Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction

Department of Cardiology and Pneumology, University of Göttingen, 37075 Göttingen, Germany.
Clinical Research in Cardiology (Impact Factor: 4.56). 03/2011; 100(9):755-64. DOI: 10.1007/s00392-011-0305-4
Source: PubMed


Comorbidities negatively affect prognosis more strongly in heart failure with preserved (HFpEF) than with reduced (HFrEF) ejection fraction. Their comparative impact on physical impairment in HFpEF and HFrEF has not been evaluated so far.
The frequency of 12 comorbidities and their impact on NYHA class and SF-36 physical functioning score (SF-36 PF) were evaluated in 1,294 patients with HFpEF and 2,785 with HFrEF. HFpEF patients had lower NYHA class (2.0 ± 0.6 vs. 2.4 ± 0.6, p < 0.001) and higher SF-36 PF score (54.4 ± 28.3 vs. 54.4 ± 27.7, p < 0.001). All comorbidities were significantly (p < 0.05) more frequent in HFrEF, except hypertension and obesity, which were more frequent in HFpEF (p < 0.001). Adjusting for age and gender, COPD, anemia, hyperuricemia, atrial fibrillation, renal dysfunction, cerebrovascular disease and diabetes had a similar (p for interaction > 0.05) negative effect in both groups. Obesity, coronary artery disease and peripheral arterial occlusive disease exerted a significantly (p < 0.05) more adverse effect in HFpEF, while hypertension and hyperlipidemia were associated with fewer (p < 0.05) symptoms in HFrEF only. The total impact of comorbidities on NYHA (AUC for prediction of NYHA III/IV vs. I/II) and SF-36 PF (r(2)) in multivariate analyses was approximately 1.5-fold higher in HFpEF, and also much stronger than the impact of a 10% decrease in ejection fraction in HFrEF or a 5 mm decrease in left ventricular end-diastolic diameter in HFpEF.
The impact of comorbidities on physical impairment is higher in HFpEF than in HFrEF. This should be considered in the differential diagnosis and in the treatment of patients with HFpEF.

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Available from: Gerd Hasenfuß,
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    • "Recently, studies focused on the molecular cell level disorder in HFPEF-like impaired nitric oxide—cyclic guanosine monophosphate (cGMP)—protein kinase G (PKG) signaling [30, 31], endothelial dysfunction [22, 32, 33], oxidative stress, and cardiac inflammation [20]. The roles of comorbidities in the HFPEF population, including arterial hypertension, coronary arterial disease (CAD), diabetes, atrial fibrillation, obesity, obstructive sleep apnoea, and chronic kidney disease (CKD), are all associated with the disease and will likely be involved in the pathophysiology [34–36]. Furthermore, patients with HFPEF are older, more often female, have less often CAD but higher rates of atrial fibrillation, and most of them have arterial hypertension [37]. "
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