Abstract 12108: What are the Implications of Coronary Artery Disease in Patients With Heart Failure and Preserved Ejection Fraction?
Background: Clinical trials to date in heart failure and preserved ejection fraction (HFpEF) have been neutral, and it has been postulated that this is because HFpEFis a highly heterogenous entity. Coronary artery disease (CAD) is common in HFpEF, and it is possible that patients with HFpEFand CAD differ in fundamentally important ways from patients with HFpEF and no CAD.
Methods: Clinical, hemodynamic, echocardiographic and outcome characteristics were compared in patients with HFpEF undergoing coronary angiography.CAD was defined by stenosis >50% in one or more >2.5mm vessel or previous revascularization.
Results: Of 376 HFpEF patients examined, 255 (68%) had CAD and 121 (32%) had no CAD. Compared to HFpEF patients without CAD, patients with CAD were more likely to be male (57% vs 25%, P≤0.001) older (73±9 vs 71±10, P=0.02) and had greater comorbidity burden, while dyspnea and angina symptom severity were similar. Patients with HFpEF and CAD had worse renal function, more concentric LV remodeling, and higher E/e’ than HFpEF without CAD.Pulmonary capillary wedge pressure, pulmonary artery pressures and cardiac index were similar. Repeat echo performed in a subset of 217 patients (58%) 1314 days (IQR 655, 1939) after catheterization showed greater decline in EF in HFpEF with CAD compared to without (-4±10 vs -1±8%, p=0.01). Over a median follow up of 1457 days (IQR 692, 2366), patients with HFpEF and CAD had higher mortality than without (Figure1), even after adjusting for age, chronic kidney disease, atrial fibrillation and pulmonary artery pressure. (HR 1.60; CI 1.03, 2.58; P=0.04)
Conclusions: CAD is common in HFpEF patients and is associated with distinct clinical, structural and outcome profiles, with greater risk of death and deterioration in LV function. Sub-phenotyping of HFpEF by the presence of CAD may allow for more effective targeting of therapies in future trials.
- © 2013 by American Heart Association, Inc.