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July 2017 - Daniel Dalos

MedUni Vienna RESEARCHER OF THE MONTH, July 2017

Functional Status, Pulmonary Artery Pressure and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction - Journal of the American College of Cardiology (IF 17.759) [1]

Background. Patients with heart failure and preserved ejection fraction (HFpEF) have functional impairment resulting in reduced quality of life. Specific pathological mechanisms underlying symptoms have not yet been defined.

Methods and Results. Between January 2011 and February 2015, 193 patients with confirmed HFpEF were enrolled. Those in more advanced New York Heart Association (NYHA) functional classes (III/IV, n=136) were older (p=0.008), had higher body mass indexes (BMI, p=0.004) and higher levels of NT-pro-brain natriuretic peptide (NT-proBNP, p=0.001) compared with less symptomatic patients (NYHA II, n=57). Furthermore, parameters reflecting left ventricular (LV) 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 (RV) afterload (diastolic pulmonary artery pressure (dPAP), p<0.001). By multivariable regression analysis, age (p=0.007), BMI (p=0.002), NT-proBNP (p<0.001) as well as early mitral inflow velocity/ mitral peak velocity of late filling (p=0.031) and dPAP (p<0.001) were independently associated with advanced NYHA class.

After 21.9 ± 13.1 months of follow-up, 64 patients (33.2%) reached the combined endpoint defined as hospitalization due to HF and/ or cardiac death. By multivariate Cox analysis NYHA functional class was independently associated with outcome (HR 2.133, p=0.040) as well as NT-proBNP (HR 1.655, p<0.001) and impaired RV function (HR 2.360, p=0.001).

Conclusion. Symptoms of breathlessness in patients with HFpEF are multi-factorial and largely related to BMI, diastolic dysfunction, and the pulmonary vasculature. Clinically meaningful therapeutic interventions should target body weight, LV stiffness, and concomitant pulmonary vascular disease.

Selected literature

1. Dalos D, Mascherbauer J, Zotter-Tufaro C, Duca F, Kammerlander AA, Aschauer S, Bonderman D. Functional Status, Pulmonary Artery Pressure, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. 2016;68:189-199. [IF 17.759]

2. Lip GY, Laroche C, Popescu MI, et al. Heart failure in patients with atrial fibrillation in Europe: a report from the EURObservational Research Programme Pilot Survey on Atrial Fibrillation. Eur J Heart Fail. 2015;17:570–582. [IF 5.135]

3. Haykowsky MJ, Kouba EJ, Brubaker PH, et al. Skeletal muscle composition and its relation to exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Cardiol. 2014;113:1211–1216. [IF 3.154]

4.  Civitarese AE, Carling S, Heilbronn LK, et al. Calorie restriction increases muscle mitochondrial biogenesis in healthy humans. PLoS Med. 2007;4: e76. [IF 13.585]

5.  Paulus J, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013; 62:263–271. [IF 17.759]

6.  Duca F, Zotter-Tufaro C, Kammerlander AA, Panzenböck A, Aschauer S, Dalos D, Köll B, Börries B, Agis H, Kain R, Aumayr K, Klinglmüller F, Mascherbauer J, Bonderman D. Cardiac extracellular matrix is associated with adverse outcome in patients with chronic heart failure. Eur J Heart Fail. 2017;19:502-5011. [IF 5.135]

7.  Köll B, Zotter-Tufaro C, Duca F, Kammerlander AA, Aschauer S, Dalos D, Antlanger M, Hecking M, Säemann M, Mascherbauer J, Bonderman D. Fluid status and outcome in patients with heart failure and preserved ejection fraction. Int J Cardiol. 2017;230:476-481. [IF 4.638]

8. Zotter-Tufaro C, Duca F, Kammerlander AA, Koell B, Aschauer S, Dalos D, Mascherbauer J, Bonderman D. Diastolic Pressure Gradient Predicts Outcome in Patients With Heart Failure and Preserved Ejection Fraction. J Am Coll Cardiol. 2015;66:1308-1310. [IF 17.759]

9. Dalos D, Gangl C, Roth C, Krenn L, Scherzer S, Vertesich M, Lang I, Maurer G, Neunteufl T, Berger R, Delle-Karth G. Mechanical properties of the everolimus-eluting bioresorbable vascular scaffold compared to the metallic everolimus-eluting stent. BMC Cardiovasc Disord. 2016;16:104-111. [IF 1.916]

10. Roth C, Gangl C, Dalos D, Krenn L, Scherzer S, Gerken A, Reinwein M, Zhang C, Hagmann M, Wrba T, Delle-Karth G, Neunteufl T, Maurer G, Vock P, Mayr H, Frey B, Berger R. Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease - An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy. PLoS One. 2016;11(4):e0154025. [IF 3.057]

Dr. Daniel Dalos

Universitätsklinik für Innere Medizin II
Abteilung für Kardiologie

Medizinische Universität Wien

Währinger Gürtel 18-20
1090 Wien

T: +43 (0)1 40400-46140
F: +43 (0)1 40400-42160