Heart Failure With Normal Ejection Fraction Research Articles

The impact of atrial fibrillation on clinical outcomes in heart failure with mid-range and preserved ejection fraction patients

BackgroundThe combined effect of left ventricular ejection fraction (LVEF) and atrial fibrillation (AF) on clinical outcomes in heart failure (HF) remains complex. ObjectiveIn this post hoc analysis of the TOPCAT trial, we aimed to evaluate the impact of AF on clinical outcomes in patients with HF stratified by LVEF range. MethodsA total of 3442 patients were included, stratified into 3 groups according to LVEF range—HF with mid-range ejection fraction (HFmrEF), LVEF of 45%–50% (n = 823); HF with preserved ejection fraction (HFpEF), LVEF of 51%–60% (n = 1682); and HF with normal ejection fraction (HFnEF), LVEF >60% (n = 937)—and subdivided according to the presence of AF at enrollment. Cox regression analysis was used to define independent associations between AF and clinical outcomes. ResultsAF was prevalent in 38.6% in HFmrEF, 34.6% in HFpEF, and 33.7% in HFnEF (P = .07). AF was associated with worse primary outcome in each subgroup and with HF hospitalizations and worse cardiovascular mortality in HFpEF and HFnEF. The hazard ratio for the primary outcome in those with AF compared with sinus rhythm (SR) was 1.11 (1.01–1.22; P = .03) in HFmrEF, 1.20 (1.11–1.29; P < .001) in HFpEF, and 1.16 (1.05–1.28; P = .004) in HFnEF. When LVEF was treated as a continuous variable, there was a linear negative association between LVEF and the effect of AF vs SR for the primary end point and HF hospitalizations and a linear positive association for cardiovascular mortality. ConclusionCompared with SR, AF was independently associated with worse outcomes across all LVEF ranges.

Prevalence, characteristics and cardiovascular and non-cardiovascular outcomes in patients with heart failure with supra-normal ejection fraction: Insight from the JROADHF study.

We aimed to investigate the characteristics and prognosis of patients with heart failure (HF) with supra-normal ejection fraction (HFsnEF) compared to HF with normal ejection fraction (HFnEF). Among 11 573 patients enrolled in the nationwide registry of hospitalized patients with HF in Japan, 1943 patients (16.8%) were classified as HFsnEF (left ventricular ejection fraction [LVEF] >65%), 3277 (28.3%) as HFnEF (50% ≤ LVEF ≤65%), 2024 (17.5%) as HF with mildly reduced ejection fraction (40% ≤ LVEF <50%) and 4329 (37.4%) as HF with reduced ejection fraction (LVEF <40%). Patients with HFsnEF were older, more likely to be women, had lower natriuretic peptide values, and had smaller left ventricles than those with HFnEF. The primary endpoint, the composite of cardiovascular death or HF readmission, did not differ between HFsnEF (802/1943, 41.3%) and HFnEF (1413/3277, 43.1%) during a median follow-up period of 870 days (hazard ratio [HR] 0.96, 95% confidence interval 0.88-1.05, p = 0.346). The incidence of secondary outcomes, including all-cause, cardiovascular, and non-cardiovascular deaths and HF readmission, did not differ between HFsnEF and HFnEF. In the multivariable Cox regression analysis, HFsnEF compared to HFnEF was associated with a lower adjusted HR for HF readmission but not with the primary and other secondary endpoints. HFsnEF was associated with a higher HR for the composite endpoint and all-cause death in women, and a higher HR for all-cause death in patients with renal dysfunction. Heart failure with supra-normal ejection fraction is a common and distinctive phenotype, and has different characteristics and prognoses from HFnEF.

Echocardiographic Evaluation of Diastolic Dysfunction among Menopausal Women: A Cross-sectional Study

