matched normotensive and hypertensive.

Conclusions: Comorbidities influence ventricular-vascular properties and outcomes in HFpEF, yet fundamental disease-specific changes in cardiovascular structure and function underlie this disorder. These data support the search for mechanistically targeted therapies in this disease.

Figure 1

LV geometry in healthy (CON) and hypertensive (HTN) controls and HFpEF. The prevalence of normal (Nl), concentric remodeling (CR) and concentric (CH) or eccentric (EH) hypertrophy based on relative wall thickness (≤ or > 0.42) and the presence or absence of LV hypertrophy (LVH) are shown using alternate methods of defining LVH.

Figure 2

Kaplan Meier survival curves in HFpEF according to the presence of obesity (A), anemia (B), diabetes (C) or renal dysfunction (D) with age, gender and concomitant comorbidity adjusted hazard ratios and 95% confidence intervals for obesity, anemia, diabetes or renal dysfunction (E).