Purpose: Heart failure with preserved ejection fraction (HFpEF) is a common stage in the course of various cardiovascular disorders. It comprises abnormalities in cardiac structure and function, as well as complex bioumoral activation, which are responsible for major clinical outcomes. Our study aimed at characterizing the bioumoral and echocardiographic profile in such patients.
Methods: We studied plasma levels of NT-proBNP, uric acid, total and conjugated bilirubin, hemoglobin, kidney function (eGFR - MDRD equation) and echocardiographic parameters of left ventricular remodeling and diastolic dysfunction in a cohort of 99 patients with HFpEF of different etiologies.
Results: Almost all patients (97 out of 99) had left ventricular (LV) concentric remodeling, quantified by a relative wall thickness (rwt) ≥ 0.42, irrespective of the presence or absence of arterial hypertension, diabetes mellitus, ischemic heart disease, valvular heart disease or atrial fibrillation. The only comorbidity which correlated significantly with LV concentric remodeling was chronic kidney disease (rwt = 0.61± 0.19 as compared to 0.54 ± 0.08 in patients without chronic kidney disease, p = 0.042). rwt significantly correlated with E/E′ ratio (r = 0.480, p = 0.001) and plasma NTproBNP values (r = 0.337, p = 0.002). Plasma uric acid correlated with plasma NT-proBNP (r = 0.259, p = 0.017) and functional NYHA class (r = 0.234, p = 0.031). One third of patients had levels of hemoglobin below 12 g/dl. Hemoglobin levels inversely correlated with plasma NT-proBNP values (r = - 0.318, p = 0.002). Conjugated bilirubin correlated with mitral E/A ratio (r = 0.401, p = 0.031), plasma NTproBNP values (r = 0.283, p = 0.026) and functional NYHA class (r = 0.267, p = 0.036).
Conclusions: Patients with HFpEF have prominent left ventricular concentric remodeling, irrespective of the etiology of heart failure. This concentric remodeling is more pronounced in patients with associated chronic kidney disease and correlates with left ventricular diastolic dysfunction and bioumoral activation. Anemia is a prevalent comorbidity in heart failure and it is associated with higher NT-proBNP levels. Plasma uric acid and conjugated bilirubin correlate with functional NYHA class and bioumoral activation, thus being potential markers of disease severity.