Abstract 16978: Predictors of Incident Heart Failure With Preserved Ejection Fraction in a Multi-Ethnic Cohort: The Multi-Ethnic Study of Atherosclerosis (MESA)
Background: Heart failure with preserved ejection fraction (HFPEF) accounts for nearly half of all patients diagnosed with heart failure (HF) and is associated with significant morbidity and mortality. HFPEF is a heterogeneous condition for which the pathophysiology and predisposing risk factors are incompletely understood. We sought to characterize the risk factors associated with incident HFPEF in a multi-ethnic cohort.
Methods: A total of 6,759 MESA participants (White, Black, Chinese, and Hispanic men and women age 45-84 years free of baseline cardiovascular disease) were followed for incident HF. Individuals were classified as HFPEF or heart failure reduced ejection fraction (HFREF) based on measured ejection fraction (EF) at time of HF diagnosis (EF ≥ 45% versus EF <45%). Cox multivariable adjusted hazard ratios (HR) were used to identify predictors of HFPEF and HFREF.
Results: Over median follow-up of 8.5 years (7.7 - 8.6), 140 individuals (2.1%) were diagnosed with incident HF; 66 (47%) had HFPEF whereas 74 (53%) had HFREF. Median EF at time of diagnosis was 57% and 34%, respectively. Older age, hypertension, diabetes, left ventricular hypertrophy (LVH), elevated N-Terminal Pro-BNP, and incident myocardial infarction (MI) predicted both HFPEF and HFREF. Higher body mass index (BMI) predicted HFPEF alone, whereas male gender, current smoking, left ventricular mass index, and worsening renal function predicted HFREF alone (Table). Ethnicity was not a predictor of HFPEF. Black individuals had an increased risk for incident HFREF compared to White individuals; no Chinese individuals developed HFREF. Coronary artery calcium, total cholesterol, elevated high sensitivity C-reactive protein, heart rate, and socioeconomic status did not predict HFPEF or HFREF.
Conclusion: In this multi-ethnic cohort, incident MI, LVH, diabetes, elevated NT-Pro-BNP, age, hypertension, and BMI were significant predictors for incident HFPEF, whereas ethnicity was not.
- © 2013 by American Heart Association, Inc.