Tags

Type your tag names separated by a space and hit enter

Diastolic dysfunction in heart failure with preserved systolic function: need for objective evidence:results from the CHARM Echocardiographic Substudy-CHARMES.
J Am Coll Cardiol 2007; 49(6):687-94JACC

Abstract

OBJECTIVES

We tested the hypothesis that diastolic dysfunction (DD) was an important predictor of cardiovascular (CV) death or heart failure (HF) hospitalization in a subset of patients (ejection fraction [EF] >40%) in the CHARM-Preserved study.

BACKGROUND

More than 40% of hospitalized patients with HF have preserved systolic function (HF-PSF), suggesting that DD may be responsible for the clinical manifestations of HF.

METHODS

Patients underwent Doppler echocardiographic examination that included assessment of pulmonary venous flow or determination of plasma NT-pro-brain natriuretic peptide > or months after randomization to candesartan or placebo. The patients were classified into 1 of 4 diastolic function groups: normal, relaxation abnormality (mild dysfunction), pseudonormal (moderate dysfunction), and restrictive (severe dysfunction).

RESULTS

There were 312 patients in the study, mean age was 66 +/- 11 years, EF was 50 +/- 10%, and 34% were women. The median follow-up was 18.7 months. Diastolic dysfunction was found in 67% of classified patients (n = 293), and moderate and severe DD were identified in 44%. Moderate and severe DD had a poor outcome compared with normal and mild DD (18% vs. 5%, p < 0.01). Diastolic dysfunction, age, diabetes, previous HF, and atrial fibrillation were univariate predictors of outcome. In multivariate analysis, moderate (hazard ratio [HR] 3.7, 95% confidence interval [CI] 1.2 to 11.1) and severe DD (HR 5.7, 95% CI 1.4 to 24.0) remained the only independent predictors (p = 0.003).

CONCLUSIONS

Objective evidence of DD was found in two-thirds of HF-PSF patients. Moderate and severe DD, which were found in less than one-half of the patients, were important predictors of adverse outcome. The results demonstrate the prognostic significance and need for objective evidence of DD in HF-PSF patients.

Authors+Show Affiliations

Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital Department of Cardiology, Stockholm, Sweden. hans.persson@ds.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17291934

Citation

Persson, Hans, et al. "Diastolic Dysfunction in Heart Failure With Preserved Systolic Function: Need for Objective Evidence:results From the CHARM Echocardiographic Substudy-CHARMES." Journal of the American College of Cardiology, vol. 49, no. 6, 2007, pp. 687-94.
Persson H, Lonn E, Edner M, et al. Diastolic dysfunction in heart failure with preserved systolic function: need for objective evidence:results from the CHARM Echocardiographic Substudy-CHARMES. J Am Coll Cardiol. 2007;49(6):687-94.
Persson, H., Lonn, E., Edner, M., Baruch, L., Lang, C. C., Morton, J. J., ... McKelvie, R. S. (2007). Diastolic dysfunction in heart failure with preserved systolic function: need for objective evidence:results from the CHARM Echocardiographic Substudy-CHARMES. Journal of the American College of Cardiology, 49(6), pp. 687-94.
Persson H, et al. Diastolic Dysfunction in Heart Failure With Preserved Systolic Function: Need for Objective Evidence:results From the CHARM Echocardiographic Substudy-CHARMES. J Am Coll Cardiol. 2007 Feb 13;49(6):687-94. PubMed PMID: 17291934.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diastolic dysfunction in heart failure with preserved systolic function: need for objective evidence:results from the CHARM Echocardiographic Substudy-CHARMES. AU - Persson,Hans, AU - Lonn,Eva, AU - Edner,Magnus, AU - Baruch,Lawrence, AU - Lang,Chim C, AU - Morton,John J, AU - Ostergren,Jan, AU - McKelvie,Robert S, AU - ,, Y1 - 2007/01/26/ PY - 2006/07/07/received PY - 2006/08/08/revised PY - 2006/08/30/accepted PY - 2007/2/13/pubmed PY - 2007/2/28/medline PY - 2007/2/13/entrez SP - 687 EP - 94 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 49 IS - 6 N2 - OBJECTIVES: We tested the hypothesis that diastolic dysfunction (DD) was an important predictor of cardiovascular (CV) death or heart failure (HF) hospitalization in a subset of patients (ejection fraction [EF] >40%) in the CHARM-Preserved study. BACKGROUND: More than 40% of hospitalized patients with HF have preserved systolic function (HF-PSF), suggesting that DD may be responsible for the clinical manifestations of HF. METHODS: Patients underwent Doppler echocardiographic examination that included assessment of pulmonary venous flow or determination of plasma NT-pro-brain natriuretic peptide > or months after randomization to candesartan or placebo. The patients were classified into 1 of 4 diastolic function groups: normal, relaxation abnormality (mild dysfunction), pseudonormal (moderate dysfunction), and restrictive (severe dysfunction). RESULTS: There were 312 patients in the study, mean age was 66 +/- 11 years, EF was 50 +/- 10%, and 34% were women. The median follow-up was 18.7 months. Diastolic dysfunction was found in 67% of classified patients (n = 293), and moderate and severe DD were identified in 44%. Moderate and severe DD had a poor outcome compared with normal and mild DD (18% vs. 5%, p < 0.01). Diastolic dysfunction, age, diabetes, previous HF, and atrial fibrillation were univariate predictors of outcome. In multivariate analysis, moderate (hazard ratio [HR] 3.7, 95% confidence interval [CI] 1.2 to 11.1) and severe DD (HR 5.7, 95% CI 1.4 to 24.0) remained the only independent predictors (p = 0.003). CONCLUSIONS: Objective evidence of DD was found in two-thirds of HF-PSF patients. Moderate and severe DD, which were found in less than one-half of the patients, were important predictors of adverse outcome. The results demonstrate the prognostic significance and need for objective evidence of DD in HF-PSF patients. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/17291934/Diastolic_dysfunction_in_heart_failure_with_preserved_systolic_function:_need_for_objective_evidence:results_from_the_CHARM_Echocardiographic_Substudy_CHARMES_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(06)02891-9 DB - PRIME DP - Unbound Medicine ER -