TY - JOUR
T1 - Implications of peripheral oedema in heart failure with preserved ejection fraction
T2 - a heart failure network analysis
AU - Fudim, Marat
AU - Ashur, Nicolas
AU - Jones, Aaron D.
AU - Ambrosy, Andrew P.
AU - Bart, Bradley A.
AU - Butler, Javed
AU - Chen, Horng H.
AU - Greene, Stephen J.
AU - Reddy, Yogesh
AU - Redfield, Margaret M.
AU - Sharma, Abhinav
AU - Hernandez, Adrian F.
AU - Felker, Gary Michael
AU - Borlaug, Barry A.
AU - Mentz, Robert J.
N1 - Funding Information:
Research reported in this publication (or press release, etc., as necessary) was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number U10 HL084904 (for the coordinating centre) and Award Numbers U10 HL110297, U10 HL110342, U10 HL110309, U10 HL110262, U10 HL110338, U10 HL110312, U10 HL110302, U10 HL110336, and U10 HL110337 (for the regional clinical centres). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
M.F. consults for Axon Therapies, Daxor, Edwards Lifesciences, and Galvani. S.J.G. has received a Heart Failure Society of America/Emergency Medicine Foundation Acute Heart Failure Young Investigator Award funded by Novartis; has received research support from Amgen, AstraZeneca, Bristol Myers Squibb, Merck, and Novartis; serves on advisory boards for Amgen and Cytokinetics; and serves as a consultant for Amgen and Merck. All other authors report no relevant disclosures. A.S. reports funding from the FRSQ‐Junior 1 scholars programme, Bayer‐Canadian Cardiovascular Society, Alberta Innovates Health Solutions, Roche Diagnostics, Takeda, Boehringer‐Ingelheim, and Akcea.
Publisher Copyright:
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology
PY - 2021/2
Y1 - 2021/2
N2 - Aims: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous condition, and tissue congestion manifested by oedema is not present in all patients. We compared clinical characteristics, exercise capacity, and outcomes in patients with HFpEF with and without oedema. Methods and results: This study was a post hoc analysis of pooled data of patients with left ventricular ejection fraction of ≥50% enrolled in the DOSE, CARRESS-HF, RELAX, ATHENA, ROSE, INDIE, and NEAT trials. Patients were dichotomized by the severity of oedema. Cox proportional hazard regression and generalized linear regression models were used to assess associations between oedema, symptoms, and clinical outcomes. The ambulatory cohort included 393 patients (228 with and 165 without oedema), and the hospitalized cohort included 338 patients (249 with ≥moderate oedema and 89 with mild or none). Among ambulatory patients, patients with oedema had a higher body mass index (35.2 kg/m2 [inter-quartile range, IQR 30.5, 41.6] vs. 31.6 kg/m2 [IQR 27.9, 36.3], P < 0.001), greater burden of co-morbidities, higher intravascular pressures estimated on physical examination (elevated jugular venous pressure: 50% vs. 24.7%, P < 0.001), poorer renal function (creatinine: 1.2 mg/dL [IQR 0.9, 1.5] vs. 1 mg/dL [IQR 0.8, 1.3], P = 0.003), and lower peak VO2 (adjusted mean difference −1.04 mL/kg/min, 95% confidence interval [−1.71, −0.37], P < 0.003). Among hospitalized patients, despite greater in-hospital fluid/weight loss in the ≥moderate oedema group, there was no difference in the improvement in dyspnoea by the visual analogue scale or well-being visual analogue scale from baseline to 3–4 days and no statistically significant difference in the rate of 60 day rehospitalization/death (adjusted hazard ratio 1.44, 95% confidence interval [0.87, 2.39], P = 0.156). Conclusions: Patients with HFpEF and oedema display higher body mass, greater burden of co-morbidities, and more severe exercise intolerance, but clinical responses to treatment appear similar. Further research is required to better understand the nature of volume distribution in different HFpEF phenotypes.
AB - Aims: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous condition, and tissue congestion manifested by oedema is not present in all patients. We compared clinical characteristics, exercise capacity, and outcomes in patients with HFpEF with and without oedema. Methods and results: This study was a post hoc analysis of pooled data of patients with left ventricular ejection fraction of ≥50% enrolled in the DOSE, CARRESS-HF, RELAX, ATHENA, ROSE, INDIE, and NEAT trials. Patients were dichotomized by the severity of oedema. Cox proportional hazard regression and generalized linear regression models were used to assess associations between oedema, symptoms, and clinical outcomes. The ambulatory cohort included 393 patients (228 with and 165 without oedema), and the hospitalized cohort included 338 patients (249 with ≥moderate oedema and 89 with mild or none). Among ambulatory patients, patients with oedema had a higher body mass index (35.2 kg/m2 [inter-quartile range, IQR 30.5, 41.6] vs. 31.6 kg/m2 [IQR 27.9, 36.3], P < 0.001), greater burden of co-morbidities, higher intravascular pressures estimated on physical examination (elevated jugular venous pressure: 50% vs. 24.7%, P < 0.001), poorer renal function (creatinine: 1.2 mg/dL [IQR 0.9, 1.5] vs. 1 mg/dL [IQR 0.8, 1.3], P = 0.003), and lower peak VO2 (adjusted mean difference −1.04 mL/kg/min, 95% confidence interval [−1.71, −0.37], P < 0.003). Among hospitalized patients, despite greater in-hospital fluid/weight loss in the ≥moderate oedema group, there was no difference in the improvement in dyspnoea by the visual analogue scale or well-being visual analogue scale from baseline to 3–4 days and no statistically significant difference in the rate of 60 day rehospitalization/death (adjusted hazard ratio 1.44, 95% confidence interval [0.87, 2.39], P = 0.156). Conclusions: Patients with HFpEF and oedema display higher body mass, greater burden of co-morbidities, and more severe exercise intolerance, but clinical responses to treatment appear similar. Further research is required to better understand the nature of volume distribution in different HFpEF phenotypes.
KW - Congestion
KW - Heart failure
KW - Oedema
UR - http://www.scopus.com/inward/record.url?scp=85097319711&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85097319711&partnerID=8YFLogxK
U2 - 10.1002/ehf2.13159
DO - 10.1002/ehf2.13159
M3 - Article
C2 - 33300277
AN - SCOPUS:85097319711
VL - 8
SP - 662
EP - 669
JO - ESC heart failure
JF - ESC heart failure
SN - 2055-5822
IS - 1
ER -