P589Subclinical lv dysfunction, functional capacity and clinical outcomes in stage a heart failure: are all etiologies the same?

Abstract

Background: Heightened attention to risk factor management is proposed for individuals with stage A heart failure (SAHF). However, the HF risk associated with different etiologies of SAHF is variable. We sought to what extent SAHF of T2DM and other HF risks showed differences in a discrepancy in subclinical LV function, exercise capacity and prognosis. Methods: 551 elderly asymptomatic SAHF patients (age 71±5 y, 49% men, 290 T2DM) with at least one risk factor were recruited from a community-based population with preserved ejection fraction. All underwent a comprehensive echo including global longitudinal strain (GLS) as well as six-minute walk test (6MWT) and were followed for 2 years. The primary endpoint was new-onset of HF and all-cause mortality. Results: The T2DM group was associated with reduced 6MW distance (451±111 vs 493±87m, P<0.001), worse diastolic function (E/e' 9.2±2.7 vs 8.7±2.4, p=0.028) as well as impaired GLS (-17.7±2.6 vs -19.1±2.6%, p<0.001). Over a median follow-up of 1.6 years, 49 T2DM-SAHF and 27 other-SAHF met the primary endpoint. T2DM-SAHF had significantly worse outcome than other- SAHF (χ2=5.34; p=0.021). In Cox models, obesity (HR 2.89; p=0.001), 6MWD (HR=0.99; p=0.025) and GLS (HR=1.22; p=0.001) was independently associated with the primary endpoint in T2DM-SAHF; as were age (HR=1.08; p=0.022) and history of heart disease (HR=2.97; p=0.019) in other-SAHF. Conclusions: T2DM-SAHF has worse subclinical LV function, exercise capacity and prognosis than other-SAHF. Impaired GLS and exercise capacity is associ- ated with a worse prognosis in T2DM-SAHF but not in other-SAHF. Not all types of SAHF are the same.