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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Prognostic significance of polyvascular disease in heart failure with preserved left ventricular ejection fraction

Koichiro Fujisue1, Takanori Tokitsu1, Eiichiro Yamamoto1

  • 1Department of Cardiovascular Medicine, Graduate School of Medical Sciences and Center for Metabolic Regulation of Healthy Aging (CMHA), Kumamoto University, Kumamoto, Japan.

Medicine
|July 16, 2019
PubMed

Insights

Patients with heart failure with preserved ejection fraction (HFpEF) and polyvascular disease (PVD) face significantly higher risks of cardiovascular events. Screening for PVD in HFpEF patients is crucial for better risk stratification and management.

Area of Science:

  • Cardiology
  • Atherosclerosis Research
  • Heart Failure Management

Background:

  • The prognostic impact of systemic atherothrombosis in heart failure with preserved ejection fraction (HFpEF) is not well understood.
  • Polyvascular disease (PVD), defined as the presence of two or more atherosclerotic conditions (coronary, peripheral, or cerebrovascular disease), is common in cardiovascular disease patients.

Purpose of the Study:

  • To investigate the association between PVD and adverse cardiovascular outcomes in patients diagnosed with HFpEF.
  • To determine if PVD is an independent predictor of cardiovascular events in this patient population.

Main Methods:

  • A prospective observational study involving 510 consecutive HFpEF patients.
  • PVD was defined as the coexistence of at least two conditions among coronary artery disease, peripheral arterial disease, and cerebrovascular disease.
  • Patients were followed for up to 1500 days for the occurrence of major cardiovascular events. Multivariable Cox proportional hazards models were used for analysis.

Main Results:

  • Patients with HFpEF and PVD experienced a significantly higher rate of cardiovascular events compared to those without PVD (44.0% vs 20.4%, P < .001).
  • Multivariable analysis identified PVD as a significant independent predictor of cardiovascular events in HFpEF patients (HR: 2.875, P < .001).
  • Other independent predictors included previous HF hospitalization, lower hemoglobin, lower serum sodium, higher ln-BNP, and higher E/e'.

Conclusions:

  • The presence of PVD is strongly associated with an increased risk of cardiovascular events in patients with HFpEF.
  • These findings highlight the importance of screening for PVD in HFpEF patients to identify individuals at higher risk.
  • Integrating PVD assessment into HFpEF management may improve prognostic accuracy and guide therapeutic strategies.

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