Abstract 12075: Is Revascularization an Effective Therapy for Heart Failure With Preserved Ejection Fraction?
Background: Myocardial ischemia acutely causes diastolic dysfunction, and coronary artery disease (CAD) is commonly observed in patients with heart failure and preserved ejection fraction (HFpEF). However, the effects of revascularization on left ventricular function and outcome remain poorly understood in HFpEF.
Methods: Patients with HFpEF undergoing coronary angiography were studied retrospectively. Significant CAD was defined as epicardial stenosis of >50% in any vessel of >2.5mm or previous revascularization. Syntax score was calculated in each patient. Effects of revascularization were assessed based upon follow up echocardiography and survival was determined from chart review and use of the social security death index.
Results: Of 376 HFpEF patients undergoing angiography, 255 patients were found to have significant CAD (73±9, men 57%). One vessel disease was present in 69 (27%), 2 vessel in 86 (33%), 3 vessel in 85 (33%) and left main in 39 (15%). Mean Syntax score was 18 (IQR 7, 28). Among HFpEF with CAD, 206 (81%) patients underwent revascularization (51% PCI, 49% CABG) and 49 (19%) did not. Over a median follow up of 1478 days (IQR 708, 2371), complete revascularization (absence of any >50% stenosis) was associated with less decline in EF (-2.0±8.7 vs -6.0±11.0%, P=0.007) and with lower mortality (figure1), independent of Syntax score, myocardial infarction history, pulmonary artery systolic pressure, chronic kidney disease, atrial fibrillation and age (hazard ratio 0.52, CI 0.32, 0.84, P=0.0061). Reduced mortality by complete revascularization was similar to that of HFpEF without CAD in Kaplan Meier analysis(P=0.62).
Conclusions: Complete revascularization improved survival in patients with HFpEF and significant coronary artery disease. Prospective trial data are urgently needed to determine the role of coronary revascularization in HFpEF.
- © 2013 by American Heart Association, Inc.