Introduction: Heart Failure with Normal Ejection Fraction (HFNEF), also known as Diastolic Heart Failure (DHF), has been well-studied since the past two decades. The signs of HFNEF are signs of heart failure and abnormal ventricular filling pressure with normal systolic function. A Metabolic Syndrome (MS) is a clustering of metabolic risk factors. Cardiovascular disease caused by metabolic syndrome includes vascular and myocardial abnormalities such as diastolic dysfunction and relaxation abnormalities. Aim: To study the assosciation between the timing of menopause and Left Ventricular Diastolic Dysfunction (LVDD) in those with and without MS. Materials And Methods: This cross-sectional study was conducted in the period between December 2021 to June 2022 at the Department of Cardiology in A.C.S Medical College and Hospital, Chennai, Tamil Nadu, India. All female patients that underwent a medical examination were selected for the study. Postmenopausal women without overt heart diseases (such as a history of heart valve disease or myocardial infarction, or a prior LV ejection fraction &gt; 50%) were included. This study included 80 patients grouped into two: those with and without MS. The MS group included 30 subjects divided into two subgroups: those who experienced menopause at or before 50 years of age (early menopause group) and those who experienced menopause at or after 50 years of age (late menopause group). Out of 80, 50 participants were divided into early menopause and late menopause groups among women without MS. This study analyse the evolution of left ventricular diastolic dysfunction (LVDD), assessed by transthoracic echocardiography (TTE), in 80 postmenopausal women with and without MS. Independent t-tests was applied to assess the association between the timing of menopause and LVDD. Results: The mean age was 60±7.3 years in women with MS and 62±8.8 years in women without MS. There were no significant differences in the duration since menopause between the postmenopausal women with and without MS. No significant difference was found between the two groups (early vs. late menopause group) with respect to any diastolic parameter, including Early (E) and Late (A), E/A ratio, and E/e in women with MS. In postmenopausal women without MS, there was a significant difference in diastolic parameters including the A, early diastolic annular velocity (e’), ratio of early diastolic transmitral flow velocity to annular flow velocity was calculated (E/e’) between the two groups (early vs. late menopause group). In comparison to patients with MS, patients without the condition had significantly lower early peak mitral inflow velocity (E, p-value=0.019), early diastolic mitral annulus motion velocity (e’-septal, p-value=0.05), late peak mitral inflow velocity ratio (E/A, p-value=0.07), and LV filling pressure values (E/e, p-value=0.02). Conclusion: Early menopause impacts diastolic function in postmenopausal women and LVDD progression in women without MS. LVDD progression in women with MS was unaffected by early menopause.

Heart Failure: The Dilemma of the 40-50% Ejection Fraction Range

The common pathophysiology contributing to fluid retention and dyspnoea in heart failure is a non-compliant and stiff myocardium with raised left ventricular end-diastolic pressure. With the rapid development of newer imaging technologies, particularly echocardiography, our understanding of the syndrome of heart failure has significantly changed. The most important imaging sign in the early eighties was reduced ejection fraction (HFrEF), with low values being used as an explanation for the development of signs and symptoms. In the early 2000s, similar Doppler echocardiographic signs became frequently recognised in patients with heart failure symptoms and signs who proved to have a relatively maintained ejection fraction (EF) of &gt;40%, hence the description of the syndrome of “diastolic heart failure”. This was later rephrased as heart failure with normal ejection fraction (HFnEF) and more recently as heart failure with preserved ejection fraction (HFpEF). Since then, HFpEF has attracted the interest of many cardiologists and scientists worldwide, searching for specific features and treatment options for the syndrome. As for the features, two important findings have now been established, the first showed that LV systolic function mainly at the subendocardial level was abnormal in HFpEF, particularly manifesting during stress/exercise when the increase in heart rate was not associated with a commensurate increase in stroke volume and a second observation of a significant impairment of left atrial function (i.e. myocardial strain) and emptying fraction associated with increased left atrial pressures and the potential development of atrial arrhythmia in HFpEF. Such atrial abnormalities have been shown to be commonly associated with cavity enlargement and poor compliance. The latter observation has similarly been reported in patients with reduced EF. Despite the above similarities in cardiac physiology between HFpEF and HFrEF, treatments of the two conditions differ markedly. When comparing HFrEF and HFpEF, we can easily see that some patients fall into the grey area on the EF spectrum with values fluctuating above and below 40%, suggesting that the substrate for the expected drug effect may differ, possibly explaining the lack of consistent response in these patients.. In addition, it should not be forgotten that most heart failure medications work on the circulation rather than the heart itself, hence the need for shared circulatory disturbances between the two conditions before we can reasonably expect identical treatment benefits when using the same medications in different clinical settings. Therefore, it is clear that classifying heart failure patients according to a single measure of LV function i.e. ejection fraction fails to help at least 50% of patients presenting with this syndrome. In contrast, aggregating such patients based on clear evidence for raised LA pressures, irrespective of EF, might show evidence for a more consistent response to vasodilators and conventional heart failure therapy, particularly those patients currently described as HFpEF.

Interatrial shunt devices for heart failure with normal ejection fraction: a technology update.

