TY - JOUR
T1 - Differential interaction of clinical characteristics with key functional parameters in heart failure with preserved ejection fraction - Results of the Aldo-DHF trial
AU - Edelmann, Frank
AU - Gelbrich, Götz
AU - Duvinage, André
AU - Stahrenberg, Raoul
AU - Behrens, Anneke
AU - Prettin, Christiane
AU - Kraigher-Krainer, Elisabeth
AU - Schmidt, Albrecht G.
AU - Düngen, Hans Dirk
AU - Kamke, Wolfram
AU - Tschöpe, Carsten
AU - Herrmann-Lingen, Christoph
AU - Halle, Martin
AU - Hasenfuss, Gerd
AU - Wachter, Rolf
AU - Pieske, Burkert
PY - 2013/11/30
Y1 - 2013/11/30
N2 - Background To investigate the interaction of clinical characteristics with disease characterising parameters in heart failure with preserved ejection fraction (HFpEF). Methods and results In the multicenter, randomized, placebo-controlled, double-blinded, Aldo-DHF trial investigating the effects of spironolactone on exercise capacity (peakVO2) and diastolic function (E/e′) n = 422 patients with HFpEF (age 67 ± 8years, 52% females, LVEF 67 ± 8%) were included. After multiple adjustment, higher age was significantly related to reduced peakVO2, and to increased E/e′, NT-proBNP, LAVI as well as LVMI (all p < 0.05). Female gender (p < 0.001), CAD (p = 0.002), BMI (p < 0.001), sleep apnoea (p = 0.02), and chronotropic incompetence (CI, p = 0.002) were related to lower peakVO2 values. Higher pulse pressure (p = 0.04), lower heart rates (p = 0.03), CI (p = 0.03) and beta-blocker treatment (p = 0.001) were associated with higher E/e′. BMI correlated inversely (p = 0.03), whereas atrial fibrillation (p < 0.001), lower haemoglobin levels (p < 0.001), CI (p = 0.02), and beta-blocker treatment (p < 0.001) were associated with higher NT-proBNP. After multiple adjustment for demographic and clinical variables peakVO2 was not significantly associated with E/e′ (r = + 0.01, p = 0.87), logNT-proBNP (r = 0.09, p = 0.08), LAVI (r = + 0.03, p = 0.55), and LVMI (r = + 0.05, p = 0.37). The associations of E/e′ with logNT-proBNP (r = 0.21, p < 0.001), LAVI (r = + 0.29, p < 0.001) and LVMI (r = 0.09, p = 0.06) were detectable also after multiple adjustment. Conclusions Demographic and clinical characteristics differentially interact with exercise capacity, resting left ventricular filling index, neurohumoral activation, and left atrial and ventricular remodelling in HFpEF. Exercise intolerance in HFpEF is multi-factorial and therapeutic approaches addressing exercise capacity should therefore not only aim to improve single pathological mechanisms. Registration: ISRCTN94726526 (http://www.controlled-trials.com), Eudra-CT-number 2006-002605-31.
AB - Background To investigate the interaction of clinical characteristics with disease characterising parameters in heart failure with preserved ejection fraction (HFpEF). Methods and results In the multicenter, randomized, placebo-controlled, double-blinded, Aldo-DHF trial investigating the effects of spironolactone on exercise capacity (peakVO2) and diastolic function (E/e′) n = 422 patients with HFpEF (age 67 ± 8years, 52% females, LVEF 67 ± 8%) were included. After multiple adjustment, higher age was significantly related to reduced peakVO2, and to increased E/e′, NT-proBNP, LAVI as well as LVMI (all p < 0.05). Female gender (p < 0.001), CAD (p = 0.002), BMI (p < 0.001), sleep apnoea (p = 0.02), and chronotropic incompetence (CI, p = 0.002) were related to lower peakVO2 values. Higher pulse pressure (p = 0.04), lower heart rates (p = 0.03), CI (p = 0.03) and beta-blocker treatment (p = 0.001) were associated with higher E/e′. BMI correlated inversely (p = 0.03), whereas atrial fibrillation (p < 0.001), lower haemoglobin levels (p < 0.001), CI (p = 0.02), and beta-blocker treatment (p < 0.001) were associated with higher NT-proBNP. After multiple adjustment for demographic and clinical variables peakVO2 was not significantly associated with E/e′ (r = + 0.01, p = 0.87), logNT-proBNP (r = 0.09, p = 0.08), LAVI (r = + 0.03, p = 0.55), and LVMI (r = + 0.05, p = 0.37). The associations of E/e′ with logNT-proBNP (r = 0.21, p < 0.001), LAVI (r = + 0.29, p < 0.001) and LVMI (r = 0.09, p = 0.06) were detectable also after multiple adjustment. Conclusions Demographic and clinical characteristics differentially interact with exercise capacity, resting left ventricular filling index, neurohumoral activation, and left atrial and ventricular remodelling in HFpEF. Exercise intolerance in HFpEF is multi-factorial and therapeutic approaches addressing exercise capacity should therefore not only aim to improve single pathological mechanisms. Registration: ISRCTN94726526 (http://www.controlled-trials.com), Eudra-CT-number 2006-002605-31.
KW - Aldosterone receptor blockade
KW - Diastolic function
KW - Exercise capacity
KW - Heart failure with preserved ejection fraction
KW - Neurohumoral activation
UR - http://www.scopus.com/inward/record.url?scp=84888013739&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2013.10.018
DO - 10.1016/j.ijcard.2013.10.018
M3 - Article
C2 - 24182675
AN - SCOPUS:84888013739
SN - 0167-5273
VL - 169
SP - 408
EP - 417
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 6
ER -