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Hospitalizations due to unstable angina pectoris in diastolic and systolic heart failure

Ali Ahmed1, Michael R Zile, Michael W Rich

  • 1University of Alabama at Birmingham, Alabama, USA. aahmed@uab.edu

The American Journal of Cardiology
|February 13, 2007
PubMed

Insights

Patients with diastolic heart failure (HF) face a higher risk of unstable angina pectoris (UAP) hospitalizations compared to those with systolic HF. Higher left ventricular ejection fraction (LVEF) levels correlate with increased UAP risk, necessitating routine ischemia evaluation.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Ischemic Heart Disease

Background:

  • Diastolic heart failure (HF), characterized by preserved left ventricular ejection fraction (LVEF), can present with symptoms of unstable angina pectoris (UAP).
  • The risk of UAP in ambulatory patients with diastolic HF remains understudied, despite potential links to coronary artery disease or subendocardial ischemia.

Purpose of the Study:

  • To investigate the incidence of UAP hospitalizations in ambulatory patients with diastolic HF compared to those with systolic HF.
  • To examine the association between varying levels of LVEF and the risk of UAP hospitalizations in patients with chronic HF.

Main Methods:

  • Analysis of data from the Digitalis Investigation Group trial, including 916 patients with diastolic HF (LVEF >45%) and 6,800 patients with systolic HF (LVEF ≤45%).
  • Median follow-up of 38 months to track incident hospitalizations for UAP.
  • Statistical analysis using adjusted hazard ratios to compare UAP risk between diastolic and systolic HF groups and across different LVEF strata.

Main Results:

  • Patients with diastolic HF had a higher incidence rate of UAP hospitalizations (536 per 10,000 person-years) compared to systolic HF (435 per 10,000 person-years), with an adjusted hazard ratio of 1.22 (p=0.032).
  • A graded increase in UAP hospitalizations was observed with increasing LVEF: 11% (<35%), 14% (35%-55%), and 17% (>55%).
  • Compared to LVEF <35%, adjusted hazard ratios for UAP hospitalization were 1.17 (35%-55% LVEF) and 1.57 (>55% LVEF).

Conclusions:

  • Ambulatory patients with chronic HF and higher LVEF exhibit an increased risk of hospitalizations due to UAP.
  • Diastolic HF patients, similar to systolic HF patients, require routine evaluation for myocardial ischemia and appropriate management.

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