Heart failure with normal ejection fraction (HeFNEF) accounts for ~50% of heart failure admissions. Its pathophysiology and diagnostic criteria are yet to be defined clearly which may hinder the search for effective treatments. The clinical hallmark of HeFNEF is exertional breathlessness, often due to an abnormal increase in left atrial pressure during exercise. Creation of an interatrial communication to offload the left atrium is a possible therapeutic approach. There are two percutaneously delivered devices currently under investigation which are discussed in this review.

Can we diagnose isolated, exercise-induced heart failure with normal ejection fraction?

A significant proportion of patients with exertional dyspnea require exercise to diagnose heart failure with normal ejection fraction (HFNEF). In this review article, we evaluate current data on the prevalence, clinical significance and specifically the establishment of a diagnosis of isolated, exercise-induced HFNEF. Despite the unquestioned clinical importance and high prevalence of exercise-induced HFNEF, there are limited and conflicting data on making a diagnosis of exercise-induced HFNEF. This mostly relies on the evidence of exercise-induced elevation in left ventricular filling pressure (LVFP). At present, there is no agreement on the ability of exercise echocardiographic parameteres to predict exercise-induced LVFP elevation. In addition, even invasively measured exercise LVFP faces the problem of defining normal exercise LVFP values. More data and probably new diagnostic approaches are necessary to reliably diagnose exercise HFNEF. There are conflicting results and significant problems associated with the diagnosis of exercise HFNEF. This review hopefully will encourage further research in this difficult but clinically important area of heart failure.

Ischemia-Induced Model of Diastolic Dysfunction in Sheep

ABSTRACTBackground: Ischemic heart failure with normal ejection fraction (HFNEF) is an increasingly recognized entity that carries similar morbidity and mortality than low ejection fraction heart failure. Animal models of diastolic dysfunction mimicking this condition are lacking and are essential for the development of therapeutic strategies. Methods and Results: Eight Corriedale sheep, 18 ± 5 months old, were included in the study. Basal echocardiography and myocardial perfusion evaluation (SPECT) was performed. Acute myocardial infarction (AMI) was made by occlusion (90 min) and reperfusion of the second diagonal branch of the anterior descending coronary artery. Two months after AMI, echocardiography and SPECT evaluation were performed prior to sacrifice. Basal and 2 months echocardiography showed similar fractional shortening and ventricular dimensions in each animal except for an increase in left atrial diameter. No mitral regurgitation was evidenced. SPECT imaging and pathology confirmed infarction in the apical, apico-anterior, and apico-septal segments. Conclusion: A novel model of ischemia-induced diastolic dysfunction with preserved ventricular thickness and ejection fraction is described. This model opens the possibility of testing therapeutic options for patients with this condition.

Left ventricular filling pressure assessed by exercise TDI was correlated with early HFNEF in patients with non-obstructive hypertrophic cardiomyopathy.

BackgroundHypertrophic cardiomyopathy (HCM) patients are more susceptible to suffer from heart failure with normal ejection fraction (HFNEF). Therefore, it is critical to evaluate the relationship between left ventricular filling pressure (LVFP) and HFNEF, even if a large proportion of HCM patients have normal LVFP at rest. The objective was to assess the correlation between exercise tissue Doppler imaging (TDI) and early HFNEF in HCM patients by treadmill exercise echocardiography combined with cardiopulmonary exercise test (CPET).MethodTwenty-seven non-obstructive HCM patients and 31 age- and gender-matched healthy volunteers were enrolled in this study. All subjects underwent treadmill exercise echocardiography combined with CPET. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were analyzed before and after exercise.ResultFive HCM patients had normal LVFP at rest and increased after exercise. For this subgroup, the relationship between minute ventilation and carbon dioxide production (VE/VCO2 slope) and NT-proBNP levels were higher compared with controls and the subgroup with normal resting and stress LVFP, but was similar to the subgroup with elevated LVFP both at rest and after exercise.ConclusionElevated LVFP after exercise suggested the occurrence of early HFNEF in patients with non-obstructive HCM.

