Abstract 3812: Ventricular-Vascular Stiffening in Patients with Heart Failure and Preserved Ejection Fraction: A Population Based Study
Background: The mechanisms causing heart failure (HF) with preserved ejection fraction (HFnlEF) remain controversial. LV diastolic dysfunction and increased systolic (Ees) and arterial stiffness (Ea) have been implicated, but the relative roles of each are unclear.
Objective: We used novel, recently validated echo and tissue Doppler methods to characterize LV relaxation, systolic and diastolic elastance, and effective arterial elastance in a large population of healthy, hypertensive, and HFnlEF patients (pts).
Methods: Groups included: non-obese subjects without CV disease (CON; n=617); subjects with hypertension but no HF (HTN; n=719); and pts with HFnlEF (n=242). All were Olmsted County, MN, residents enrolled in population based studies with EF≥50%. Tissue Doppler e’ velocity was used to estimate LV relaxation. LV end diastolic pressure (EDP) was estimated (=11.96 ± 0.596*E/e’) and EDV measured (Teichholz) to derive curve fitting (α) and stiffness (β) constants (EDP = αEDVβ). Derived α and β were then used to calculate the EDV at a common EDP of 40 (V40). Ees was determined using blood pressure (BP), stroke volume (SV), EF, timing intervals, and an estimated normalized ventricular elastance at arterial end diastole. Ea was estimated as 0.9*systolic BP/SV. Comparisons were adjusted for age, sex and body surface area (BSA).
Results: HFnlEF pts had more impaired relaxation (lower e’) and increased diastolic LV stiffness (lower EDV40/BSA) compared to both CON and HTN. Both Ea and Ees were increased in HTN and HFnlEF compared to CON, but were similar in HFnlEF and HTN. Coupling ratio (Ea/Ees) was preserved across groups.
Conclusions: LV systolic - arterial stiffening and diastolic dysfunction are both prevalent in pts with hypertension but HFnlEF pts had more severe diastolic dysfunction, which may suggest a key role for diastolic dysfunction in mediating development of HF in patients with hypertensive heart disease.