Page 11 - SHJ V5 No2 2018
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SHJ Vol 5, No 2, 2018                                           Elbur MA Prognosis in HFpEF                                 By: Dr.Mohamed El
                                                          http://dx.doi.org/10.25239/SHJ/Vol5/No2/ReviewArticle

               diastolic  dysfunction,  and  1  percent  had      with HFrEF were older (mean age 71 vs. 66
               severe  diastolic  dysfunction.  At  a  median     years),  were  more  often  women  (50  vs.
               follow-up  of  3.5  years,  48  subjects  died.    28%),  and  have  a  history  of  hypertension
               After  controlling  for  age,  sex,  and  left     (51  vs.  41%).  Ischemic  etiology  was  less
               ventricular  EF  (LVEF),  all-cause  mortality     common  (43  vs.  59%)  in  patients  with
               was increased in patients with mild diastolic      HFpEF.  There  were  121  [95%  confidence
               dysfunction (96 percent without a diagnosis        interval  (CI):  117,  126]  deaths  per  1000
               of  HF;  hazard  ratio  8.3)  and  in  those  with   patient-years in those with HFpEF and 141
               moderate to severe diastolic dysfunction (90       (95% CI: 138, 144) deaths per 1000 patient-
               percent  without  a  diagnosis  of  HF;  hazard    years  in  those  with  HFrEF.  Patients  with
               ratio 10.2). [8]                                   HFpEF had lower mortality than those with
               In another report, 3008 Native Americans 45        HFrEF  (adjusted  for  age,  gender,  etiology,
               to  74  years of age were followed  for three      and  history  of  hypertension,  diabetes,  and
               years  following  Doppler  echocardiography.       atrial  fibrillation);  hazard  ratio  0.68  (95%
               Sixteen percent of patients had an E/A ratio       CI:  0.64,  0.71).  The  risk  of  death  did  not
               <0.6  (impaired  diastolic  relaxation)  and  3    increase  notably  until  EF  fell  below  40%.
               percent  had  an  E/A  ratio  >1.5  (restrictive   [11]
               pattern  due  to  reduced  compliance).  After     Thirty  one  of  the  56  identified  studies
               adjustment for covariates, an E/A ratio >1.5,      contributed data on 54 416 patients (Figure
               but not an E/A ratio <0.6, was independently       3). One thousand one hundred and seventy-
               associated  with  all-cause  and  cardiac          nine  patients  were  excluded  due  to
               mortality  (relative  risks  1.7  and  2.8,        irresolvable  dates  or  death  during  an  index
               respectively).[9]                                  hospital  admission  and  2246  excluded  as
               A  Cleveland  Clinic  study  followed  36,261      heart  failure  was  secondary  to  severe
               adults  (mean  age  58)  with  LVEF  ≥55           valvular  heart  disease  or  hypertrophic
               percent  for  a  mean  of  6.2  years.  Sixty      cardiomyopathy. Ejection fraction data were
               percent  had  mild  diastolic  dysfunction,  4.8   not available for 9019 patients, and thus the
               percent had moderate diastolic dysfunction,        main analysis was based on 41 972 patients
               and  0.4  percent  had  severe  diastolic          for whom EF data were available. Ejection
               dysfunction.  During  the  follow-up  period,      fraction     was       assessed       using
               5789 deaths occurred. Moderate and severe          echocardiography  in  33  717  (80.4%),
               (but  not  mild)  diastolic  dysfunction  were     scintigraphy   in   6899    (16.4%),    and
               independent  risk  factors  for  mortality  after   angiography  in  1356  (3.2%).  Quantitative
               adjustment  for  cardiovascular  risk  factors     EF  data  were  available  for  38  484  (92%)
               and  comorbidities  (hazard  ratio  1.58;  95%     patients  and  the  remainder  (3488,  8%)  had
               CI 1.20-1.28 and hazard ratio 1.84; 95% CI         semi-quantitative  EF  assessment:  10  347
               1.29-2.62).[10]                                    (24.7%)  patients  had  HFpEF  and  31  625
               In  the  meta-analysis  of  Global  Group  in      (75.3%)  had  HFrEF.  When  compared  with
               Chronic  Heart  Failure  (MAGGIC),  They           the HFrEF patients, those with HFpEF were
               compared  survival  in  patients  with  HFpEF      older (mean age 71 years SD 12 vs. 66 years
               with that in patients with HFrEF in a meta-        SD  12),  were  more  often  women  (50  vs.
               analysis  using  individual  patient  data.        28%),  more  often  had  a  history  of
               Preserved EF was defined as an EF ≥ 50%.           hypertension  (51  vs.  41%)  and  atrial
               The 31 studies included 41 972 patients: 10        fibrillation  (27  vs.  18%),  and  less  often
               347  with  HFPEF  and  31  625  with  HFrEF.       ischemic  etiology  (43  vs.  59%).  Patients
               Compared  with  patients  with  HFrEF,  those      with HFrEF were more commonly receiving


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