Abstract
Background: A growing body of evidence supports heart failure (HF) patients (pts) having equivalent mortality and morbidity burden regardless of ejection fraction (EF). Yet to date, most clinical care and therapeutic strategies have focused on pts with low EF. As a result, HF with preserved EF (HFpEF) remains poorly understood. This study aims to explore the heterogeneity and functional manifestations of HF in patients with EF >35%. Methods: We studied clinical features, ECG and echo characteristics, in HF pts: 25 with EF between 35–50% (Group 1); 30 with EF>50% (Group 2); and 10 healthy controls (Group 3). Results: HFpEF, in general, had expected clinical and functional differences from group 3. However, there were significant demographic and functional differences between groups 1 & 2, in terms of age, gender, BMI, history, etiology and chamber dimensions. Functionally, these groups also had significant HR, QRS duration and filling time differences. The table summarizes major demographic and functional findings across the 3 groups.Interestingly, it appears that significant differences in pharmacological management of the two HFpEF groups also exist, where more pts in group 2 are on calcium channel blockers (83 vs. 4% in group 1); no difference in beta blocker, diuretic, statin and anti-arrhythmic drug utilization; more pts in group 1 on Aspirin (60 vs. 23%), ACE/ARB (72 vs. 33%), Digoxin (32 vs. 0%) and Spironolactone (52 vs. 0%), compared to group 2. Conclusion: HFpEF is a term used to describe a widely heterogeneous group of HF pts with relatively preserved EF. Significant clinical, functional and medical management heterogeneities, as a function of EF exist within the HFpEF population. Therefore, there may be benefit in dichotomizing patients according to EF and investigating medical care in those with elevated EF distinctly from those with moderately reduced or normal EF.
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