title: Comparison of ventricular structure and function in Chinese patients with heart failure and ejection fractions >55% versus 40% to 55% versus <40%.
abstract: Subjects with heart failure (HF) and a preserved ejection fraction (EF) are heterogenous and the EF used to define this syndrome varies considerably among studies. We sought to determine if physiologic differences exist between subjects with a normal EF (>55%) or mildly decreased EF (40% to 55%). 357 consecutive Chinese patients who were healthy (n = 93) or had HF (n = 264) underwent comprehensive echocardiography, Doppler analysis, and measurement of neurohormones. Subjects with HF were stratified by EF into those with normal EF (>55%, n = 128), mildly decreased EF (40% to 55%, n = 38), or moderate to severely decreased EF (<40%, n = 100). Employing noninvasive pressure-volume analysis, estimated end-systolic and end-diastolic pressure-volume relations were calculated. Subjects with HF and an EF 40% to 55% more often had a previous myocardial infarction and diabetes than those with HF and an EF >55%. Physiologically, the cohort with a mildly decreased EF had eccentrically enlarged ventricles with evidence of remodeling (rightward shifted end-diastolic pressure-volume relation) and decreased chamber contractility (downward shifted end-systolic pressure-volume relation) most comparable to subjects with overt systolic HF. In conclusion, in subjects with HF and a preserved EF, there are distinct physiologic differences between those with a normal (>55%) and a mildly decreased (40% to 55%) EF.
authors.affiliation: Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China. hekunlun2002@yahoo.com
authors.forename: Kun-Lun
authors.initials: KL
authors.lastname: He
authors.forename: Daniel
authors.initials: D
authors.lastname: Burkhoff
authors.forename: Wen-Xiu
authors.initials: WX
authors.lastname: Leng
authors.forename: Zhi-Ru
authors.initials: ZR
authors.lastname: Liang
authors.forename: Li
authors.initials: L
authors.lastname: Fan
authors.forename: Jie
authors.initials: J
authors.lastname: Wang
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013318:Stroke Volume; D014463:Ultrasonography; D016277:Ventricular Function, Left