Implications of coronary artery disease in heart failure with preserved ejection fraction
Language English Country United States Media print-electronic
Document type Journal Article
PubMed
24768876
DOI
10.1016/j.jacc.2014.03.034
PII: S0735-1097(14)02000-2
Knihovny.cz E-resources
- Keywords
- coronary artery disease, diastolic heart failure, heart failure, heart failure with preserved ejection fraction, revascularization,
- MeSH
- Time Factors MeSH
- Echocardiography MeSH
- Ventricular Function, Left physiology MeSH
- Coronary Angiography MeSH
- Humans MeSH
- Survival Rate trends MeSH
- Follow-Up Studies MeSH
- Coronary Artery Disease complications diagnostic imaging surgery MeSH
- Prognosis MeSH
- Retrospective Studies MeSH
- Myocardial Revascularization methods MeSH
- Aged MeSH
- Heart Failure complications diagnosis mortality MeSH
- Stroke Volume * MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Minnesota epidemiology MeSH
OBJECTIVES: This study investigated the characteristics, evaluation, prognostic impact, and treatment of coronary artery disease (CAD) in patients with heart failure and preserved ejection fraction (HFpEF). BACKGROUND: CAD is common in patients with HFpEF, but it remains unclear how CAD should be categorized, evaluated for, and treated in HFpEF. METHODS: Clinical, hemodynamic, echocardiographic, treatment, and outcome characteristics were examined in consecutive patients with previous HFpEF hospitalizations who underwent coronary angiography. RESULTS: Of the 376 HFpEF patients examined, 255 (68%) had angiographically-proven CAD. Compared with HFpEF patients without CAD, patients with CAD were more likely to be men, to have CAD risk factors, and to be treated with anti-ischemic medications. However, symptoms of angina and heart failure were similar in patients with and without CAD, as were measures of cardiovascular structure, function, and hemodynamics. Compared with patients without CAD, HFpEF patients with CAD displayed greater deterioration in ejection fraction and increased mortality, independent of other predictors (hazard ratio: 1.71, 95% confidence interval: 1.03 to 2.98; p = 0.04). Complete revascularization was associated with less deterioration in ejection fraction and lower mortality compared with patients who were not completely revascularized, independent of other predictors (hazard ratio: 0.56, 95% confidence interval: 0.33 to 0.93; p = 0.03). CONCLUSIONS: CAD is common in patients with HFpEF and is associated with increased mortality and greater deterioration in ventricular function. Revascularization may be associated with preservation of cardiac function and improved outcomes in patients with CAD. Given the paucity of effective treatments for HFpEF, prospective trials are urgently needed to determine the optimal evaluation and management of CAD in HFpEF.
Division of Cardiovascular Diseases Department of Medicine Mayo Clinic Rochester Rochester Minnesota
References provided by Crossref.org
Myocardial Injury and Cardiac Reserve in Patients With Heart Failure and Preserved Ejection Fraction
