The Impact of Extra Cardiac Comorbidities on Pressure Volume Relations in Heart Failure and Preserved Ejection Fraction

Abstract Background Extracardiac comorbidities are common in patients with heart failure and a preserved ejection fraction (HFPEF). We sought to evaluate the relationship between comorbidities and ventricular structure and function in patients with HFPEF through evaluation of pressure-volume analysi...

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Bibliographic Details
Published in:Journal of cardiac failure 2011-07, Vol.17 (7), p.547-555
Main Authors: Abramov, Dmitry, MD, MS, He, Kun-Lun, MD, PhD, Wang, Jie, MD, PhD, Burkhoff, Daniel, MD, PhD, Maurer, Mathew S., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Blood Pressure - physiology
Cardiovascular
China - epidemiology
Cohort Studies
comorbidities
Comorbidity
ejection fraction
Female
Heart failure
Heart Failure - epidemiology
Heart Failure - physiopathology
Humans
Hypertension - epidemiology
Hypertension - physiopathology
Male
Middle Aged
Stroke Volume - physiology
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Summary:Abstract Background Extracardiac comorbidities are common in patients with heart failure and a preserved ejection fraction (HFPEF). We sought to evaluate the relationship between comorbidities and ventricular structure and function in patients with HFPEF through evaluation of pressure-volume analysis. Methods and Results Two hundred twenty Chinese patients with a preserved ejection fraction who were either healthy (n = 75), hypertensive without heart failure (HTN; n = 89), or hypertensive with HFPEF (HFPEF; n = 56) were studied. Using echocardiographic measures, estimated end-systolic and end-diastolic pressure-volume relationships, and the area between them as a function of EDP, the isovolumic pressure-volume areas (PVAiso ), were calculated. Ventricular capacitance, as measured by V30 , was larger in patients with HFPEF compared with normal control subjects and tended to be larger compared with hypertensive control subjects. The presence of diabetes and renal insufficiency was independently associated with greater ventricular capacitance in patients with HFPEF. The PVAiso was increased in patients with HFPEF compared with HTN and normal control subjects, and in particular, it was increased in HFPEF patients with multiple comorbidities. Conclusions The presence of comorbid conditions is associated with altered pressure-volume relations and enhanced pump function in subjects with HFPEF, supporting an important role for extracardiac comorbidities in the pathophysiology of patients with this condition.
ISSN:1071-9164
1532-8414
DOI:10.1016/j.cardfail.2011.03.010