Abstract
Background: Fatigue is prevalent in heart failure (HF) patients and strongly linked to adverse outcomes, but the relationship of cardiac structure and function with fatigue type and severity in HF is unknown. Methods: We included 947 individuals with prevalent HF from visit 5 (2011-2013) of the ARIC study with data on general and exertional fatigue, and echocardiographic measures. We previously identified four subtypes of fatigue using latent class analysis: Low/no fatigue, high general/low exertional, moderate general/moderate exertional, and high general/high exertional fatigue. We used multinomial logistic regression to determine the relationship between 1-SD higher echocardiographic parameters and fatigue subtypes, adjusting for age and sex. Results: Our sample was 54% female and 38% Black, with mean age of 77 ± 5.5 and LVEF of 61% ± 10. Adjusting for sex and age, worse longitudinal strain (OR = 1.55 [1.13, 2.13]), higher LV mass index (OR = 1.62 [1.23, 2.14]), and multiple measures of impaired diastolic function were associated with higher odds of having the high general/high exertional fatigue subtype compared to the low/no fatigue subtype (Table) . LV mass index and impaired diastolic function were also associated with higher odds of having the moderate general/moderate exertional fatigue subtype (Table) . Adjustment for additional sociodemographic and clinical characteristics attenuated associations, with only lateral E/e` significantly associated with the high general/high exertional fatigue subtype (OR= 1.81 [1.12, 2.91]), and the moderate general/moderate exertional fatigue subtype (OR=1.44 [1.10, 1.96]). Conclusions: Associations of fatigue subtype with cardiac structure and function are largely explained by other sociodemographic and clinical characteristics. Supplementary interventions targeting non-cardiac structural and functional mechanisms of fatigue may contribute to improved fatigue symptomatology in prevalent HF.
Published Version
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