Einfluss von typischen Komorbiditäten auf die Ausprägung der Symptomatik bei Herzinsuffizienz mit eingeschränkter und erhaltener linksventrikulärer Funktion

Abstract

The prevalence of heart failure with preserved ejection fraction (HFPEF) is increasing. HFPEF accounts for more than 50% of heart failure cases and the relative proportion is higher among women and the very elderly. Patients suffer from progressive exercise intolerance, dyspnoe, fatigue and impaired quality of life. While the therapy of heart failure with reduced ejection fraction (HFREF) occurs on the basis of guidelines, the management of HFPEF is challenging because no pharmacological therapy, which causes an improvement of symptoms, exercise tolerance, quality of life and mortality could be established. Co-morbidities contribute to morbidity and mortality in HFREF, but their impact on symptoms and complications is unknown in patients suffering from HFPEF. Therefore, we aimed to evaluate the frequency of different comorbidities in patients suffering from heart failure with reduced ejection fraction versus preserved ejection fraction, and to examine the impact of different co-morbidities on the burden of symptoms. Patients with heart failure were prospectively included in the multicenter German Competence Network on Heart Failure (KNHI). A comprehensive common data set was obtained. Thereof we could acquire 4079 patients with proven heart failure for our analysis. The patients were classified as suffering from HFPEF or HFREF. Therefore the left ventricular ejection fraction (LVEF) cut-off of 50% was determined echocardiographically. All values are given as mean (+-SD) or as odds ratio (OR, 95% confidence interval). The relationship between NYHA-class and co-morbidties was analysed by ordinal regression analyses controlled for age, sex and LVEF. The mean age of 4079 patients was 64+-13 years, 1405 of them were female, 2785 suffered from HFREF and 1294 of the patients suffered from HFPEF. The NYHA-classes II and III could be measured most frequently in all patients, but patients with HFREF were in higher NYHA-classes. The presence of different co-morbidities and their effects on symptoms of heart failure in HFPEF and HFREF was proved: hypertension and obesity could be found in patients with HFPEF more often, while diabetes mellitus, hyperuricemia, renal failure, anaemia, COPD, coronary artery disease and hyperlipidemia could be measured in patients suffering from HFREF most frequently. The presence of diabetes mellitus, hyperuricemia, renal failure or anaemia was significantly associated with a higher NYHA-class, but to a comparable extent in HFPEF and in HFREF. The existence of COPD in male patients was significantly accompanied with higher NYHA-classes, but there was no interaction with the LVEF. Coronary artery disease and obesity were related to more severe dyspnoe in patients suffering from HFPEF, but not in patients suffering from HFREF. The presence of hypertension could show a positive influence on the NYHA-class of patients with HFREF, however there was no significant relationship in the HFPEF group. While hyperlipidemia was associated with a higher NYHA-class in patients with HFPEF, the presence of hyperlipidemia had a positive influence on NYHA-class in the HFREF group. In conclusion patients with HFREF were more symptomatic than those suffering from HFPEF. Several typical co-morbidities in heart failure patients differentially affect symptoms in HFREF and HFPEF. In the results of multiple ordinal regression analysis the extent of the negative effect of comorbidities on symptoms of heart failure is more severe when compared with the effect of pathophysiologic parameters in patients with HFPEF than in those suffering from HFREF. This should be considered in the evaluation and treatment of these patients.