title: The impact of extra cardiac comorbidities on pressure volume relations in heart failure and preserved ejection fraction.
abstract: BACKGROUND
  Extracardiac comorbidities are common in patients with heart failure and a preserved ejection fraction (HFPEF). We sought to evaluate the relationship between comorbidities and ventricular structure and function in patients with HFPEF through evaluation of pressure-volume analysis.
  
  
  RESULTS
  Two hundred twenty Chinese patients with a preserved ejection fraction who were either healthy (n = 75), hypertensive without heart failure (HTN; n = 89), or hypertensive with HFPEF (HFPEF; n = 56) were studied. Using echocardiographic measures, estimated end-systolic and end-diastolic pressure-volume relationships, and the area between them as a function of EDP, the isovolumic pressure-volume areas (PVA(iso)), were calculated. Ventricular capacitance, as measured by V(30), was larger in patients with HFPEF compared with normal control subjects and tended to be larger compared with hypertensive control subjects. The presence of diabetes and renal insufficiency was independently associated with greater ventricular capacitance in patients with HFPEF. The PVA(iso) was increased in patients with HFPEF compared with HTN and normal control subjects, and in particular, it was increased in HFPEF patients with multiple comorbidities.
  
  
  CONCLUSIONS
  The presence of comorbid conditions is associated with altered pressure-volume relations and enhanced pump function in subjects with HFPEF, supporting an important role for extracardiac comorbidities in the pathophysiology of patients with this condition.
authors.affiliation: Columbia University Medical Center, New York, New York 10032, USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Abramov
authors.forename: Kun-Lun
authors.initials: KL
authors.lastname: He
authors.forename: Jie
authors.initials: J
authors.lastname: Wang
authors.forename: Daniel
authors.initials: D
authors.lastname: Burkhoff
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology*