Abstract 20761: Predictors of Incident HFrEF and HFpEF in a Large Multiracial Cohort of Preclinical Diastolic Dysfunction
Introduction: Preclinical diastolic dysfunction (PDD) is defined as left ventricular diastolic dysfunction and normal left ventricular ejection fraction (LVEF) without symptoms. PDD is a known risk factor for clinical heart failure. Progression of PDD to heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) has not been described.
Methods: Patients who underwent echocardiogram from 2003 to 2008 with LVEF ≥50%, grade 1 diastolic dysfunction without baseline diagnosis of heart failure were included. The end point was the new diagnosis of HFpEF or HFrEF. Baseline characteristics were compared between patients with HFpEF and HFrEF. Cumulative probabilities were estimated using Kaplan-Meier method. Multivariable adjusted Cox proportional hazards models, with adjustment of baseline demographics and comorbidities, were performed to examine predictors of incident HFpEF and HFrEF.
Results: A total of 7,878 PDD patients (77% non-White) were included in the study with median follow-up of 5.9 years. There were 146 patients who developed HFrEF and 635 patients who developed HFpEF during the follow-up period. The 10-year cumulative probabilities of HFrEF and HFpEF were 3.1% and 12.6% respectively. The incidence of HFrEF was significantly lower in non-Hispanic (NH) Black patients (2.2%) compared with NH White patients (4.5%). Age, diabetes, myocardial infarction, and renal disease were independent predictors of both HFrEF and HFpEF. The impact of older age on incident HFpEF was significantly greater than on HFrEF (Hazard ratio (HR) 1.05 vs 1.02, P for heterogeneity=0.005). Male gender (HR=1.58, P=0.014), cerebral vascular disease (HR=1.72, P=0.005) and low baseline LVEF (HR=1.14. p<0.001) were significantly associated with incident HFrEF only; whereas, pulmonary disease (HR=2.00, P<0.001), increased blood urea nitrogen (HR=1.01, P=0.002) and anemia (HR=1.09, P=0.001) were independent predictors of HFpEF only.
Conclusions: Our large multiracial cohort with PDD revealed a distinct set of antecedent predictors for incident HFrEF and HFpEF. Our results underscore a differential approach of risk stratification, prevention, and early treatment based on heart failure subtypes.
Author Disclosures: L. Zhang: None. J.J. Liebelt: None. N. Madan: None. J. Shan: None. C.C. Taub: None.
- © 2016 by American Heart Association, Inc.