Comorbidity and ventricular and vascular structure and function in heart failure with preserved ejection fraction: a community-based study.
BACKGROUND
Patients with heart failure and preserved ejection fraction (HFpEF) display increased adiposity and multiple comorbidities, factors that in themselves may influence cardiovascular structure and function. This has sparked debate as to whether HFpEF represents a distinct disease or an amalgamation of comorbidities. We hypothesized that fundamental cardiovascular structural and functional alterations are characteristic of HFpEF, even after accounting for body size and comorbidities.


RESULTS
Comorbidity-adjusted cardiovascular structural and functional parameters scaled to independently generated and age-appropriate allometric powers were compared in community-based cohorts of HFpEF patients (n=386) and age/sex-matched healthy n=193 and hypertensive, n=386 controls. Within HFpEF patients, body size and concomitant comorbidity-adjusted cardiovascular structural and functional parameters and survival were compared in those with and without individual comorbidities. Among HFpEF patients, comorbidities (obesity, anemia, diabetes mellitus, and renal dysfunction) were each associated with unique clinical, structural, functional, and prognostic profiles. However, after accounting for age, sex, body size, and comorbidities, greater concentric hypertrophy, atrial enlargement and systolic, diastolic, and vascular dysfunction were consistently observed in HFpEF compared with age/sex-matched normotensive and hypertensive.


CONCLUSIONS
Comorbidities influence ventricular-vascular properties and outcomes in HFpEF, yet fundamental disease-specific changes in cardiovascular structure and function underlie this disorder. These data support the search for mechanistically targeted therapies in this disease.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Selma F
SF
Mohammed
Barry A
BA
Borlaug
Véronique L
VL
Roger
Sultan A
SA
Mirzoyev
Richard J
RJ
Rodeheffer
Julio A
JA
Chirinos
Margaret M
MM
Redfield
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006333:Heart Failure / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology*