Open AccessImplications of peripheral oedema in heart failure with preserved ejection fraction: a heart failure network analysis
Author(s) -
Fudim Marat,
Ashur Nicolas,
Jones Aaron D.,
Ambrosy Andrew P.,
Bart Bradley A.,
Butler Javed,
Chen Horng H.,
Greene Stephen J.,
Reddy Yogesh,
Redfield Margaret M.,
Sharma Abhinav,
Hernandez Adrian F.,
Felker Gary Michael,
Borlaug Barry A.,
Mentz Robert J.
Publication year - 2021
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13159
Subject(s) - medicine , ejection fraction , heart failure , peripheral edema , hazard ratio , cardiology , ambulatory , confidence interval , quartile , proportional hazards model , heart failure with preserved ejection fraction , renal function , cohort , adverse effect
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/m 2 [inter‐quartile range, IQR 30.5, 41.6] vs. 31.6 kg/m 2 [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 VO 2 (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.