title: Heart Failure with Preserved and Reduced Ejection Fraction in Hemodialysis Patients: Prevalence, Disease Prediction and Prognosis.
abstract: OBJECTIVE
  Heart failure (HF) is a main cause of mortality of hemodialysis (HD) patients. While HF with reduced ejection fraction (HFrEF) is known to only affect a minority of patients, little is known about the prevalence, associations with clinical characteristics and prognosis of HF with preserved ejection fraction (HFpEF).
  
  
  METHODS
  We included 105 maintenance HD patients from the Medical University of Vienna into this prospective single-center cohort study and determined the prevalence of HFpEF (per the 2013 criteria of the European Society of Cardiology) and HFrEF (EF <45%), using standardized post-HD transthoracic echocardiography. We also assessed clinical, laboratory and volume status parameters (by bioimpedance spectroscopy). These parameters served to calculate prediction models for both disease entities, while clinical outcomes (frequency of cardiovascular hospitalizations and/or cardiac death) were assessed prospectively over 27±4 months of follow-up.
  
  
  RESULTS
  All but 4 patients (96%) had evidence of diastolic dysfunction. 70% of the entire cohort fulfilled HF criteria (81% HFpEF, 19% HFrEF). Age, female sex, body mass index, blood pressure and dialysis vintage were predictive of HFpEF (sensitivity 86%, specificity 63%; AUC 0.87), while age, female sex, NT pro-BNP, history of coronary artery disease and atrial fibrillation were predictive of HFrEF (sensitivity 85%, specificity 90%; AUC 0.95). Compared to patients without HF, those with HFpEF and HFrEF had a higher risk of hospitalization for cardiovascular reason and/or cardiac death (adjusted HR 4.31, 95% CI 0.46-40.03; adjusted HR 3.24, 95% CI 1.08-9.75, respectively).
  
  
  CONCLUSIONS
  Diastolic dysfunction and HFpEF are highly prevalent in HD patients while HFrEF only affects a minority. Distinct patient-specific characteristics predict diagnosis of either entity with good accuracy.
authors.affiliation: Department of Internal Medicine III, Division of Nephrology and Dialysis, Vienna, Austria.
authors.forename: Marlies
authors.initials: M
authors.lastname: Antlanger
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Aschauer
authors.affiliation: Department of Internal Medicine III, Division of Nephrology and Dialysis, Vienna, Austria.
authors.forename: Chantal
authors.initials: C
authors.lastname: Kopecky
authors.affiliation: Department of Internal Medicine III, Division of Nephrology and Dialysis, Vienna, Austria.
authors.forename: Manfred
authors.initials: M
authors.lastname: Hecking
authors.affiliation: Department of Internal Medicine III, Division of Nephrology and Dialysis, Vienna, Austria.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Kovarik
authors.affiliation: Department of Internal Medicine III, Division of Nephrology and Dialysis, Vienna, Austria.|Department of Internal Medicine I, Division of Nephrology, Hanusch Hospital, Vienna, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Werzowa
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Mascherbauer
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.|Institute of Public Health, Federal University of Bahia, Salvador, Brazil.
authors.forename: Bernd
authors.initials: B
authors.lastname: Genser
authors.affiliation: Department of Internal Medicine III, Division of Nephrology and Dialysis, Vienna, Austria.|Department of Internal Medicine VI, Division of Nephrology, Wilhelminenspital, Vienna, Austria.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Säemann
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Diana
authors.initials: D
authors.lastname: Bonderman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D013318:Stroke Volume
keywords: Ejection fraction; Heart failure; Hemodialysis