Are there differences in clinical characteristics in patients with heart failure symptoms across different heart failure phenotypes?
T Popov, A Gvozdenovic, S Cemerlic Maksimovic, D Andric, V Todic, I Popov, V Lecic, J TripunovicAbstract
Abstract
Introduction and aim: Heart failure is defined by insufficient pumping function of the heart or increased filling pressure, regardless of the ejection fraction. However, the decision on the treatment is mostly guided by the values of the ejection fraction. Are there differences in clinical characteristics in patients with symptoms of heart failure depending on the ejection fraction is the topic of this research.
Methods
The research included 388 patients treated at the Heart Failure Clinic due to exacerbation of chronic heart failure during 2022/2023, of which 277 had HFrEF, 45 HFmrEF, 66 HFpEF. The clinical findings of the examined patients were analyzed.
Results
Patients with HFpEF were older, average 73 years, HFmrEF 70 years, HFrEF 66 years, p<0.05. In the HFrEF group, men predominate 82%, in HFpEF 42%, p=0.001, while in HFmrEF 69% were men. Patients with HFPEF had a higher systolic blood pressure of 138 mmHg, compared to 122 mmHg in HFrEF p=0.02, while HFmrEF had 133 mmHg. Ischemic heart disease was present in 69% of patients with HFrEF and HFmrEF, and in 50% of patients with HFpEF, p>0.05. Patients with HFrEF had larger left ventricular dimensions (left ventricular diameter in diastole in HFrEF, HFmrEF, HFpEF respectively 6.1cm, 5.1cm, 4.7cm) and volume (left ventricular end-diastolic volume 184ml, 116ml, 87ml), thinner walls (diastolic septal thickness 1.12cm, 1.16cm, 1.21cm), while those differences are not statistically significant between the HFmrEF and HFpEF groups. Patients with HFmrEF and HFpEF had higher right ventricular systolic pressure (49mmHg versus 42mmHg in HfrEF, p=0.014. Patients with HFrEF had higher NTproBNP compared to the other groups (15304pg/ml; 10397pg/ml; 7270pg/ml), while patients with HFpEF had lower serum hemoglobin 116g/l, HFmrEF 122g/l, HFrEF 136g/l, p<0.005. There were no statistically significant differences in other laboratory findings, as well as in the presence of comorbidities between the examined heart failure phenotypes. Hospital mortality was 5% in the HFrEF group and 27% in the HFpEF group, while it was 6% in the HFmrEF group, p=0,001.
Conclusion
Most of patients hospitalized due to acute heart failure are patients with HFrEF, however, patients with HFpEF have higher in-hospital mortality.