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Differential interaction of clinical characteristics with key functional parameters in heart failure with preserved ejection fraction--results of the Aldo-DHF trial.
Int J Cardiol. 2013 Nov 30; 169(6):408-17.IJ

Abstract

BACKGROUND

To investigate the interaction of clinical characteristics with disease characterising parameters in heart failure with preserved ejection fraction (HFpEF). Methods and results In the multicenter, randomized, placebo-controlled, double-blinded, Aldo-DHF trial investigating the effects of spironolactone on exercise capacity (peakVO2) and diastolic function (E/e') n=422 patients with HFpEF (age 67 ± 8 years, 52% females, LVEF 67 ± 8%) were included. After multiple adjustment, higher age was significantly related to reduced peakVO2, and to increased E/e', NT-proBNP, LAVI as well as LVMI (all p<0.05). Female gender (p<0.001), CAD (p=0.002), BMI (p<0.001), sleep apnoea (p=0.02), and chronotropic incompetence (CI, p=0.002) were related to lower peakVO2 values. Higher pulse pressure (p=0.04), lower heart rates (p=0.03), CI (p=0.03) and beta-blocker treatment (p=0.001) were associated with higher E/e'. BMI correlated inversely (p=0.03), whereas atrial fibrillation (p<0.001), lower haemoglobin levels (p<0.001), CI (p=0.02), and beta-blocker treatment (p<0.001) were associated with higher NT-proBNP. After multiple adjustment for demographic and clinical variables peakVO2 was not significantly associated with E/e' (r=+0.01, p=0.87), logNT-proBNP (r=0.09, p=0.08), LAVI (r=+0.03, p=0.55), and LVMI (r=+0.05, p=0.37). The associations of E/e' with logNT-proBNP (r=0.21, p<0.001), LAVI (r=+0.29, p<0.001) and LVMI (r=0.09, p=0.06) were detectable also after multiple adjustment.

CONCLUSIONS

Demographic and clinical characteristics differentially interact with exercise capacity, resting left ventricular filling index, neurohumoral activation, and left atrial and ventricular remodelling in HFpEF. Exercise intolerance in HFpEF is multi-factorial and therapeutic approaches addressing exercise capacity should therefore not only aim to improve single pathological mechanisms.

REGISTRATION

ISRCTN94726526 (http://www.controlled-trials.com), Eudra-CT-number 2006-002605-31.

Authors+Show Affiliations

Department of Cardiology and Pneumology, University of Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany; German Center for Cardiovascular Research, Germany. Electronic address: fedelmann@med.uni-goettingen.de.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

Language

eng

PubMed ID

24182675

Citation

Edelmann, Frank, et al. "Differential Interaction of Clinical Characteristics With Key Functional Parameters in Heart Failure With Preserved Ejection Fraction--results of the Aldo-DHF Trial." International Journal of Cardiology, vol. 169, no. 6, 2013, pp. 408-17.
Edelmann F, Gelbrich G, Duvinage A, et al. Differential interaction of clinical characteristics with key functional parameters in heart failure with preserved ejection fraction--results of the Aldo-DHF trial. Int J Cardiol. 2013;169(6):408-17.
Edelmann, F., Gelbrich, G., Duvinage, A., Stahrenberg, R., Behrens, A., Prettin, C., Kraigher-Krainer, E., Schmidt, A. G., Düngen, H. D., Kamke, W., Tschöpe, C., Herrmann-Lingen, C., Halle, M., Hasenfuss, G., Wachter, R., & Pieske, B. (2013). Differential interaction of clinical characteristics with key functional parameters in heart failure with preserved ejection fraction--results of the Aldo-DHF trial. International Journal of Cardiology, 169(6), 408-17. https://doi.org/10.1016/j.ijcard.2013.10.018
Edelmann F, et al. Differential Interaction of Clinical Characteristics With Key Functional Parameters in Heart Failure With Preserved Ejection Fraction--results of the Aldo-DHF Trial. Int J Cardiol. 2013 Nov 30;169(6):408-17. PubMed PMID: 24182675.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential interaction of clinical characteristics with key functional parameters in heart failure with preserved ejection fraction--results of the Aldo-DHF trial. AU - Edelmann,Frank, AU - Gelbrich,Götz, AU - Duvinage,André, AU - Stahrenberg,Raoul, AU - Behrens,Anneke, AU - Prettin,Christiane, AU - Kraigher-Krainer,Elisabeth, AU - Schmidt,Albrecht G, AU - Düngen,Hans-Dirk, AU - Kamke,Wolfram, AU - Tschöpe,Carsten, AU - Herrmann-Lingen,Christoph, AU - Halle,Martin, AU - Hasenfuss,Gerd, AU - Wachter,Rolf, AU - Pieske,Burkert, Y1 - 2013/10/11/ PY - 2013/07/22/received PY - 2013/10/05/accepted PY - 2013/11/5/entrez PY - 2013/11/5/pubmed PY - 2014/8/13/medline KW - Aldosterone receptor blockade KW - Diastolic function KW - Exercise capacity KW - Heart failure with preserved ejection fraction KW - Neurohumoral activation SP - 408 EP - 17 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 169 IS - 6 N2 - BACKGROUND: To investigate the interaction of clinical characteristics with disease characterising parameters in heart failure with preserved ejection fraction (HFpEF). Methods and results In the multicenter, randomized, placebo-controlled, double-blinded, Aldo-DHF trial investigating the effects of spironolactone on exercise capacity (peakVO2) and diastolic function (E/e') n=422 patients with HFpEF (age 67 ± 8 years, 52% females, LVEF 67 ± 8%) were included. After multiple adjustment, higher age was significantly related to reduced peakVO2, and to increased E/e', NT-proBNP, LAVI as well as LVMI (all p<0.05). Female gender (p<0.001), CAD (p=0.002), BMI (p<0.001), sleep apnoea (p=0.02), and chronotropic incompetence (CI, p=0.002) were related to lower peakVO2 values. Higher pulse pressure (p=0.04), lower heart rates (p=0.03), CI (p=0.03) and beta-blocker treatment (p=0.001) were associated with higher E/e'. BMI correlated inversely (p=0.03), whereas atrial fibrillation (p<0.001), lower haemoglobin levels (p<0.001), CI (p=0.02), and beta-blocker treatment (p<0.001) were associated with higher NT-proBNP. After multiple adjustment for demographic and clinical variables peakVO2 was not significantly associated with E/e' (r=+0.01, p=0.87), logNT-proBNP (r=0.09, p=0.08), LAVI (r=+0.03, p=0.55), and LVMI (r=+0.05, p=0.37). The associations of E/e' with logNT-proBNP (r=0.21, p<0.001), LAVI (r=+0.29, p<0.001) and LVMI (r=0.09, p=0.06) were detectable also after multiple adjustment. CONCLUSIONS: Demographic and clinical characteristics differentially interact with exercise capacity, resting left ventricular filling index, neurohumoral activation, and left atrial and ventricular remodelling in HFpEF. Exercise intolerance in HFpEF is multi-factorial and therapeutic approaches addressing exercise capacity should therefore not only aim to improve single pathological mechanisms. REGISTRATION: ISRCTN94726526 (http://www.controlled-trials.com), Eudra-CT-number 2006-002605-31. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/24182675/Differential_interaction_of_clinical_characteristics_with_key_functional_parameters_in_heart_failure_with_preserved_ejection_fraction__results_of_the_Aldo_DHF_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(13)01832-9 DB - PRIME DP - Unbound Medicine ER -