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Implications of coronary artery disease in heart failure with preserved ejection fraction

Seok-Jae Hwang1, Vojtech Melenovsky2, Barry A Borlaug3

  • 1Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota; Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.

Journal of the American College of Cardiology
|April 29, 2014
PubMed

Insights

Coronary artery disease (CAD) is prevalent in heart failure with preserved ejection fraction (HFpEF) and linked to worse outcomes. Revascularization in these patients may improve cardiac function and survival, warranting further research.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Heart Failure Research

Background:

  • Coronary artery disease (CAD) is frequently observed in patients with heart failure with preserved ejection fraction (HFpEF).
  • Optimal strategies for CAD evaluation and management in HFpEF remain undefined.

Purpose of the Study:

  • To investigate the characteristics of CAD in HFpEF patients.
  • To evaluate the prognostic impact of CAD on HFpEF outcomes.
  • To examine the role of revascularization in managing CAD in HFpEF.

Main Methods:

  • Analysis of clinical, hemodynamic, echocardiographic, treatment, and outcome data.
  • Coronary angiography performed on consecutive HFpEF patients with prior hospitalizations.
  • Comparison of outcomes between HFpEF patients with and without CAD, and with different revascularization strategies.

Main Results:

  • 68% of HFpEF patients had angiographically-proven CAD.
  • CAD patients exhibited greater ejection fraction deterioration and increased mortality (HR 1.71).
  • Complete revascularization was associated with preserved ejection fraction and lower mortality (HR 0.56).

Conclusions:

  • CAD is common in HFpEF and associated with adverse outcomes.
  • Revascularization may improve cardiac function and survival in these patients.
  • Prospective trials are essential to establish optimal CAD management in HFpEF.
Abstract

Keywords:
coronary artery diseasediastolic heart failureheart failureheart failure with preserved ejection fractionrevascularization

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