Abstract 12017: Correlates of Regional Diastolic Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction

Abstract

Introduction: The underlying mechanisms of regional myocardial dysfunction in patients with heart failure with preserved ejection fraction (HFpEF) remain poorly defined. Hypothesis: We investigated physiological correlates of regional diastolic dysfunction in HFpEF using a novel technique based on point-by-point measurement of local diastolic delay. Methods: We enrolled 30 patients with HFpEF (LVEF >50%, E/e' >15, NT-proBNP >300 pg/ml). In all patients we performed electroanatomical mapping of the left ventricle and assessed regional diastolic function by a novel algorithm based on the measurement of local diastolic delay. Local diastolic delay was considered significant if the time delay between global left ventricular end diastolic time and local diastolic time was >50 msec. At the time of mapping, we performed clinical evaluation, echocardiography and measured plasma levels of 27 biomarkers of angiogenesis and endothelial dysfunction. Results: Our cohort included 23 male and 7 female patients, aged 46-70 years. Using electroanatomical mapping we measured regional diastolic function in 4820 mapping points. The mean local diastolic delay was >50 msec in 12 patients (Group A), and <50 msec in 18 patients (Group B). The groups did not differ in age (64±11 years in Group A vs. 51±8 years in Group B, P=0.22), gender, (male: 83% vs. 73%, P=0.48), creatinine (1.08±0.31 mg/dL vs. 1.10±0.30 mg/dL, P=0.52), LVEF (56±4% vs. 58±7%, P=0.42), or NT-proBNP levels (1570±1310 pg/mL vs. 1230±1240 pg/mL, P=0.22). However, in Group A, we found higher values of E/e’ (18.2±3.4 vs. 17.0±2.8 in Group B, P=0.04), and lower myocardial viability (unipolar voltage: 7.73±1.8 mV vs. 9.03±2.1 mV, P=0.02). When compared to Group B, patients in Group A displayed lower levels of pro-angiogenic biomarkers (vascular endothelial growth factor: 33±22 pg/mL vs. 47±24 pg/mL, P=0.01; platelet-derived growth factor: 47±23 pg/mL vs. 78±34 pg/mL, P=0.02), and higher levels of anti-angiogenic biomarkers (agiopoietin-2: 7.0±3.8 ng/mL vs. 2.7±1.0 ng/mL, P=0.01; endostatin: 87±33 ng/mL vs. 65±21 ng/mL, P=0.02). Conclusion: In patients with HFpEF, regional diastolic dysfunction appears to be associated with increased E/e’, decreased myocardial viability, and impaired angiogenesis.