Role of cardiopulmonary dysfunction and left atrial remodeling in development of acute decompensated heart failure in chronic heart failure with preserved left ventricular ejection fraction

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• 作者：Hidehiro Kaneko ; MD ; ^{h-kaneko@cvi.or.jp} ; Akira Koike ; MD ; FJCC ; Keitaro Senoo ; MD ; Shingo Tanaka ; MD ; Shinya Suzuki ; MD ; Osamu Nagayama ; MD ; Koichi Sagara ; MD ; Takayuki Otsuka ; MD ; Shunsuke Matsuno ; MD ; Ryuichi Funada ; MD ; Tokuhisa Uejima ; MD ; Yuji Oikawa ; MD ; Junji Yajima ; MD ; Kazuyuki Nagashima ; MD ; Hajime Kirigaya ; MD ; Hitoshi Sawada ; MD ; FJCC ; Tadanori Aizawa ; MD ; FJCC ; Takeshi Yamashita ; MD ; FJCC
• 关键词：Exercise test ; Oxygen consumption ; Ventilation ; Heart failure
• 刊名：Journal of Cardiology
• 出版年：2012
• 期刊代码：P90_09145087
• 类别：med
• 出版时间：May, 2012
• 卷：59
• 期：3
• 页码：359-365
• 文件大小：249 K

摘要

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Summary

Background

The presence of heart failure (HF) with preserved ejection fraction (HFPEF) is increasingly recognized. However, prognostic factors for HFPEF remain unclear.

Methods and results

The data were derived from Shinken Database 2004-2010, a prospective cohort study (n = 15,227). We examined 301 consecutive HFPEF patients (New York Heart Association Class II or greater) and tracked them for an average 3.5 years. Cardiopulmonary exercise testing (CPX), blood exams, and ultrasound cardiogram (UCG) were performed at the first medical examination. Acute decompensated HF (ADHF) admission was observed in 19 patients (6.3%). CPX showed that the anaerobic threshold was lower (7.3 卤 4.8 mL/min/kg vs. 9.7 卤 4.3 mL/min/kg, p = 0.02) and slope of the increase in ventilation to the increase in CO₂ output (VE-VCO₂ slope) was higher (40.6 卤 8.5 vs. 34.6 卤 7.9, p < 0.01) in patients with ADHF admission than those without. Serum brain natriuretic peptide (BNP) tended to be higher and left atrial (LA) dimension was significantly greater (47.0 卤 15.8 mm vs. 41.0 卤 9.9 mm, p = 0.01) in patients with ADHF admission than those without. Multivariate analysis showed that higher VE-VCO₂ slope and greater LA dimension were independent determinants of ADHF admission.

Conclusion

An aggravated CPX parameter and LA dilatation were associated with ADHF admission in patients with symptomatic HFPEF, suggesting the prognostic role of cardiopulmonary dysfunction during exercise and LA remodeling in the pathogenesis of decompensated HF development in HFPEF.