Prevalence and Significance of Alterations in Cardiac Structure and Function in Patients With Heart Failure and a Preserved Ejection Fraction
Abstract
Background—: The purpose of this study was to examine the prevalence of abnormalities in cardiac structure and function present in patients with heart failure and a preserved ejection fraction (HFPEF) and to determine whether these alterations in structure and function were associated with cardiovascular morbidity and mortality. Methods and Results—: The Irbesartan in HFPEF trial (I-PRESERVE) enrolled 4128 patients; echocardiographic determination of left ventricular (LV) volume, mass, left atrial (LA) size, systolic function, and diastolic function were made at baseline in 745 patients. The primary end point was death or protocol-specific cardiovascular hospitalization. A secondary end point was the composite of heart failure death or heart failure hospitalization. Associations between baseline structure and function and patient outcomes were examined using univariate and multivariable Cox proportional hazard analyses. In this substudy, LV hypertrophy or concentric remodeling was present in 59%, LA enlargement was present in 66%, and diastolic dysfunction was present in 69% of the patients. Multivariable analyses controlling for 7 clinical variables (including log N-terminal pro-B–type natriuretic peptide) indicated that increased LV mass, mass/volume ratio, and LA size were independently associated with an increased risk of both primary and heart failure events (all P <0.05). Conclusions—: Left ventricular hypertrophy or concentric remodeling, LA enlargement, and diastolic dysfunction were present in the majority of patients with HFPEF. Left ventricular mass and LA size were independently associated with an increased risk of morbidity and mortality. The presence of structural remodeling and diastolic dysfunction may be useful additions to diagnostic criteria and provide important prognostic insights in patients with HFPEF. Clinical Trial Registration—: http://www.clinicaltrials.gov . Unique identifier: NCT00095238.
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Cardiac myocytes isolated from HFpEF patients and experimental models exhibit prolonged relaxation, diminished contraction velocity, a decrease in β-adrenergic response, and increased myocardial stiffness.
“Cardiac myocytes isolated from HFpEF patients and experimental models exhibit prolonged relaxation, diminished contraction velocity, a decrease in β-adrenergic response, and increased myocardial stiffness.45,46”
From Reversal of contractile defects by mediating calcium homeostasis in human mini-heart models of heart failure with preserved ejection fraction (HFpEF) leads to first-in-human gene therapy clinical trial (2024) · cites this paper as [46]
The Function section (p. 6) reports impaired relaxation in 29% of patients and an abnormal ventricular shortening velocity in 14%. These are echocardiographic findings, not measurements from isolated cardiac myocytes. The paper does not establish the claimed β-adrenergic response, increased myocardial stiffness, or findings in experimental models. (LLM, conf=0.85)
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- Authors
- Zile, M. R., Gottdiener, J. S., Hetzel, S. J., McMurray, J. J., Komajda, M., McKelvie, R., Baicu, C. F., Massie, B. M., & Carson, P. E.
- Affiliations
- University of Maryland Medical Center (US)
- From the RHJ Department of Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, SC (M.R.Z., C.F.B.); University of Maryland Medical Center, Baltimore, MD (J.S.G.); University of Wisconsin School of Medicine and Public Health, Madison, WI (S.J.H.); British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK (J.J.M.); Université Paris 6; Pitié Salpêtrière Hospital, Paris, France (M.K.); Hamilton Health Sciences, McMaster...
- ORCID
- Venue
- Circulation
- Published
- 2011-12-06
- Volume
- 124
- Issue
- 23
- Pages
- 2491-2501
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2149841172
- Cited by
- 517
- References
- 41
- Citations by year
- 2026: 18 · 2025: 28 · 2024: 26 · 2023: 24 · 2022: 45 · 2021: 42 · 2020: 37 · 2019: 41 · 2018: 32 · 2017: 36 · 2016: 48 · 2015: 29 · 2014: 47 · 2013: 41 · 2012: 21
- FWCI
- 23.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Keywords
- heart failure with preserved ejection fraction, left ventricular hypertrophy, concentric remodeling, left atrial enlargement, diastolic dysfunction, left ventricular mass, left ventricular volume, cardiovascular morbidity and mortality, heart failure hospitalization, irbesartan, prognostic factors, N-terminal pro-brain natriuretic peptide
- MeSH terms
- Irbesartan, Aged, Biphenyl Compounds, Diastole, Echocardiography, Female, Heart Failure, Heart Ventricles, Humans, Male, Morbidity, Prognosis, Risk Factors, Stroke Volume, Systole, Tetrazoles, Echocardiography, Doppler, Cohort Studies, Prevalence, Ventricular Remodeling, Angiotensin II Type 1 Receptor Blockers
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