title: Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction.
abstract: BACKGROUND
  The purpose of this study was to examine the prevalence of abnormalities in cardiac structure and function present in patients with heart failure and a preserved ejection fraction (HFPEF) and to determine whether these alterations in structure and function were associated with cardiovascular morbidity and mortality.
  
  
  RESULTS
  The Irbesartan in HFPEF trial (I-PRESERVE) enrolled 4128 patients; echocardiographic determination of left ventricular (LV) volume, mass, left atrial (LA) size, systolic function, and diastolic function were made at baseline in 745 patients. The primary end point was death or protocol-specific cardiovascular hospitalization. A secondary end point was the composite of heart failure death or heart failure hospitalization. Associations between baseline structure and function and patient outcomes were examined using univariate and multivariable Cox proportional hazard analyses. In this substudy, LV hypertrophy or concentric remodeling was present in 59%, LA enlargement was present in 66%, and diastolic dysfunction was present in 69% of the patients. Multivariable analyses controlling for 7 clinical variables (including log N-terminal pro-B-type natriuretic peptide) indicated that increased LV mass, mass/volume ratio, and LA size were independently associated with an increased risk of both primary and heart failure events (all P<0.05).
  
  
  CONCLUSIONS
  Left ventricular hypertrophy or concentric remodeling, LA enlargement, and diastolic dysfunction were present in the majority of patients with HFPEF. Left ventricular mass and LA size were independently associated with an increased risk of morbidity and mortality. The presence of structural remodeling and diastolic dysfunction may be useful additions to diagnostic criteria and provide important prognostic insights in patients with HFPEF.
authors: Division of Cardiology, Department of Medicine, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC 29425, USA. zilem@musc.edu
authors: Michael R
authors: MR
authors: Zile
authors: John S
authors: JS
authors: Gottdiener
authors: Scott J
authors: SJ
authors: Hetzel
authors: John J
authors: JJ
authors: McMurray
authors: Michel
authors: M
authors: Komajda
authors: Robert
authors: R
authors: McKelvie
authors: Catalin F
authors: CF
authors: Baicu
authors: Barry M
authors: BM
authors: Massie
authors: Peter E
authors: PE
authors: Carson
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000627:therapeutic use*; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D000077405:Irbesartan; D008297:Male; D009017:Morbidity; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology; D013777:Tetrazoles / Q000627:therapeutic use*; D020257:Ventricular Remodeling / Q000502:physiology*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan