jsmc-10155

ePREVALENCE OF ISCHEMIC HEART DISEASE IN HEART FAILURE WITH PRESERVED EJECTION FRACTION

Amanj Abubakr Khaznadar a and Didar Rzgar Aziz b

a Department of Medicine, College of Medicine, University of Sulaimani.

b Kurdistan Board Candidate, Shahid HemnTeaching Hospital for Medical Diseases.

Submitted: 19/2/2018; Accepted: 15/5/2018; Published 1/8/2018

DOI Link: https://doi.org/10.17656/jsmc.10155

ABSTRACT

Background

The pathogenesis and prevalence of ischemic heart disease (IHD) in heart failure (HF) with reduced ejection fraction (HFrEF; EF <50%) is well established, but its prevalence and pathogenesis significance in HF with preserved ejection fraction (HFpEF; EF ≥50%) has been much less explored.

Objectives

To identify prevalence of IHD in HFpEF and to correlate the effect of clinical data and diagnostic tools in HFpEF

Methods

This cross sectional study was carried out in Sulaimani Cardiac Center and Shar Teaching Hospital from April 2017 to January 2018. 104 patients of heart failure whom showed ejection fraction above 50% when evaluated by echocardiography were further evaluated for ischemic heart disease by CT coronary angiography and/or percutaneous coronary angiography

Results

Among the patients, 34 (32.7%) were males and 70 (63.7%) were females, and their mean age was 65.49±4.9 with the IHD was equal in both genders with P value of 0.5. However, it was more common in overweight and obese patients with P value of 0.07 when comparing with underweight and normal, in our study 81.6% of patients were HTN and 62.6% of patients were diabetic, a strong relationship between past medical disease and CAD with p value of <0.001. Overall, 43.3% had ischemic heart disease.

Conclusion

Our data suggest that coronary artery disease is more prevalent in heart failure with preserved ejection fraction and it depends on other risk factors and risks of ischemic heart disease.

KEYWORDS

HFpEF, IHD, Sulaimani.

References

1. Lund LH, Mancini D. Heart failure in women. Med Clin North Am. 2004;88:1321–1345, xii. doi: 10.1016/j.mcna.2004.03.003.

2. Gerber Y, Weston SA, Berardi C, McNallan SM, Jiang R, Redfield MM,Roger VL. Contemporary trends in heart failure with reduced and preserved ejection fraction after myocardial infarction: a community study.Am J Epidemiol. 2013;178:1272–1280. doi: 10.1093/aje/kwt109.

3. Lam CS, Solomon SD. The middle child in heart failure: heart failure with mid-range ejection fraction (40-50%). Eur J Heart Fail. 2014;16:1049–1055. doi: 10.1002/ejhf.159.

4. Badar AA, Perez-Moreno AC, Hawkins NM, Jhund PS, Brunton AP, Anand IS, McKelvie RS, Komajda M, Zile MR, Carson PE,Gardner RS, Petrie MC, McMurray JJ. Clinical characteristics and outcomes of patients with coronary artery disease and angina: analysisof the irbesartan in patients with heart failure and preserved systolic function trial. Circ Heart Fail. 2015;8:717–724. doi: 10.1161/CIRCHEARTFAILURE.114.002024.

5. Coles AH, Fisher K, Darling C, Yarzebski J, McManus DD, Gore JM, Lessard D, Goldberg RJ. Long-term survival for patients with acute decompensated heart failure according to ejection fraction findings. Am J Cardiol. 2014;114:862–868. doi: 10.1016/j.amjcard.2014.06.017.

6. Solomon SD, Anavekar N, Skali H, McMurray JJ, Swedberg K, Yusuf S,Granger CB, Michelson EL, Wang D, Pocock S, Pfeffer MA; Candesartan in Heart Failure Reduction in Mortality (CHARM) Investigators.Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation. 2005;112:3738–3744. doi: 10.1161/CIRCULATIONAHA.105.561423.

7. Gottdiener JS, McClelland RL, Marshall R, Shemanski L, Furberg CD,Kitzman DW, Cushman M, Polak J, Gardin JM, Gersh BJ, Aurigemma GP, Manolio TA. Outcome of congestive heart failure in elderly persons:influence of left ventricular systolic function. The Cardiovascular Health Study. Ann Intern Med. 2002;137:631–639.

8. Lee DS, Gona P, Vasan RS, Larson MG, Benjamin EJ, Wang TJ, Tu JV,Levy D. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the Framingham heart study of the national heart, lung, and blood institute. Circulation. 2009;119:3070–3077. doi: 10.1161/CIRCULATIONAHA.108.815944.

9. Rusinaru D, Houpe D, Szymanski C, Lévy F, Maréchaux S, Tribouilloy C. Coronary artery disease and 10-year outcome after hospital admission for heart failure with preserved and with reduced ejection fraction. Eur J Heart Fail. 2014;16:967–976. doi: 10.1002/ejhf.142.

10. Udelson JE. Heart failure with preserved ejection fraction. Circulation 2011;124:e540–3.

11. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006;355:251—9.

12. Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis 2005;47:320–332.

13. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–9.

14. Bhatia RS, Tu JV, Lee DS , et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355:260–9.

15. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129—200.

16. Lam CS, Teng TH. Understanding heart failure with mid-range ejectionfraction. JACC Heart Fail. 2016;4:473–476. doi: 10.1016/j. jchf.2016.03.025.

17. Lund LH. Heart failure with “mid-range” ejection fraction-new opportunities. J Card Fail. 2016;22:769–771. doi: 10.1016/j.cardfail.2016.07.439.

18. Choudhury L, Gheorghiade M, Bonow RO. Coronary artery disease in patients with heart failure and preserved systolic function. Am J Cardiol.2002;89:719–722.

19. Hwang SJ, Melenovsky V, Borlaug BA. Implications of coronary artery disease in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2014;63(25 pt A):2817–2827. doi: 10.1016/j.jacc.2014.03.034.

20. Eleid MF, Appleton CP, Lopez AG, Cha S, Hurst RT. Coronary artery plaque burden does not affect left ventricular diastolic function in asymptomatic adults with normal ejection fraction. J Am Soc Echocardiogr 2011;24:909-14.

21. Garcia MM, Rodrigues MG, Reis Neto JA, Correia LC. Influence of subclinical atherosclerosis on diastolic function in individuals free of cardiovascular disease. Arq Bras Cardiol 2010;95:473-8.

22. Lam CS, Donal E, Kraigher-Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail 2011;13:18–28.

23. Lee DS, Gona P, Vasan RS, et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the Framingham Heart Study of the National Heart, Lung, and Blood Institute. Circulation 2009;119:3070–7.

24. Judge KW, Pawitan Y, Caldwell J, Gersh BJ, Kennedy JW. Congestive heart failure symptoms in patients with preserved left ventricular systolic function: analysis of the CASS registry. J Am Coll Cardiol 1991; 18:377–82.

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