Risk factors for heart failure are associated with alterations of the LV end-diastolic pressure-volume relationship in non-heart failure individuals: data from a large-scale, population-based cohort

• Published in: European heart journal Vol. 37; no. 23; pp. 1807 - 1814
• Main Authors: Schwarzl, Michael, Ojeda, Francisco, Zeller, Tanja, Seiffert, Moritz, Becher, Peter M, Munzel, Thomas, Wild, Philipp S, Blettner, Maria, Lackner, Karl J, Pfeiffer, Norbert, Beutel, Manfred E, Blankenberg, Stefan, Westermann, Dirk
• Format: Journal Article
• Language: English
• Published: England 14.06.2016
• Subjects: Adult; Aged; Cardiac Volume - physiology; Cause of Death; Echocardiography; Female; Germany - epidemiology; Heart Failure - mortality; Heart Failure - physiopathology; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain - metabolism; Peptide Fragments - metabolism; Prognosis; Prospective Studies; Risk Factors; Stroke Volume - physiology; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Pressure - physiology; Ventricular Remodeling - physiology; Diastolic function; Heart failure; Population-based study; Risk factor; Pressure–volume relationship
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehw120

Left-ventricular (LV) remodelling impacts on the LV end-diastolic pressure-volume relationship (EDPVR), which is different in heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). In a large-scale, population-based cohort (Gutenberg Health Study), we aimed to investigate alterations of the EDPVR in HF patients and their association to risk factors and all-cause mortality in non-HF individuals. Based on clinical and echocardiographic data, participants were divided into 'No HF' (n = 14487), HFrEF (n = 215), and HFpEF (n = 79). We estimated the position of the EDPVR and its stiffness-coefficient β from echocardiographic data using a single-beat method. The EDPVR was shifted rightward in HFrEF and leftward in HFpEF compared with 'No HF', while the stiffness-coefficient β was increased in both HFrEF and HFpEF. In 'No HF', a higher stiffness-coefficient β was associated with age, female gender, hypertension, diabetes, and obesity, while age and female gender were associated with a leftward shift of the EDPVR, whereas dyslipidaemia, obesity, smoking, and impaired renal function were associated with a rightward shift of the EDPVR. Both changes of the EDPVR were associated with increased all-cause mortality. In a large-scale, population-based cohort, we show distinct alterations of the EDPVR in HFrEF and HFpEF. Already in non-HF individuals, the presence of risk factors for HF is linked alterations of the EDPVR, which are associated with increased mortality.