Abstract 3814: Cardiac Structural Changes and Diastolic Function in Heart Failure with Preserved Ejection Fraction - Importance of Left Atrial Volume: the iPRESERVE Study
Background: Heart failure (HF) in the presence of “preserved” systolic function (PSF) is traditionally thought to result from LV hypertrophy (LVH) and diastolic dysfunction (DD), whereas left atrial enlargement (LAE) may reflect chronically elevated LV filling pressures. This study examines the relative prevalence of these characteristics.
Methods: The I-PRESERVE is an ongoing trial of Irbesartan in HF with HFPSF that has enrolled 4128 pts ≥60 yrs of age with LVEF ≥45% and clinical HF. As a substudy, 2D echo and Doppler mitral valve and tissue annulus recordings were performed by a specific protocol at baseline in 741 pts in sinus rhythm (age 72±7 yrs, BP 136±15/79±9 mmHg, 62% women), and analyzed in a central echo core lab. Cornell-Naples criteria and American Society of Echocardiography (ASE) criteria (LA volume biplane area length method >29ml/m^2 BSA) were used to define LVH and LAE respectively; DD was categorized based on mitral inflow and anular tissue velocities.
Results: LVH (Cornell-Naples criteria) was present in 183 Pts (25%); and 25% of these had “concentric” LVH. Concentric remodeling, defined as increased LV wall thickness relative to cavity size without increase in LV mass, was present in 105 (14%) pts. Diastolic function was normal in 349 (47%), grade 1 (impaired relaxation) in 343 (46%), Grade 2 (pseudonormal) in 49 (7%), and no pt had Grade 3 (restrictive) DD. LAE was present in 390/ 457 (85%) evaluable pts; and was moderate or severe (ASE criteria) in 316/457(69%). Severe LAE was more common (69%) in pts with Grade 2 than in Grade 1 (42%, p = 0.0058). Isovolumic relaxation time (IVRT) was normal for age (61–127 msec) in 89%, mitral inflow deceleration time(DT) was normal for age(133–295 msec) in 79%, and mitral early inflow velocity (Epk) was normal for age (36–78 cm/sec) in 55% pts.
Conclusions: In pts with clinically diagnosed HFPSF, LVH or concentric remodeling is present in less than half , and DD greater than Grade 1, and abnormal DT, IVRT, and Epk are uncommon in echos done while pts are clinically stable. However, increased LA volume is present in the majority of pts. These results suggest that LAE, which may reflect the effects of impaired LV diastolic filling over time, is a more prevalent finding in HFPSF than LVH or Doppler indices of DD.