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Cardiac volume regulation: transition among two phenotypes in heart failure (1073.2)
Author(s) -
Kerkhof Peter,
Li John,
Kresh J,
Heyndrickx Guy
Publication year - 2014
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.28.1_supplement.1073.2
Subject(s) - cardiology , medicine , heart failure , ejection fraction
Background. Guidelines for heart failure (HF) with preserved ejection fraction (pEF) dictate that left ventricular (LV) end‐diastolic pressure > 16 mmHg, EF > 50% and end‐diastolic volume index (EDVI) < 97 mL/m2. Only half of HF patients (pts) present with a classical pattern of reduced EF (rEF). Prevalence of transition from HFpEF to HFrEF reportedly constitutes (either way) as much as 39%. The volume regulation graph (VRG) is explored to theoretically elucidate this occurrence. Methods. LV EDVI and end‐systolic volume index (ESVI) by angiography are analyzed in 48 pts receiving betablockers, with HFpEF (n=35) and HFrEF (n=13) subgroups. Regression analysis for ESVI to EDVI yields VRG. The 2SE ranges and 98% CI limits show potential transition to the complementary territory. Results. For pEF: ESVI = 0.31 EDVI ‐ 2.55, r=0.51 and for rEF: ESVI = 0.66 EDVI ‐ 5.45, r=0.95. The 2SE zones show overlap, suggesting occurrence of transition, especially for 50 < ESVI < 100 mL/m2. An additional group of 44 pts with follow‐up (ranging from 27 to 2385 days) reveals that over time ESVI may decrease by 50% or increase by up to 250%, thus demonstrating LV volumetric plasticity. Notably, about 25% of HFpEF pts can transit to HFrEF territory with a 10% increase in ESVI, while some 40% would convert to HFpEF with a 10% reduction in ESVI. Conclusions. The VRG explains considerable transition from HFrEF to HFpEF and v.v., requiring only a 10% change of ESVI, or roughly a 10% alteration in EF. The novel VRG construct confirms observations from other longitudinal studies.