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Edelmann, F; Gelbrich, G; Duvinage, A; Stahrenberg, R; Behrens, A; Prettin, C; Kraigher-Krainer, E; Schmidt, AG; Düngen, HD; Kamke, W; Tschöpe, C; Herrmann-Lingen, C; Halle, M; Hasenfuss, G; Wachter, R; Pieske, B.
Differential interaction of clinical characteristics with key functional parameters in heart failure with preserved ejection fraction--results of the Aldo-DHF trial.
Int J Cardiol. 2013; 169(6):408-417 Doi: 10.1016/j.ijcard.2013.10.018 [OPEN ACCESS]
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Co-Autor*innen der Med Uni Graz

Kraigher-Krainer Elisabeth

Pieske Burkert Mathias

Schmidt Albrecht

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Abstract:

To investigate the interaction of clinical characteristics with disease characterising parameters in heart failure with preserved ejection fraction (HFpEF). Methods and results In the multicenter, randomized, placebo-controlled, double-blinded, Aldo-DHF trial investigating the effects of spironolactone on exercise capacity (peakVO2) and diastolic function (E/e') n=422 patients with HFpEF (age 67 ± 8 years, 52% females, LVEF 67 ± 8%) were included. After multiple adjustment, higher age was significantly related to reduced peakVO2, and to increased E/e', NT-proBNP, LAVI as well as LVMI (all p<0.05). Female gender (p<0.001), CAD (p=0.002), BMI (p<0.001), sleep apnoea (p=0.02), and chronotropic incompetence (CI, p=0.002) were related to lower peakVO2 values. Higher pulse pressure (p=0.04), lower heart rates (p=0.03), CI (p=0.03) and beta-blocker treatment (p=0.001) were associated with higher E/e'. BMI correlated inversely (p=0.03), whereas atrial fibrillation (p<0.001), lower haemoglobin levels (p<0.001), CI (p=0.02), and beta-blocker treatment (p<0.001) were associated with higher NT-proBNP. After multiple adjustment for demographic and clinical variables peakVO2 was not significantly associated with E/e' (r=+0.01, p=0.87), logNT-proBNP (r=0.09, p=0.08), LAVI (r=+0.03, p=0.55), and LVMI (r=+0.05, p=0.37). The associations of E/e' with logNT-proBNP (r=0.21, p<0.001), LAVI (r=+0.29, p<0.001) and LVMI (r=0.09, p=0.06) were detectable also after multiple adjustment. Demographic and clinical characteristics differentially interact with exercise capacity, resting left ventricular filling index, neurohumoral activation, and left atrial and ventricular remodelling in HFpEF. Exercise intolerance in HFpEF is multi-factorial and therapeutic approaches addressing exercise capacity should therefore not only aim to improve single pathological mechanisms. ISRCTN94726526 (http://www.controlled-trials.com), Eudra-CT-number 2006-002605-31. © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

Find related publications in this database (using NLM MeSH Indexing)

Aged -

Cohort Studies -

Double-Blind Method -

Exercise Tolerance - drug effects

Female -

Heart Failure - diagnosis

Humans -

Male -

Middle Aged -

Mineralocorticoid Receptor Antagonists - pharmacology

Prospective Studies -

Spironolactone - pharmacology

Stroke Volume - drug effects

Find related publications in this database (Keywords)

Heart failure with preserved ejection fraction

Aldosterone receptor blockade

Exercise capacity

Diastolic function

Neurohumoral activation

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