Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community

Carolyn S P Lam, Asya Lyass, Elisabeth Kraigher-Krainer, Joseph M. Massaro, Douglas S. Lee, Jennifer E. Ho, Daniel Levy, Margaret May Redfield, Burkert M. Pieske, Emelia J. Benjamin, Ramachandran S. Vasan

Research output: Contribution to journalArticle

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Abstract

BACKGROUND-: Heart failure (HF) is a clinical syndrome characterized by signs and symptoms involving multiple organ systems. Longitudinal data demonstrating that asymptomatic cardiac dysfunction precedes overt HF are scarce, and the contribution of noncardiac dysfunction to HF progression is unclear. We hypothesized that subclinical cardiac and noncardiac organ dysfunction would accelerate the manifestation of HF. METHODS AND RESULTS-: We studied 1038 participants of the Framingham Heart Study original cohort (mean age, 76±5 years; 39% men) with routine assessment of left ventricular systolic and diastolic function. Major noncardiac organ systems were assessed with the use of serum creatinine (renal), serum albumin (hepatic), ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1:FVC ratio; pulmonary), hemoglobin concentration (hematologic/oxygen-carrying capacity), and white blood cell count (systemic inflammation). On follow-up (mean, 11 years), there were 248 incident HF events (146 in women). After adjustment for established HF risk factors, antecedent left ventricular systolic dysfunction (hazard ratio, 2.33; 95% confidence interval, 1.43 to 3.78) and diastolic dysfunction (hazard ratio, 1.32; 95% confidence interval, 1.01 to 1.71) were associated with increased HF risk. After adjustment for cardiac dysfunction, higher serum creatinine, lower FEV1:FVC ratios, and lower hemoglobin concentrations were associated with increased HF risk (all P<0.05); serum albumin and white blood cell count were not. Subclinical dysfunction in each noncardiac organ system was associated with a 30% increased risk of HF (P=0.013). CONCLUSIONS-: Antecedent cardiac dysfunction and noncardiac organ dysfunction are associated with increased incidence of HF, supporting the notion that HF is a progressive syndrome and underscoring the importance of noncardiac factors in its occurrence.

Original languageEnglish (US)
Pages (from-to)24-30
Number of pages7
JournalCirculation
Volume124
Issue number1
DOIs
StatePublished - Jul 5 2011

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Heart Failure
Leukocyte Count
Serum Albumin
Creatinine
Hemoglobins
Confidence Intervals
Vital Capacity
Conservation of Natural Resources
Forced Expiratory Volume
Left Ventricular Dysfunction
Serum
Signs and Symptoms
Cohort Studies
Oxygen
Inflammation
Kidney
Lung
Liver
Incidence

Keywords

  • echocardiography
  • epidemiology
  • heart failure
  • risk factors

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community. / Lam, Carolyn S P; Lyass, Asya; Kraigher-Krainer, Elisabeth; Massaro, Joseph M.; Lee, Douglas S.; Ho, Jennifer E.; Levy, Daniel; Redfield, Margaret May; Pieske, Burkert M.; Benjamin, Emelia J.; Vasan, Ramachandran S.

In: Circulation, Vol. 124, No. 1, 05.07.2011, p. 24-30.

Research output: Contribution to journalArticle

Lam, CSP, Lyass, A, Kraigher-Krainer, E, Massaro, JM, Lee, DS, Ho, JE, Levy, D, Redfield, MM, Pieske, BM, Benjamin, EJ & Vasan, RS 2011, 'Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community', Circulation, vol. 124, no. 1, pp. 24-30. https://doi.org/10.1161/CIRCULATIONAHA.110.979203
Lam, Carolyn S P ; Lyass, Asya ; Kraigher-Krainer, Elisabeth ; Massaro, Joseph M. ; Lee, Douglas S. ; Ho, Jennifer E. ; Levy, Daniel ; Redfield, Margaret May ; Pieske, Burkert M. ; Benjamin, Emelia J. ; Vasan, Ramachandran S. / Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community. In: Circulation. 2011 ; Vol. 124, No. 1. pp. 24-30.
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abstract = "BACKGROUND-: Heart failure (HF) is a clinical syndrome characterized by signs and symptoms involving multiple organ systems. Longitudinal data demonstrating that asymptomatic cardiac dysfunction precedes overt HF are scarce, and the contribution of noncardiac dysfunction to HF progression is unclear. We hypothesized that subclinical cardiac and noncardiac organ dysfunction would accelerate the manifestation of HF. METHODS AND RESULTS-: We studied 1038 participants of the Framingham Heart Study original cohort (mean age, 76±5 years; 39{\%} men) with routine assessment of left ventricular systolic and diastolic function. Major noncardiac organ systems were assessed with the use of serum creatinine (renal), serum albumin (hepatic), ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1:FVC ratio; pulmonary), hemoglobin concentration (hematologic/oxygen-carrying capacity), and white blood cell count (systemic inflammation). On follow-up (mean, 11 years), there were 248 incident HF events (146 in women). After adjustment for established HF risk factors, antecedent left ventricular systolic dysfunction (hazard ratio, 2.33; 95{\%} confidence interval, 1.43 to 3.78) and diastolic dysfunction (hazard ratio, 1.32; 95{\%} confidence interval, 1.01 to 1.71) were associated with increased HF risk. After adjustment for cardiac dysfunction, higher serum creatinine, lower FEV1:FVC ratios, and lower hemoglobin concentrations were associated with increased HF risk (all P<0.05); serum albumin and white blood cell count were not. Subclinical dysfunction in each noncardiac organ system was associated with a 30{\%} increased risk of HF (P=0.013). CONCLUSIONS-: Antecedent cardiac dysfunction and noncardiac organ dysfunction are associated with increased incidence of HF, supporting the notion that HF is a progressive syndrome and underscoring the importance of noncardiac factors in its occurrence.",
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AU - Lyass, Asya

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AU - Massaro, Joseph M.

AU - Lee, Douglas S.

AU - Ho, Jennifer E.

AU - Levy, Daniel

AU - Redfield, Margaret May

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AU - Benjamin, Emelia J.

AU - Vasan, Ramachandran S.

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