Cardiac structure and function and quality of life associations in HFpEF: An analysis from TOPCAT-Americas

Abstract

BackgroundPatients with heart failure with preserved ejection fraction (HFpEF) have poor health-related quality of life (HR-QoL). However, the relationship between HR-QoL measures and the alterations of cardiac structure and function that are present in patients with HFpEF remains unknown. AimsTo study the associations between HR-QoL and echocardiographic parameters in HFpEF. MethodsRegression modelling in patients from TOPCAT-Americas who had both HR-QoL questionnaires and a baseline echocardiogram. ResultsA total of 631 patients (36% of the TOPCAT-Americas population) had both echocardiographic and HR-QoL at baseline. KCCQ-23 Overall Summary Score (OSS; 0–100 points) was negatively (higher echocardiographic values-poorer/lower HR-QoL scores) associated with left ventricular end-diastolic diameter (LVEDD: β = −3.56 [−7.00 to −0.13] points-per-1 cm, P = 0.042), interventricular septum thickness (β = −1.31 [−2.19 to −0.42] points-per-1 mm, P = 0.004), posterior wall thickness (β = −1.57 [−2.52 to −0.63] points-per-1 mm, P = 0.001 and left atrial width (β = −3.27 [−6.39 to −0.15], P = 0.040) points-per-1 cm, and positively (higher echocardiographic values-better/higher HR-QoL scores) associated with left ventricular end-diastolic volume index (LVEDVi: β = 0.23 [0.09 to 0.37] points-per-1 ml/m2, P = 0.002) and left ventricular end-systolic volume index (LVESVi: β = 0.41 [0.18 to 0.63] points-per-1 ml/m2, P < 0.001). Body mass index (BMI: β = −0.74 [−1.02 to −0.47] points-per-1Kg/m2, P < 0.001), diabetes (β = −6.01 [−10.05 to −1.97], P = 0.004), and asthma (β = −6.78 [−13.52 to −0.04], P = 0.049) were negatively associated with OSS. A similar pattern of associations was observed for KCCQ-23 Clinical Summary Score, EQ5D-VAS and NYHA class. ConclusionIn patients with HFpEF, HR-QoL measures were associated with cardiac structure and function alterations. Extra-cardiac factors were also associated with HR-QoL, which may influence HR-QoL results when testing cardiovascular drugs.