Systolic and diastolic heart failure in the community.
BACKGROUND
The heart failure (HF) syndrome is heterogeneous. While it can be defined by ejection fraction (EF) and diastolic function, data on the characteristics of HF in the community are scarce, as most studies are retrospective, hospital-based, and rely on clinically indicated tests. Further, diastolic function is seldom systematically assessed based on standardized techniques.


OBJECTIVE
To prospectively measure EF, diastolic function, and brain natriuretic peptide (BNP) in community residents with HF.


METHODS
Echocardiographic measures of EF and diastolic function, measurement of blood levels of BNP, and 6-month mortality.


METHODS
Olmsted County residents with incident or prevalent HF (inpatients or outpatients) between September 10, 2003, and October 27, 2005, were prospectively recruited to undergo assessment of EF and diastolic function by echocardiography and measurement of BNP.


RESULTS
A total of 556 study participants underwent echocardiography at HF diagnosis. Preserved EF (> or =50%) was present in 308 (55%) and was associated with older age, female sex, and no history of myocardial infarction (all P<.001). Isolated diastolic dysfunction (diastolic dysfunction with preserved EF) was present in 242 (44%) patients. For patients with reduced EF, moderate or severe diastolic dysfunction was more common than when EF was preserved (odds ratio, 1.67; 95% confidence interval [CI], 1.11-2.51; P = .01). Both low EF and diastolic dysfunction were independently related to higher levels of BNP. At 6 months, mortality was 16% for both preserved and reduced EF (age- and sex-adjusted hazard ratio, 0.85; 95% CI, 0.61-1.19; P = .33 for preserved vs reduced EF).


CONCLUSIONS
In the community, more than half of patients with HF have preserved EF, and isolated diastolic dysfunction is present in more than 40% of cases. Ejection fraction and diastolic dysfunction are independently related to higher levels of BNP. Heart failure with preserved EF is associated with a high mortality rate, comparable to that of patients with reduced EF.
Bursi
Francesca
F
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn 55905, USA.
Weston
Susan A
SA
Redfield
Margaret M
MM
Jacobsen
Steven J
SJ
Pakhomov
Serguei
S
Nkomo
Vuyisile T
VT
Meverden
Ryan A
RA
Roger
Véronique L
VL
D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*; D015897:Comorbidity; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000453:epidemiology
D020097:Natriuretic Peptide, Brain