HF with Preserved LV Systolic Function: A Call to Action

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HF with Preserved LV Systolic Function: A Call to Action

A growing body of evidence shows that heart failure with preserved left-ventricular systolic function is at least as common, and perhaps as deadly, as HF with reduced LV systolic function.

Two studies published earlier in 2006 showed that heart failure (HF) with preserved left-ventricular systolic function is becoming more common but that the prognosis is not improving (Journal Watch Cardiology Aug 16 2006). Two new studies teach us more about this important clinical syndrome.

In a community-based study, researchers prospectively studied 556 patients (mean age, 76) in Minnesota who had HF according to Framingham diagnostic criteria. Preserved systolic function (LV ejection fraction $≥$ 50%), documented in 55% of the cohort, was associated with older age, female sex, and lack of prior MI. Of the cohort, 44% presented with isolated diastolic dysfunction, assessed with mitral inflow and Doppler tissue imaging of mitral annular motion. Severe diastolic dysfunction was more common in patients with LVEFs <50% than in those with preserved systolic function. Both diastolic dysfunction and reduced LVEF were associated with high brain-type natriuretic peptide levels. The 6-month mortality rate was 16% in both the reduced-LVEF and preserved-LVEF subgroups and remained statistically similar after adjustment for age and sex.

A separate research group used the industry-funded OPTIMIZE-HF registry to study systolic blood pressure levels and outcomes in 41,267 hospitalized patients (mean age, 73) with discharge diagnoses of HF. At admission, 51% had preserved LVEF and 50% had SBP levels >140 mm Hg. Patients with elevated SBP were more likely to be female, to be black, and to have preserved LVEFs. High SBP on admission was associated with significantly reduced in-hospital mortality rates and, in the 10% of the cohort with follow-up data, with reduced 60- and 90-day mortality rates, regardless of whether LVEF was preserved. Consistent with prior findings, overall mortality rates were similar in patients with preserved LVEF and reduced LVEF.

Comment: These studies underscore the clinical importance of HF with preserved LV systolic function and the need to identify effective treatment strategies for this large subgroup of HF patients. HF with preserved LVEF might be even more common than HF with reduced LVEF, and mortality rates appear to be similar in these two subgroups. Conducting clinical treatment trials with large numbers of HF patients with preserved LV function, which has been studied much less than HF with reduced LVEF, is clearly an urgent need.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology November 7, 2006

Citation(s):

Bursi F et al. Systolic and diastolic heart failure in the community. JAMA 2006 Nov 8; 296:2209-16.

Original article (Subscription may be required)
Medline abstract (Free)

Gheorghiade M et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 2006 Nov 8; 296:2217-26.