PMID- 27386773
OWN - NLM
STAT- MEDLINE
DCOM- 20170630
LR  - 20201216
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 68
IP  - 2
DP  - 2016 Jul 12
TI  - Functional Status, Pulmonary Artery Pressure, and Clinical Outcomes in Heart 
      Failure With Preserved Ejection Fraction.
PG  - 189-99
LID - S0735-1097(16)33084-4 [pii]
LID - 10.1016/j.jacc.2016.04.052 [doi]
AB  - BACKGROUND: Patients with heart failure with preserved ejection fraction have 
      functional impairment resulting in reduced quality of life. Specific pathological 
      mechanisms underlying symptoms have not yet been defined. OBJECTIVES: The aim of 
      this study was to identify hemodynamic and other patient-related variables that 
      are associated with New York Heart Association (NYHA) functional class and to 
      analyze functional class in perspective with other clinical, laboratory, imaging, 
      and hemodynamic parameters with respect to its influence on outcomes. METHODS: 
      Between January 2011 and February 2015, 193 patients with confirmed heart failure 
      with preserved ejection fraction were enrolled. RESULTS: Those in more advanced 
      NYHA functional classes (III and IV; n = 136) were older (p = 0.008), had higher 
      body mass indexes (p = 0.004), and had higher levels of N-terminal pro-brain 
      natriuretic peptide (p = 0.001) compared with less symptomatic patients (NYHA 
      class II; n = 57). Furthermore, parameters reflecting left ventricular diastolic 
      dysfunction were more pronounced in advanced NYHA classes (early mitral inflow 
      velocity/early diastolic mitral annular velocity; p = 0.023) as well as 
      parameters reflecting right ventricular afterload (diastolic pulmonary artery 
      pressure; p < 0.001). By multivariate regression analysis, age (p = 0.007), body 
      mass index (p = 0.002), N-terminal pro-brain natriuretic peptide (p < 0.001), 
      early mitral inflow velocity/mitral peak velocity of late filling (p = 0.031), 
      and diastolic pulmonary artery pressure (p < 0.001) were independently associated 
      with advanced NYHA class. After 21.9 months of follow-up, 64 patients (33.2%) 
      reached the combined endpoint, defined as hospitalization for heart failure 
      and/or cardiac death. By multivariate Cox analysis, NYHA functional class was 
      independently associated with outcome (hazard ratio: 2.133; p = 0.040), as well 
      as N-terminal pro-brain natriuretic peptide (hazard ratio: 1.655; p < 0.001) and 
      impaired right ventricular function (hazard ratio: 2.360; p = 0.001). 
      CONCLUSIONS: Symptoms of breathlessness in patients with heart failure with 
      preserved ejection fraction are multifactorial and largely related to body mass 
      index, left ventricular diastolic function, and the pulmonary vasculature. 
      Clinically meaningful therapeutic interventions should target body weight, left 
      ventricular stiffness, and concomitant pulmonary vascular disease.
CI  - Copyright (c) 2016 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Dalos, Daniel
AU  - Dalos D
AD  - Division of Cardiology, Department of Internal Medicine II, Medical University of 
      Vienna, Vienna, Austria.
FAU - Mascherbauer, Julia
AU  - Mascherbauer J
AD  - Division of Cardiology, Department of Internal Medicine II, Medical University of 
      Vienna, Vienna, Austria.
FAU - Zotter-Tufaro, Caroline
AU  - Zotter-Tufaro C
AD  - Division of Cardiology, Department of Internal Medicine II, Medical University of 
      Vienna, Vienna, Austria.
FAU - Duca, Franz
AU  - Duca F
AD  - Division of Cardiology, Department of Internal Medicine II, Medical University of 
      Vienna, Vienna, Austria.
FAU - Kammerlander, Andreas A
AU  - Kammerlander AA
AD  - Division of Cardiology, Department of Internal Medicine II, Medical University of 
      Vienna, Vienna, Austria.
FAU - Aschauer, Stefan
AU  - Aschauer S
AD  - Division of Cardiology, Department of Internal Medicine II, Medical University of 
      Vienna, Vienna, Austria.
FAU - Bonderman, Diana
AU  - Bonderman D
AD  - Division of Cardiology, Department of Internal Medicine II, Medical University of 
      Vienna, Vienna, Austria. Electronic address: diana.bonderman@meduniwien.ac.at.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2016 Jul 12;68(2):200-3. PMID: 27386774
MH  - Aged
MH  - Blood Flow Velocity
MH  - Blood Pressure/*physiology
MH  - Cardiac Catheterization
MH  - Diastole
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/diagnosis/*physiopathology
MH  - Heart Ventricles/diagnostic imaging/*physiopathology
MH  - Humans
MH  - Male
MH  - Prognosis
MH  - Prospective Studies
MH  - Pulmonary Artery/diagnostic imaging/*physiopathology
MH  - *Quality of Life
MH  - Stroke Volume/*physiology
MH  - Time Factors
MH  - Ventricular Function, Left/*physiology
OTO - NOTNLM
OT  - functional capacity
OT  - heart failure
OT  - outcome
EDAT- 2016/07/09 06:00
MHDA- 2017/07/01 06:00
CRDT- 2016/07/09 06:00
PHST- 2016/03/10 00:00 [received]
PHST- 2016/04/12 00:00 [accepted]
PHST- 2016/07/09 06:00 [entrez]
PHST- 2016/07/09 06:00 [pubmed]
PHST- 2017/07/01 06:00 [medline]
AID - S0735-1097(16)33084-4 [pii]
AID - 10.1016/j.jacc.2016.04.052 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2016 Jul 12;68(2):189-99. doi: 10.1016/j.jacc.2016.04.052.