Congestive heart failure despite normal left ventricular systolic function in a population-based sample: the Strong...

Area of Science:

• Cardiology
• Echocardiography
• Heart Failure Research

Background:

• Over 50% of congestive heart failure (CHF) patients in clinical settings lack left ventricular (LV) systolic dysfunction.
• The prevalence of CHF with preserved ejection fraction (HFpEF) in general populations is not well understood.

Purpose of the Study:

• To investigate the characteristics of CHF patients with normal LV ejection fraction (EF) in a population-based sample.
• To compare the clinical and echocardiographic features of CHF with normal EF versus CHF with reduced EF.

Main Methods:

• Utilized clinical examination and echocardiography in the Strong Heart Study (3,184 participants).
• Identified 95 participants with CHF, categorizing them by LV EF: normal (>54%), mildly reduced (40-54%), and severely reduced (<40%).
• Compared participants with CHF to those without CHF, analyzing creatinine, diabetes, hypertension, and echocardiographic parameters.

Main Results:

• CHF patients, regardless of EF, exhibited higher creatinine, diabetes, and hypertension rates than controls.
• CHF with normal EF was associated with prolonged deceleration time, reduced E/A, higher LV mass, and increased relative wall thickness.
• CHF with normal EF disproportionately affected older women who were overweight, presenting with renal dysfunction, impaired diastolic relaxation, and concentric LV geometry.

Conclusions:

• In population samples, CHF with normal LV EF is characterized by specific demographic and clinical profiles, including older age, female sex, obesity, and diastolic dysfunction.
• CHF with severely reduced EF was more common in men and associated with a restrictive filling pattern and eccentric LV hypertrophy.