Clinical, Echocardiographic, and Therapeutic Characteristics of Heart Failure in Patients with Preserved, Mid-Range, and Reduced Ejection Fraction: Future Directions

Figures & data

Table 1 Clinical and Echocardiographic Characteristics of Study Population

	HFpEF n=105 (36.46%)	HFmrEF n=49 (17.01%)	HFrEF n=134 (46.53%)	P value
Age (years)	63.00 ± 13.27	62.57± 14.01	62.35 ± 13.27	0.933
Sex (Males)	51 (48.57%)	32 (65.31%)	104 (77.61%)	<0.001
Height (cm)	160.68 ± 10.18	160.10 ± 8.22	164.23 ± 8.96	0.004
Weight (Kg)	80.00 (70.00, 95.00)	78.85 (70.00, 86.75)	72.00 (64.70, 87.00)	0.030
BMI	31.45 (26.40, 36.70)	29.85 (25.77, 34.18)	26.60 (23.70, 31.70)	<0.001
Systemic Hypertension	84 (80.00%)	40 (81.63%)	101 (75.37%)	0.559
Diabetes mellitus type 1	3 (2.86%)	2 (4.08%)	3 (2.24%)	0.797
Diabetes mellitus type 2	70 (66.67%)	34 (69.39%)	95 (70.90%)	0.781
Ischemic heart disease	67 (63.81%)	36 (73.47%)	104 (77.61%)	0.060
Atrial fibrillation*	22 (24.18%)	5 (13.16%)	20 (18.69%)	0.329
eGFR (mL/min/1.73m^2)	69.70 ± 26.86	69.31 ± 24.66	68.54 ± 24.31	0.939
Serum creatinine (mg/dL)	1.00 (0.83, 1.30)	1.06 (0.90, 1.30)	1.10 (0.90, 1.39)	0.084
Uric acid (mg/dL)**	6.14 ± 1.86	6.47 ± 1.78	7.11 ± 2.57	0.131
Glycated hemoglobin (%)***	7.20 (6.30, 9.30)	7.15 (6.38, 8.15)	7.45 (6.40, 9.05)	0.849
Total cholesterol (mg/dL)	148.00 (129.00, 169.00)	145.00 (126.25, 186.75)	138.00 (116.00, 168.00)	0.101
Triglycerides (mg/dL)	121.24 (78.00, 186.00)	134.00 (89.46, 162.07)	97.00 (68.14, 142.00)	0.005
HDL-Ch (mg/dL)	37.00 (31.00, 45.00)	36.00 (31.00, 42.92)	34.42 (28.00, 42.50)	0.130
LDL-Ch (mg/dL)	80.00 (63.03, 99.00)	90.00 (71.00, 118.00)	81.20 (64.80, 108.50)	0.365
Serum hemoglobin (g/dL)	12.89 ± 1.88	13.22 ± 1.68	13.32 ± 1.90	0.250
SBP (mmHg)	131.07 ± 17.34	126.76 ± 20.77	122.48 ± 17.67	0.002
DBP (mmHg)	72.77 ± 12.59	71.39 ± 11.90	71.89 ± 11.16	0.760
HR (/min)	75.00 (67.00, 86.00)	75.00 (65.00, 83.00)	76.50 (67.00, 86.00)	0.416
LVM (grams)	170.00 (132.00, 224.00)	174.00 (139.00, 224.50)	226.00 (169.00, 272.00)	<0.001
LVMI (g/cm^2)	89.00 (67.00, 115.00)	92.50 (75.00, 116.75)	121.00 (94.50, 151.50)	<0.001
Ejection fraction (%)	55.00 (55.00, 60.00)	44.00 (40.00, 45.00)	30.00 (23.00, 35.00)	<0.001
LV geometry^¥				<0.001
Normal	33 (32.04%)	27 (55.10%)	43 (32.58%)
Concentric remodeling	37 (35.92%)	7 (14.29%)	5 (3.79%)
Eccentric hypertrophy	13 (12.62%)	7 (14.29%)	72 (54.55%)
Concentric hypertrophy	20 (19.42%)	8 (16.33%)	12 (9.09%)
Diastolic function^€				<0.001
Normal	15 (19.74%)	2 (5.41%)	2 (2.20%)
Impaired relaxation	50 (65.79%)	24 (64.86%)	37 (40.66%)
Pseudonormal pattern	9 (11.84%)	10 (27.03%)	34 (37.36%)
Restrictive pattern	2 (2.63%)	1 (2.70%)	18 (19.78%)

Notes: *Data from 236 patients **From 105 patients; ***From 207 patients, ^¥From 284 patients, and ^€From 204 patients.

Abbreviations: BMI, body mass index; eGFR, estimated glomerular filtration rate; HDL, high-density lipoprotein; LDL, low-density lipoprotein; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; LVM, left ventricular mass; LVMI, left ventricular mass index; LV, left ventricular.

Figure 1 Body mass index and sex distribution among the 3 categories of heart failure. BMI comparison – Kruskal–Wallis test (P<0.001). Sex comparison – Chi-square test (P<0.001).

Table 2 Pharmacological Management of Study Population

Pharmacological Class	HFpEF n=105 (36.46%)	HFmrEF n=49 (17.01%)	HFrEF n=134 (46.53%)	P value
Heart failure medications
Angiotensin converting enzyme inhibitors	44 (41.90%)	30 (61.22%)	81 (60.45%)	0.009
Angiotensin receptor antagonists	40 (38.10%)	17 (34.69%)	42 (31.34%)	0.446
Beta-blockers	84 (80.00%)	45 (91.84%)	112 (83.58%)	0.180
Calcium channel blockers	34 (32.38%)	11 (22.45%)	26 (19.40%)	0.064
Thiazide diuretics	24 (22.86%)	10 (20.41%)	18 (13.43%)	0.153
Loop diuretics	65 (61.90%)	32 (65.31%)	107 (79.85%)	0.007
Aldosterone receptor antagonists	21 (20.00%)	17 (34.69%)	76 (56.72%)	<0.001
Aspirin	81 (77.14%)	44 (89.80%)	114 (85.07%)	0.102
Clopidogrel	38 (36.19%)	22 (44.90%)	56 (41.79%)	0.524
Statins	69 (65.71%)	42 (85.71%)	105 (78.36%)	0.013
Nitrates	24 (22.86%)	17 (34.69%)	51 (38.06%)	0.039
Digoxin*	9 (9.89%)	4 (10.53%)	23 (21.50%)	0.052
Warfarin*	14 (15.38%)	5 (13.16%)	18 (16.82%)	0.863
Diabetes mellitus medications
Insulin	36 (34.29%)	19 (38.78%)	51 (38.06%)	0.795
Sulphonylureas	21 (20.00%)	6 (12.24%)	37 (27.61%)	0.068
Metformin	38 (36.19%)	23 (46.94%)	57 (42.54%)	0.397
Dipeptidyl peptidase-4 inhibitors	16 (15.24%)	8 (16.33%)	9 (6.72%)	0.061

Note: *Data from 236 patients.

Figure 2 Kaplan–Meier survival analysis in patient’s population based on ejection fraction.

Abbreviations: HFpEF, heart failure with preserved ejection fraction; HFmrEF, heart failure with mid-range ejection fraction; HFrEF, heart failure with reduced ejection fraction.