Assessment of left ventricular systolic function in patients with atrial fibrillation and heart failure with normal ejection fraction by speckle tracking imaging

Objective To explore the left ventricular systolic function in patients with atrial fibrillation（AF） and heart failure with normal ejection fraction（HFnEF） using tri-plane 2D, 3D speckle tracking imaging （STI） and single-beat real-time three-dimensional ultrasound. Methods Thirty-four patients with AF and HFnEF were enrolled as HFnEF group and twenty-nine AF patients without any kind of heart failure as control group. Left ventricular ejection fraction （LVEF） was measured by hi-plane Simpson＇s method, regional systolic function of left ventricle was evaluated by 2D-STI and 3D-STI, and synchronism of left ventricle was assessed using tissue Doppler imaging （TDI）, tri-plane 2D-STI and 3I）- STI.Resnlts HFnEF group had higher two-dimensional longitudinal strain and lower two-dimensional radial strain.Left ventricular synchronism in HFnEF group was significantly poorer than that in control group. Conclusions 2D/3D STI is more sensitive than TDI and it can discover contractility abnormal and asynchronism in patients with both AF and HFnEF with the help of tri-plane imaging and single-beat real- time three-dimensional ultrasound. Key words: Echocardiography; Heart failure; Atrial fibrillation

PREVALENCE OF RISK FACTORS IN PATIENTS WITH HEART FAILURE WITH NORMAL EJECTION FRACTION (HFNEF)

Objective: To determine prevalence of risk factors in patients with heart failure with normal ejection fraction (HFNEF). Methodology: This was a cross sectional descriptive study conducted at the Department of Cardiology, Lady Reading Hospital, Peshawar. Patients referred from Out Patient and Emergency Departments to the Echocardiography department meeting the criteria for HFNEF were included. All the patients were carefully scrutinized for common risk factors. They were subjected to detailed history and clinical examination. Their clinical record was checked, BMI calculated, ECG and Transthoracic echocardiography was performed. Data was analyzed on SPSS version 15. Results: The total number of patients studied was 139. Males were 45.3% and females were 54.7%. Mean age ± SD was 56.64 ± 10 years. Patients were divided into three groups on the basis of age. There were 42.4% patients in age group 40-54 years, 44.6% in age group 55-69 and 12.9% in age group 70 and above. Majority (51.8%) of the patients were in NYHA class II. Hypertension (59.7%) was the most common risk factor for HFNEF, followed by Coronary artery disease in 34.5%, Diabetes mellitis (DM) 33.1% and Obesity in 15.1%. A significant number of patients 21.6% had no obvious risk factor. Sixty one (43.88%) patients had more than one risk factor contributing to diastolic dysfunction. Conclusion: Arterial hypertension, Coronary artery disease, diabetes mellitus and obesity are the major factors in patients with diastolic dysfunction and HFNEF. A significant proportion of patients have multiple risk factors for HFNEF.

Incremental prognostic significance of the elevated levels of pentraxin 3 in patients with heart failure with normal left ventricular ejection fraction.

BackgroundPentraxin 3 (PTX3) is a novel inflammatory marker produced by various cell types including those of the vasculature and the heart. The relationship between inflammatory markers and prognosis of patients with heart failure with normal ejection fraction (HFNEF) remains unknown. We investigated whether plasma PTX3 levels can predict future cardiovascular events in patients with HFNEF.Methods and ResultsPlasma PTX3, high‐sensitivity C‐reactive protein, and B‐type natriuretic peptide levels were measured prospectively in 360 stable patients with HFNEF. The subsequent incidence of cardiovascular events, including cardiovascular death, nonfatal myocardial infarction (MI), unstable angina pectoris, nonfatal ischemic stroke, hospitalization for heart failure decompensation, and coronary revascularization, was determined. During a mean 30‐month follow‐up, 106 patients experienced cardiovascular events. These events were more frequent in patients with high plasma PTX3 levels (>3.0 ng/mL) than low levels (≤3.0 ng/mL). Multivariable Cox hazard analysis showed that PTX3 (hazard ratio: 1.16; 95% CI: 1.05 to 1.27; P<0.01) and B‐type natriuretic peptide (hazard ratio: 1.08; 95% CI: 1.03 to 1.14; P<0.001), but not high‐sensitivity C‐reactive protein levels, were significant predictors of future cardiovascular events. Multivariable Cox analysis with the forced inclusion model, including 5 previously identified prognostic factors, found that PTX3 was a significant predictor of cardiovascular events (hazard ratio: 1.16; 95% CI: 1.06 to 1.27; P<0.01). The C‐statistics for cardiovascular events substantially increased from 0.617 to 0.683 when PTX3 was added to the 5 previously identified prognostic factors.ConclusionsHigh plasma PTX3 levels, but not other inflammatory markers, are correlated with future cardiovascular events in patients with HFNEF. PTX3 may be a useful biomarker for assessment of risk stratification in HFNEF.Clinical Trial RegistrationURL: http://www.umin.ac.jp; Unique identifier: UMIN000002170.

