Abstract 14911: The Impact of LV Dilatation on Mortality in Heart Failure with Preserved Ejection Fraction: Implications for Current Heart Failure Guidelines
Background: Patients (pts) with heart failure (HF) may present with either preserved (>50%) or low ejection fraction (HF-PEF or HF-lowEF). This is a prognostically important differentiation: a large international individual patient meta-analysis, Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC) has recently shown that mortality is lower in pts with HF-PEF. Recent diagnostic guidelines incorporate LV size defining patients with HF-PEF.
Objective & Hypothesis: This MAGGIC sub-analysis evaluated the impact of LV dilatation on mortality in pts with HF-lowEF and HF-PEF to test the hypothesis that HF-PEF with LV dilatation is associated with higher mortality than HF-PEF without LV dilatation.
Methods: This analysis was restricted to 10,563 pts in whom echocardiography data was available. Pts were divided on the basis of EF, then by severe LV dilatation (LVD) based on ASE partition values: unidexed LVEDD: >62 mm (women) >69 mm (men) or LVEDV: >131mm (women) >201 mm (men)). Three year mortality was examined using a Cox proportional hazards model including LVD, age, gender and study.
Results: 8153 pts had HF-lowEF (3159 had severe LVD, 39%); 2410 (23%) had HF-PEF (166 had severe LVD, 7%) (see table). In the HF-lowEF group mortality was related to severe LVD: HR 1.42(1.24,1.63); age: HR 1.03 (1.03,1.04); and gender HR 1.21 (1.04,1.40). In the HF-PEF group mortality was related to age: HR 1.04 (1.03,1.06); and gender HR 1.42 (1.11,1.81), but the relationship with severe LVD: HR 1.63(0.96,2.76) did not reach conventional significance, probably due to small numbers in this group.
Conclusion: HF-PEF with severe LV dilation was uncommon in this large cohort. Our data suggest that if LV dilation is present, mortality is higher in both pts with HF-lowEF and HF-PEF. In particular these data support the current guidelines approach, which is to classify pts with HF-PEF and severe LVD separately.
- © 2010 by American Heart Association, Inc.