Clinical Features of Heart Failure With Normal Ejection Fraction: Insights From the ASIAN-HF Registry.

Background

Heart failure and left ventricular ejection fraction in the normal range (HFnEF) (left ventricular ejection fraction [LVEF] of ≥55% for men and ≥60% for women) is understudied.

Objectives

The authors aimed to characterize patients with HFnEF compared with those with preserved (≥50%) yet below the normal LVEF.

Methods

In an Asian HF registry, clinical characteristics, echocardiographic features, and outcomes were compared across: 1) HFnEF; 2) heart failure with preserved left ventricular ejection fraction (HFpEF) (LVEF of ≥50%) and below normal LVEF; and 3) community-based controls without HF. Cluster analysis of echocardiographic parameters was performed and validated in an external cohort.

Results

Among 1,765 patients with HFpEF (age 68 ± 12 years; 50% women), 1,313 (74.4%) had HFnEF. Compared with patients with HFpEF and below normal LVEF, patients with HFnEF had less coronary artery disease (33.7% vs 27.9%), greater LV wall thickness, and higher stroke volume, but similar 2-year age-adjusted all-cause mortality (HR: 0.8; 95% CI: 0.6-1.2). Five echocardiographic clusters with similar 2-year mortality were identified: 1) normal LV (normal structure despite increased filling pressure; least comorbidities) in 25%; 2) restrictive (smallest stroke volume; predominantly elderly women) in 26%; 3) hypertrophic (most concentric hypertrophy; more men) in 25%; 4) high output (greatest stroke volume; predominantly obese younger men) in 10%; and 5) atrial dominant (most left atrial myopathy; mainly elderly women with multiple comorbidities) in 10%. Similar patterns were found in the validation cohort.

Conclusions

The majority of patients with HFpEF had normal LVEF, which consists of patients with different patterns of cardiac features and clinical characteristics. Results may carry implications for targeted treatment approaches in HFpEF.

Informations de copyright

© 2023 The Authors.

Déclaration de conflit d'intérêts

The ASIAN-HF is supported by research grants from Boston Scientific Investigator Sponsored Research Program, National Medical Research Council of Singapore (R-172-003-219-511), The ATTRaCT program (SPF2014/003, SPF2014/004, SPF2014/005), and Bayer. The PROMIS-HFpEF study was sponsored by AstraZeneca. Dr Tromp is supported by the National University of Singapore Start-up grant, the tier 1 grant from the ministry of education and the CS-IRG New Investigator Grant from the National Medical Research Council; has received consulting or speaker fees from Daiichi Sankyo, Boehringer Ingelheim, Roche diagnostics and Us2.ai, owns patent US-10702247-B2 unrelated to the present work. Dr Chandramouli has received grants from National Medical Research Council Singapore; philanthropic research grants from Lee Foundation Singapore; and consulting or speaker fees from Boehringer Ingelheim, Us2.ai, and Sanofi. Dr Anand has received consulting fees from Amgen, ARCA Pharma, AstraZeneca, Boehringer Ingelheim, Boston Scientific, LivaNova, and Novartis. Dr Lund is supported by Karolinska Institutet, the Swedish Research Council [grant 523-2014-2336], the Swedish Heart Lung Foundation [grants 20150557, 20190310], and the Stockholm County Council [grants 20170112, 20190525]; reports consultancy with AstraZeneca, Novartis, Bayer, Vifor Pharma, Sanofi, Lexicon, Myokardia, Pharmacosmos, Merck/MSD, Respicardia, Medscape; lecture fees from AstraZeneca, Novartis, Vifor Pharma, Bayer, Orion Pharma, Abbott, Medscape, Radcliffe Cardiology, research grants from AstraZeneca, Novartis, Boehringer Ingelheim, Boston Scientific, Vifor Pharma, Pharmacosmos, and stock ownership in AnaCardio. Dr Richards has received research support from Boston Scientific, Bayer, AstraZeneca, Medtronic, Roche Diagnostics, Abbott Laboratories, Thermo Fisher, and Critical Diagnostics; and has consulted for Bayer, Novartis, Merck, AstraZeneca, and Roche Diagnostics. Dr Shah has received grants from the U.S. National Institutes of Health (U54 HL160273, R01 HL107577, R01 HL127028, R01 HL140731, R01 HL149423), Actelion, AstraZeneca, Corvia, Novartis, and Pfizer; and consulting fees from Abbott, Actelion, AstraZeneca, Amgen, Aria CV, Axon Therapies, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardiora, Coridea, CVRx, Cyclerion, Cytokinetics, Edwards Lifesciences, Eidos, Eisai, Imara, Impulse Dynamics, Intellia, Ionis, Ironwood, Lilly, Merck, MyoKardia, Novartis, Novo Nordisk, Pfizer, Prothena, Regeneron, Rivus, Sanofi, Shifamed, Tenax, Tenaya, and United Therapeutics. Dr Lam is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from AstraZeneca, Bayer, Boston Scientific, and Roche Diagnostics; has served as consultant or on the Advisory Board/Steering Committee/ Executive Committee for Actelion, Amgen, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Cytokinetics, Darma Inc., Us2.ai, Janssen Research & Development LLC, Medscape, Merck, Novartis, Novo Nordisk, Radcliffe Group Ltd., Roche Diagnostics, Sanofi, and WebMD Global LLC; and serves as co-founder & non-executive director of Us2.ai. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.