Predictors of adverse outcome in patients with heart failure and preserved ejection fraction

Abstract

Purpose: Patients with heart failure and preserved left ventricular ejection fraction (HFPEF) face an adverse outcome. The aim of the present study was to identify factors that determine prognosis. Method(s): Consecutive patients with HFPEF diagnosed according to current ESC guidelines were recruited in our prospective registry, which was approved by the local ethics committee. Death and/or hospitalization for heart failure were defined as primary outcome variables. Outcome groups were compared with respect to potential prognostic predictors using the Student's t-test and the Chi-square test. Multivariable logistic regression analysis was applied to determine whether parameters of interest were associated with adverse outcome. P<0.05 indicated statistical significance. Result(s): Between December 2010 and January 2013, 102 HFPEF patients (71 f/31 m, mean age 70+/-8 years) were registered. After a mean follow-up of 13+/-9 months, 24 (24%) patients were hospitalized or died. Patients in the adverse outcome group were characterized by a shorter 6-minute walk distance in m (254+/-117 versus 347+/-112, p=0.002), a higher borg dyspnea score (BDS, 6+/-2 versus 3+/-2, p < 0.001), lower haemoglobin values in g/dl (11.6+/-1.3 versus 12.7+/-1.9, p=0.011), higher NT-proBNP in pg/ml (2107+/-1409 versus 1363+/-1243, p=0.017) and a lower forced expiratory volume in one second in % (69+/-24 versus 81+/-24, p=0.042) at enrolment. Diabetes mellitus II (DM II, 58% versus 27%, p=0.005) was more prevalent among patients with adverse outcome. With respect to hemodynamic parameters a higher mean pulmonary arterial pressure in mmHg (39+/-9 versus 33+/-9, p=0.009), a higher mean pulmonary capillary wedge pressure (mPCWP in mmHg, 20+/-4 versus 23+/-5, p=0.006), a higher mean right atrial pressure in mmHg (16+/-7 versus 12+/-5, p=0.008) and a higher transpul-monary gradient (TPG > 12 mmHg, 83% versus 55%, p=0.013) were detected. In the multivariable regression model, DM II (odds ratio: 5.5 [95% confidence interval 1.5-20.2]; p=0.010), the BDS (odds ratio: 6.2 [95% confidence interval 1.7-22.1]; p=0.005), the mPCWP (odds ratio: 1.2 [95% confidence interval 1.0-1.3] p=0.007) as well as TPG > 12 mmHg (odds ratio: 3.9 [95% confidence interval 1.0-15.1]; p=0.046) remained independent predictors of adverse outcome Conclusion(s): Presence of DM II, a higher BDS, a higher mPCWP and a TPG > 12 mmHg predict adverse outcome in HFPEF patients.