title: Role of cardiopulmonary dysfunction and left atrial remodeling in development of acute decompensated heart failure in chronic heart failure with preserved left ventricular ejection fraction.
abstract: BACKGROUND
  The presence of heart failure (HF) with preserved ejection fraction (HFPEF) is increasingly recognized. However, prognostic factors for HFPEF remain unclear.
  
  
  RESULTS
  The data were derived from Shinken Database 2004-2010, a prospective cohort study (n=15,227). We examined 301 consecutive HFPEF patients (New York Heart Association Class II or greater) and tracked them for an average 3.5 years. Cardiopulmonary exercise testing (CPX), blood exams, and ultrasound cardiogram (UCG) were performed at the first medical examination. Acute decompensated HF (ADHF) admission was observed in 19 patients (6.3%). CPX showed that the anaerobic threshold was lower (7.3±4.8mL/min/kg vs. 9.7±4.3mL/min/kg, p=0.02) and slope of the increase in ventilation to the increase in CO(2) output (VE-VCO(2) slope) was higher (40.6±8.5 vs. 34.6±7.9, p<0.01) in patients with ADHF admission than those without. Serum brain natriuretic peptide (BNP) tended to be higher and left atrial (LA) dimension was significantly greater (47.0±15.8mm vs. 41.0±9.9mm, p=0.01) in patients with ADHF admission than those without. Multivariate analysis showed that higher VE-VCO(2) slope and greater LA dimension were independent determinants of ADHF admission.
  
  
  CONCLUSIONS
  An aggravated CPX parameter and LA dilatation were associated with ADHF admission in patients with symptomatic HFPEF, suggesting the prognostic role of cardiopulmonary dysfunction during exercise and LA remodeling in the pathogenesis of decompensated HF development in HFPEF.
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan. h-kaneko@cvi.or.jp
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kaneko
authors.forename: Akira
authors.initials: A
authors.lastname: Koike
authors.forename: Keitaro
authors.initials: K
authors.lastname: Senoo
authors.forename: Shingo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagayama
authors.forename: Koichi
authors.initials: K
authors.lastname: Sagara
authors.forename: Takayuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsuno
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Funada
authors.forename: Tokuhisa
authors.initials: T
authors.lastname: Uejima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sawada
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015308:Anaerobic Threshold; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain