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Autoimmune Disorders in Heart Failure With Preserved Ejection Fraction
Atsushi Tada1, Shunichi Doi1, Tomonari Harada1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JACC. Heart Failure
|May 31, 2024
Summary
Heart failure with preserved ejection fraction (HFpEF) patients with autoimmune disorders show impaired oxygen transport and a doubled risk of death or hospitalization. This highlights the impact of systemic inflammation on HFpEF outcomes.
Area of Science:
- Cardiology
- Immunology
- Internal Medicine
Background:
- Inflammation is key in heart failure with preserved ejection fraction (HFpEF) pathogenesis.
- HFpEF can stem from cardiometabolic issues or systemic inflammatory diseases like rheumatoid arthritis or lupus.
Purpose of the Study:
- To determine the prevalence, pathophysiology, and outcomes of HFpEF patients with autoimmune or primary inflammatory disorders.
- To compare HFpEF patients with and without autoimmune conditions.
Main Methods:
- Invasive cardiopulmonary hemodynamic exercise testing defined HFpEF.
- 8.0% (79/982) of HFpEF patients had autoimmune disorders.
Main Results:
- Autoimmune HFpEF patients exhibited lower peripheral oxygen extraction and impaired ventilatory efficiency (VE/VCO2 slope).
- These patients had a higher risk of death or heart failure hospitalization (HR: 1.95) over 3 years, mainly due to HF hospitalizations (HR: 2.87).
Conclusions:
- HFpEF patients with autoimmune disorders share hemodynamic issues but have greater peripheral oxygen transport deficits.
- Autoimmune disorders are linked to worse outcomes in HFpEF, emphasizing the need for integrated care.
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