Echocardiographic Features of Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction

• Published in: Journal of the American College of Cardiology 2019-12, Vol.74 (23), p.2858-2873
• Main Authors: Shah, Amil M., Cikes, Maja, Prasad, Narayana, Li, Guichu, Getchevski, Stoyan, Claggett, Brian, Rizkala, Adel, Lukashevich, Ilya, O’Meara, Eileen, Ryan, John J., Shah, Sanjiv J., Mullens, Wilfred, Zile, Michael R., Lam, Carolyn S.P., McMurray, John J.V., Solomon, Scott D.
• Format: Article
• Language: English
• Subjects: Aged; Aminobutyrates - therapeutic use; Angiotensin Receptor Antagonists - therapeutic use; Blood pressure; Brain; Brain natriuretic peptide; Cardiology; Cardiovascular disease; Clinical trials; Confidence intervals; Congestive heart failure; Consent; Death; Diastole; diastolic function; Double-Blind Method; Drug Combinations; Echocardiography; Echocardiography - methods; Ejection fraction; Electrocardiography; Enlargement; Expansion; Female; Fibrillation; Follow-Up Studies; Genotype & phenotype; Hazard assessment; Health hazards; Heart failure; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Heterogeneity; Humans; Hypertension; Hypertrophy; Laboratories; Male; Mercury; Middle Aged; Morbidity; Mortality; Neprilysin; Patients; preserved left ventricular function; Prognosis; Prospective Studies; Pulmonary artery; Risk analysis; Risk factors; Statistical models; Stroke Volume - physiology; Structure-function relationships; Studies; Systolic pressure; Tetrazoles - therapeutic use; Time Factors; Ultrasonic imaging; Velocity; Ventricle; Ventricular Function, Left - physiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2019.09.063

The PARAGON-HF (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction) trial tested the efficacy of sacubitril-valsartan in patients with heart failure with preserved ejection fraction (HFpEF). Existing data on cardiac structure and function in patients with HFpEF suggest significant heterogeneity. The aim of this study was to characterize cardiac structure and function, quantify their associations with clinical outcomes, and contextualize these findings with other HFpEF studies. Echocardiography was performed in 1,097 of 4,822 PARAGON-HF patients within 6 months of enrollment. Associations with incident first heart failure hospitalization or cardiovascular death were assessed using Cox proportional hazards models adjusted for age, sex, region of enrollment, randomized treatment, N-terminal pro–brain natriuretic peptide, and clinical risk factors. Average age was 74 ± 8 years, 53% of patients were women, median N-terminal pro–brain natriuretic peptide level was 918 pg/ml (interquartile range: 485 to 1,578 pg/ml), 94% had hypertension, and 35% had atrial fibrillation. The mean left ventricular (LV) ejection fraction was 58.6 ± 9.8%, prevalence of LV hypertrophy was 21%, prevalence of left atrial enlargement was 83%, prevalence of elevated E/e′ ratio was 53%, and prevalence of pulmonary hypertension was 31%. Heart failure hospitalization or cardiovascular death occurred in 288 patients at 2.8-year median follow-up. In fully adjusted models, higher LV mass index (hazard ratio [HR]: 1.05 per 10 g/m2; 95% confidence interval [CI]: 1.00 to 1.10; p = 0.03), E/e′ ratio (HR: 1.04 per unit; 95% CI: 1.02 to 1.06; p