title: Ventricular structure and function in hypertensive participants with heart failure and a normal ejection fraction: the Cardiovascular Health Study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate left ventricular (LV) size and structure in elderly subjects with hypertension (HTN) and heart failure who have a normal ejection fraction (HFNEF) in a large population-based sample.
  
  
  BACKGROUND
  The pathophysiology of HFNEF is incompletely understood but is generally attributed to LV diastolic dysfunction with normal or reduced LV diastolic chamber size despite greater than normal filling pressures.
  
  
  METHODS
  In the Cardiovascular Health Study (n = 5,888), demographic and clinical characteristics and ventricular structure and function were compared in healthy normal subjects (healthy; n = 499), subjects with HTN but not heart failure (HTN; n = 2,184), and subjects with HTN and HFNEF (HFNEF; n = 167).
  
  
  RESULTS
  Subjects with HFNEF were older, more obese, and more often African American than healthy and HTN subjects and had a higher prevalence of diabetes, coronary heart disease, and anemia than HTN subjects. Serum creatinine and cystatin-C were increased in HFNEF subjects. Average LV diastolic dimension was significantly increased in HFNEF subjects (5.2 +/- 0.8 cm) compared with healthy (4.8 +/- 0.6 cm) and HTN (4.9 +/- 0.6 cm) subjects. As a result, average calculated stroke volume (89 +/- 25 ml vs. 78 +/- 20 ml and 80 +/- 20 ml) and cardiac output (6.0 +/- 2.0 l/min vs. 4.8 +/- 1.3 l/min and 5.1 +/- 1.4 l/min) were increased in HFNEF compared with healthy and HTN subjects, respectively.
  
  
  CONCLUSIONS
  As a group, HFNEF subjects have increased LV diastolic diameter and increased calculated stroke volume. They also have increased prevalence of multiple comorbidities, including anemia, renal dysfunction, and obesity, that can cause volume overload. These data suggest that extracardiac factors, via volume overload, may contribute to the pathophysiology of HFNEF in the elderly.
authors.affiliation: Clinical Cardiovascular Research Laboratory for the Elderly, Columbia University, College of Physicians and Surgeons, Allen Pavilion of New York Presbyterian Hospital, New York, New York 10034, USA. msm10@columbia.edu
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.forename: Daniel
authors.initials: D
authors.lastname: Burkhoff
authors.forename: Linda P
authors.initials: LP
authors.lastname: Fried
authors.forename: John
authors.initials: J
authors.lastname: Gottdiener
authors.forename: Donald L
authors.initials: DL
authors.lastname: King
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
mesh_terms: D017677:Age Distribution; D000368:Aged; D049628:Body Size; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D012307:Risk Factors; D017678:Sex Distribution; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology