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Updated: Dec 8, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Relative contribution of risk factors/co-morbidities to heart failure pathogenesis: interaction with ejection
Grigorios Giamouzis1, Andrew Xanthopoulos1, Michail Papamichalis1
1Department of Cardiology, General University Hospital of Larissa, PO Box 1425, Larissa, 411 10, Greece.
Insights
Hypertension is a key factor in heart failure (HF) across all ejection fraction levels. Myocardial infarction (MI) and atrial fibrillation (AF) are significant contributors to HF with reduced or mid-range ejection fraction.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- The interplay of comorbidities in heart failure (HF) pathogenesis is not fully elucidated.
- Understanding the prevalence of individual comorbidities across different HF phenotypes is crucial for targeted treatment strategies.
Purpose of the Study:
- To assess the prevalence of cardiac and non-cardiac comorbidities in HF patients.
- To evaluate the association of specific comorbidities with HF, stratified by left ventricular ejection fraction (LVEF).
Main Methods:
- Prospective observational study of 1064 ambulatory chronic HF patients (Jan 2016-Jan 2019).
- Patients classified into three LVEF groups: <40%, 40-49%, and ≥50%.
- Evaluation of coexisting morbidities within each LVEF group.
Main Results:
- Hypertension was the most common comorbidity in HF with LVEF ≥50% (85.7%).
- In HF with LVEF 40-49%, hypertension (35.7%), atrial fibrillation (AF) (28.6%), and myocardial infarction (MI) (21.4%) were prevalent.
- In HF with LVEF <40%, MI (30.8%) and AF (30.8%) were most common, followed by hypertension (15.4%).
Conclusions:
- Hypertension is strongly linked to HF across all LVEF categories.
- MI and AF are significantly associated with HF characterized by low or intermediate LVEF.
Aims:
The relative impact of each individual coexisting morbidity on the pathogenesis of heart failure (HF) is incompletely understood. This study aimed to evaluate the prevalence of individual cardiac and non-cardiac coexisting morbidities both in the overall HF population and in the subgroup of HF patients with a single coexisting morbidity, stratified by left ventricular ejection fraction (LVEF) categories, as a measure of the relative contribution of each co-morbidity to the pathogenesis of HF.
Methods And Results:
This is a prospective, observational study, in which unselected ambulatory patients with chronic HF visiting the HF clinic of a tertiary university hospital from January 2016 to January 2019 were classified according to baseline LVEF into three groups: (i) LVEF < 40%, (ii) LVEF = 40-49%, and (iii) LVEF ≥ 50% and then evaluated for various coexisting morbidities. Overall, 1064 patients (age 73.4 ± 12.1 years, male gender 57.7%, LVEF 43.6 ± 13.9, N-terminal pro-brain natriuretic peptide 2187 ± 710 ng/L, and estimated glomerular filtration rate 67.2 ± 25 mL/min/1.73 m2 ) were recruited in this study. Of these, 361 (33.9%) had an LVEF < 40%, 247 (23.2%) an LVEF = 40-49%, and 456 (42.9%) an LVEF ≥ 50%. There were 90 (8.5%) HF patients with a single coexisting morbidity, 33 (36.7%) with LVEF ≥ 50%, 27 (30.0%) with LVEF = 40-49%, and 30 (33.3%) with LVEF < 40%. Among these patients, those with LVEF ≥ 50% suffered mostly from hypertension (85.7%), whereas the second most common coexisting morbidity was atrial fibrillation (AF) (9.5%). HF patients with LVEF = 40-49% usually suffered from hypertension (35.7%), AF (28.6%), or myocardial infarction (MI) (21.4%). Finally, HF patients with LVEF < 40% usually suffered from MI (30.8%), AF (30.8%), or hypertension (15.4%).
Conclusions:
Hypertension is strongly associated with the development of HF with low, intermediate, or near-normal/normal LVEF whereas a history of MI or AF with HF with a low or an intermediate LVEF.
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