The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis.

Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand.
European Journal of Heart Failure (Impact Factor: 5.25). 09/2009; 11(9):855-62. DOI: 10.1093/eurjhf/hfp103
Source: PubMed

ABSTRACT Heart failure (HF) with normal or preserved left ventricular (LV) ejection fraction (HFPEF) has been reported to be associated with similar outcome as HF with reduced EF (HFREF) in registry-based and epidemiological analyses, but many of these studies excluded patients who did not have EF measurements. Conversely, prior prospective studies have reported better outcome for patients with HFPEF. We performed a meta-analysis of prospective observational studies comparing all-cause mortality in patients with HFREF and HFPEF.
We searched several online databases for studies comparing outcome in HFREF and HFPEF, published before 2007. Inclusion criteria: prospective, clinical HF, near complete EF data, and mortality outcome. Review Manager version 4.2.3 software was used for the analysis. Overall, 24 501 patients [9299 deaths (38%)] from 17 studies are included. Average follow-up was 47 months; the HFPEF group was older (69 vs. 66 years) and more likely to be female (44% vs. 26%). Of the 7688 patients with HFPEF 2468 died (32.1%), compared with 6831 of the 16 813 patients with HFREF (40.6%): odds ratio 0.51 (95% CI: 0.48, 0.55).
This literature-based meta-analysis demonstrates that mortality among patients with HFPEF was half that observed in those with HFREF, in contrast to previous reports suggesting that mortality may be similar between both groups.

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    ABSTRACT: Aims A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reported mixed results whether survival is similar to those patients with heart failure and reduced EF (HF-REF). Methods and results We compared survival in patients with HF-PEF with that in patients with HF-REF in a meta-analysis using individual patient data. Preserved EF was defined as an EF ≥ 50%. The 31 studies included 41 972 patients: 10 347 with HF-PEF and 31 625 with HF-REF. Compared with patients with HF-REF, those with HF-PEF were older (mean age 71 vs. 66 years), were more often women (50 vs. 28%), and have a history of hypertension (51 vs. 41%). Ischaemic aetiology was less common (43 vs. 59%) in patients with HF-PEF. There were 121 [95% confidence interval (CI): 117, 126] deaths per 1000 patient-years in those with HF-PEF and 141 (95% CI: 138, 144) deaths per 1000 patient-years in those with HF-REF. Patients with HF-PEF had lower mortality than those with HF-REF (adjusted for age, gender, aetiology, and history of hypertension, diabetes, and atrial fibrillation); hazard ratio 0.68 (95% CI: 0.64, 0.71). The risk of death did not increase notably until EF fell below 40%. Conclusion Patients with HF-PEF have a lower risk of death than patients with HF-REF, and this difference is seen regardless of age, gender, and aetiology of HF. However, absolute mortality is still high in patients with HF-PEF highlighting the need for a treatment to improve prognosis.
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    ABSTRACT: Current guidelines for the diagnosis of heart failure with normal or preserved ejection fraction (HFpEF) are based on measurements at rest. However, in HFpEF ventricular dysfunction is more apparent on exercise. We hypothesized that Mitral annular plane systolic excursion (MAPSE) which is easy to acquire on exercise could be used to detect occult left ventricular (LV) impairment. Cardiopulmonary exercise testing and 2D-Doppler echocardiography were performed at rest and on exercise. MAPSE was assessed by using M-mode (apical four-chamber view). Sixty-two patients with HFpEF [LV ejection fraction (LVEF)=60 ± 7%] with reduced VO(2) max (18.6 ± 5.2 mL/min/kg) and 36 control subjects (LVEF=62 ± 7%, VO(2) max 29.4 ± 4.8 mL/min/kg) were studied. MAPSE at rest was significantly lower in patients (10.9 ± 2.1 vs. 12.1 ± 2.2 mm in controls, P= 0.008) which was even more pronounced on exercise (12.0 ± 2.2 mm and 16.2 ± 2.7 mm, respectively, P< 0.001). At rest MAPSE correlated with longitudinal strain (r = 0.432, P= 0.001), peak systolic myocardial velocity (r = 0.545, P< 0.001), and early diastolic myocardial velocity (r = 0.322, P= 0.02) and on exercise with LV apical rotation (r = 0.582, P< 0.001), longitudinal strain (r = 0.589, P< 0.001), and myocardial tissue velocities (P< 0.001). The area under the receiver operating characteristic curve for MAPSE was 0.655 (confidence interval 0.540-0.770) at rest and 0.901 (confidence interval 0.835-0.967) on exercise, to differentiate between patients and controls. Mitral annular plane systolic excursion at rest and on exercise correlates well with more sophisticated measurements of ventricular function in HFpEF patients. It is potentially a useful and easily acquired measurement, especially on exercise, for the diagnosis of HFpEF.
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    European Journal of Heart Failure 05/2014; · 5.25 Impact Factor