Abstract 15568: First Baseline Characteristics of Aldo-DHF (Aldosterone Receptor Blockade in Diastolic Heart Failure), the Largest Prospective International Multicenter Trial on Heart Failure with Preserved Ejection Fraction
The prevalence of heart failure with preserved ejection fraction (HFprEF) is continuously increasing and nowadays, over 50% of all heart failure patients suffer from HFprEF. Therefore, we currently perform the BMBF-funded international multicenter Aldo-DHF trial.
Methods: A total of 420 DHF patients were prospectively recruited from 2007 to 2010 and were extensively phenotyped including comprehensive assessment of diastolic function (echocardiography including tissue Doppler), exercise capacity (spiroergometry) and NTproBNP.
Results: The mean age of the patients was 69±8 years, 49.9% were female. Blood pressure upon inclusion was 135±19/79±11 mmHg, mean heart rate 67±12/min, and mean body mass index (BMI) 28.9±3.5 kg/m2. All patients were symptomatic with 85% being in NYHA stage II, and 15% in NYHA stage III; 80% with nycturia, 38% with peripheral edema, and 11% with orthopnea. The most prevalent risk factors were hypertension (91%), dyslipidemia (60%), hyperuricemia (45%), and diabetes (16%). Upon echocardiography, mean ejection fraction was 68±8%, left ventricular end-diastolic volume 74±28ml, intraventricular septal thickness 12.2±1.8 mm, and mean left atrial diameter 45±6mm. Quantitative analysis of diastolic dysfunction revealed stage I in 75%, and stage II/III in 25%. E/é medial as Doppler-derived index for filling pressure was 12.8±6.4. Spiroergometry revealed a peak VO2 of 16.5±3.6 ml/kg/min, and VE/VCO2 slope 30.2±5.3 with a mean RER of 1.11 ± 0.12. Mean NTproBNP was 257.3 ± 327 pg/ml.
Conclusion: Baseline characteristics demonstrate a classical elderly heart failure population with typical echo features of adverse LA & LV remodeling, preserved EF, and diastolic dysfunction. A majority only classifies for stage I diastolic dysfunction. Exercise capacity and ventilatory efficiency are largely impaired, but mean NTproBNP is only slightly elevated. Therefore, the degree of diastolic dysfunction and NTproBNP are poor predictors of exercise intolerance in DHF. Aldosterone receptor blockade may be a therapeutic option in DHF. Outcome data for Aldo-DHF will be available by april 2012. A large mortality trial for spironolactone (TOPCAT) is underway. Aldo-DHF and TOPCAT will clearify the role of aldosterone blockade in DHF.
- © 2011 by American Heart Association, Inc.