Rationale and design of the Karolinska-Rennes (KaRen) prospective study of dyssynchrony in heart failure with preserved ejection fraction.
OBJECTIVE
Heart failure with preserved ejection fraction (HFPEF) is common but not well understood. Electrical dyssynchrony in systolic heart failure is harmful. Little is known about the prevalence and the prognostic impact of dyssynchrony in HFPEF.


RESULTS
We have designed a prospective, multicenter, international, observational study to characterize HFPEF and to determine whether electrical or mechanical dyssynchrony affects prognosis. Patients presenting with acute heart failure (HF) will be screened so as to identify 400 patients with HFPEF. Inclusion criteria will be: acute presentation with Framingham criteria for HF, left ventricular ejection fraction>or=45%, brain natriuretic peptide (BNP)>100 pg/mL or NT-proBNP>300 pg/mL. Once stabilized, 4-8 weeks after the index presentation, patients will return and undergo questionnaires, serology, ECG, and Doppler echocardiography. Thereafter, patients will be followed for mortality and HF hospitalization every 6 months for at least 18 months. Sub-studies will focus on echocardiographic changes from the acute presentation to the stable condition and on exercise echocardiography, cardiopulmonary exercise testing, and serological markers.


CONCLUSIONS
KaRen aims to characterize electrical and mechanical dyssynchrony and to assess its prognostic impact in HFPEF. The results might improve our understanding of HFPEF and generate answers to the question whether dyssynchrony could be a target for therapy in HFPEF.
Donal
Erwan
E
Cardiology, CHU Pontchaillou, 35033 Rennes, France. erwan.donal@chu-rennes.fr
Lund
Lars H
LH
Linde
Cecilia
C
Edner
Magnus
M
Lafitte
Stéphane
S
Persson
Hans
H
Bauer
Fabrice
F
Ohrvik
John
J
Ennezat
Pierre-Vladimir
PV
Hage
Camilla
C
Löfman
Ida
I
Juilliere
Yves
Y
Logeart
Damien
D
Derumeaux
Geneviève
G
Gueret
Pascal
P
Daubert
Jean-Claude
JC
D001145:Arrhythmias, Cardiac / Q000150:complications*; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005080:Exercise Test; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D015337:Multicenter Studies as Topic / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012129:Respiratory Function Tests; D013318:Stroke Volume