FRI0099 Prevalence of Heart Failure in Rheumatoid Arthritis is Doubled in Remission yet Quadrupled in Active Disease

BackgroundRisk of heart failure (HF) is increased in patients with rheumatoid arthritis (RA) and the predominantly prevalent type is diastolic HF with normal ejection fraction (HFNEF). Traditional cardiovascular risk factors...

Left Atrial Enlargement in the Early Stage of Hypertensive Heart Disease: A Common But Ignored Condition

How to identify the early signs of hypertensive heart disease is the key to block or reverse the process of heart failure. The aim of this study was to evaluate the predictive value of left atrial (LA) enlargement in the early stage of hypertensive heart disease and to explore the correlations between LA enlargement and heart failure with normal ejection fraction (HFnEF), as well as the metabolic syndrome (MetS). Baseline clinical characteristics, biochemical indices, electrocardiographic and echocardiographic data were collected from 341 consecutive patients with essential hypertension. Among those patients, LA enlargement was more frequently presented than LV enlargement (57.2% vs 17.9%). Compared with patients without HFnEF, the prevalence of LA enlargement was higher in patients with HFnEF (82.9% vs 49.0%, P<.0001). From grade 2 to grade 3 hypertension, LA size was significantly larger in patients with MetS (P<.01) than those without. Multivariate linear regression analyses showed that age, body mass index, waist circumference, triglyceride level, and left ventricular diameter were independent predictors of LA enlargement. The simple measurement for identification of LA enlargement potentially allows early recognition of those patients at risk for heart failure, particularly among patients with MetS.

High prevalence of exercise-induced heart failure with normal ejection fraction in post-heart transplant patients

Post-heart transplant patients are at increased risk of diastolic dysfunction. The aim of this study was to assess the prevalence of isolated only exercise-induced heart failure with normal ejection fraction (HFNEF) in heart transplant recipients. To determine pulmonary capillary wedge pressure (PCWP) at rest and during exercise, 81 patients after orthotopic heart transplantation with normal left ventricular ejection fraction (LVEF) underwent exercise right heart catheterization with simultaneous exercise echocardiography. Based on PCWP values, the patients were divided into three groups. Twenty-one patients had no evidence of HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise < 25 mmHg, prevalence 26%). Forty-seven subjects were found to have only exercise-induced HFNEF (PCWP at rest < 15 mmHg, maximal PCWP during exercise ≥ 25 mmHg, prevalence 58%). Thirteen patients had HFNEF already at rest (PCWP ≥ 15 mmHg at rest, prevalence 16%). Of the noninvasive parameters obtained at rest, multivariate regression analysis identified LV mass index adjusted for allograft age to be an independent predictor of exercise-induced HFNEF. In heart transplant recipients with normal LVEF, there is a high prevalence of exercise-induced HFNEF. LV mass index adjusted for allograft age is predictive of exercise-induced HFNEF.

Systems biology applied to heart failure with normal ejection fraction.

Heart failure with normal ejection fraction (HFNEF) is currently the most prevalent clinical phenotype of heart failure. However, the treatments available have shown no reduction in mortality so far. Advances in the omics sciences and techniques of high data processing used in molecular biology have enabled the development of an integrating approach to HFNEF based on systems biology.This study aimed at presenting a systems-biology-based HFNEF model using the bottom-up and top-down approaches.A literature search was conducted for studies published between 1991 and 2013 regarding HFNEF pathophysiology, its biomarkers and systems biology. A conceptual model was developed using bottom-up and top-down approaches of systems biology.The use of systems-biology approaches for HFNEF, a complex clinical syndrome, can be useful to better understand its pathophysiology and to discover new therapeutic targets.

Clinical Profile and Treatment Management of Heart Failure with Preserved Systolic Function in Rural Setting of India

Background: In recent decades, the hospital admission due to heart failure with normal ejection fraction (HFnEF) or diastolic heart failure has increased particularly in elderly patients. However, sufficient data regarding prevalence, etiologies and treatment of diastolic heart failure are not available for Indian population. So, we carried out an observational study to determine clinical profile and medical therapy for patients experiencing diastolic heart failure. Methods: This was prospective observational study carried out in rural area of India for the period of 12 months. All the patients diagnosed with heart failure with normal ejection fraction were included in the study. If the patient was having severe anemia (hemoglobin 8.00 g/dl), hemodynamically significant valvular disease, prosthetic valve replacement, and ventricular pacemaker, they were excluded. Results: A total of 53 patients diagnosed with HFnEF were included in the study. There were 24 male patients. Hypertension, CAD and diabetes mellitus were present in 33, 24 and 16 patients respectively. 18 patients developed severe diastolic dysfunction and more common in female as compared to male (37.9% vs. 33.3%). Most frequently observed clinical feature was tachycardia (96% cases) followed by pedal edema (86%). The patients were treated according to underlying cause. Conclusions: Diastolic heart failure is more common in elderly patients. In Indian population, diastolic heart failure has been associated with hypertension, diabetes mellitus and coronary artery diseases in most of the cases.

Biomarkers of heart failure with normal ejection fraction: a systematic review

Heart failure with normal ejection fraction (HFNEF) is a major and growing public health problem, currently representing half of the heart failure burden. Although many studies have investigated the diagnostic and prognostic value of new biomarkers in heart failure, limited data are available on biomarkers other than natriuretic peptides in HFNEF. We performed a systematic review of epidemiological studies on the associations of biomarkers with the occurrence of HFNEF and with the prognosis of HFNEF patients. Biomarkers examined most extensively in HFNEF include biomarkers of myocyte stress, inflammation, and extracellular matrix remodelling. Some biomarkers have been shown to be increased to a different extent in HFNEF compared with heart failure with reduced ejection fraction (HFREF). Several biomarkers, including biomarkers of myocyte stress, inflammation, extracellular matrix remodelling, growth differentiation factor 15 (GDF-15), cystatin C, resistin, and galectin-3, were associated with development of HFNEF and with clinical outcomes of HFNEF patients in terms of morbidity and mortality. Several biomarkers, including biomarkers of myocyte stress, inflammation, extracellular matrix remodelling, GDF-15, cystatin C, resistin, and galectin-3, appeared to be promising diagnostic and prognostic tools in patients with HFNEF. Investigation of the incremental diagnostic and prognostic value of these biomarkers, or a combination thereof, over established clinical covariates and imaging techniques in large, prospective studies is warranted.

Pulmonary artery wave reflection: observations in pulmonary hypertension

Introduction: PIMR is a novel index of pulmonary microvascular function calculated from PressureWirederived distal pressure and flow. While PIMR has been reported in a large animal model of pulmonary arterial hypertension (PAH), its utility in the clinical setting has not been explored. Methods: Patients referred for diagnostic right heart catheterisation underwent Swan Ganz catheter and PressureWire (placed in 3rd order PA branch) measurement of pulmonary haemodynamics both before and during adenosine infusion. PIMR was calculated as mean transit time× (distal PA pressure−PA wedge pressure). Results: Thirty-eight subjects (average age 61 years) were studied including five normal, eleven PAH, fifteen heart failure with normal ejection fraction (HFNEF), five mitral valve disease, and two interstitial lung disease patients. Adenosine infusion resulted in 28% fall in pulmonary vascular resistance (PVR) and a 29% fall in systemic vascular resistance driven mainly by an increase in cardiac output (5.9± 0.3 L/min vs. 8.6± 0.4 L/min, p< 0.001). PIMR was closely related to PVR during adenosine (r= 0.63, p< 0.001). PIMR was higher in patients with transpulmonary gradient greater than 12 (6.9± 1.3 vs. 3.6± 0.9, p< 0.018) and in patients with PAH compared to those with HFNEF (10.5± 1.7 vs. 3.2± 0.4, p< 0.001). Conclusions: PIMR is closely related to PVR, suggesting that resistance in the pulmonary circulation occurs mainly at the microvascular level. While adenosine is an effective pulmonary vasodilator, its substantial effect on systemic resistance may make alternative agents such as PDE-5 inhibitors more attractive for pulmonary vasodilator challenge.

FRI0124 Increased risk of diastolic heart failure in RA – what should we screening for?

BackgroundPatients with rheumatoid arthritis (RA) share an increased risk of diastolic heart failure with normal ejection fraction (HFNEF), which is often underrecognized. Age, female gender and history of hypertension are...

THU0069 Increased rate of diastolic heart failure in rheumatoid arthritis correlates with systemic inflammation and persistent disease activity, independent from treatment strategy

BackgroundIncreased prevalence of chronic heart failure is observed in patients with rheumatoid arthritis (RA) and heart failure with normal ejection fraction (HFNEF) is the predominant type. Although traditional cardiovascular risk...