Incidence of chronic heart failure with preserved left ventricular ejection fraction in patients with hypertension and isolated mild diastolic dysfunction

INTRODUCTION Heart failure (HF) with preserved ejection fraction (HFPEF) is still a challenge in clinical practice. The prognosis of patients with HFPEF is similar to or only slightly better than that of patients with HF with reduced ejection fraction (HFREF). Impaired relaxation is the mildest form of diastolic dysfunction, which should not be accompanied by symptoms of HFPEF. OBJECTIVES The aim of the study was to assess the incidence of chronic HFPEF in patients with hypertension and isolated mild diastolic dysfunction. PATIENTS AND METHODS It was a cross-sectional study including 210 patients (mean age, 56.11 +/- 6.24 years; women, 58%) with isolated abnormalities of left ventricular relaxation and arterial hypertension. In addition, we identified patients with type 2 diabetes to compare the incidence of HFPEF between patients with and without diabetes. HFPEF was diagnosed when clinical symptoms of HF were present simultaneously with echocardiographic markers of elevated left ventricular diastolic pressure, pulmonary congestion on chest X-ray, or elevated serum brain natriuretic peptide (BNP) levels. RESULTS HFPEF was diagnosed in 42% of the patients with impaired relaxation. An elevated left atrial volume index (> 34 ml/m(2)) was observed in 38% of the patients; E/e' ratio exceeding 8, in 37%; elevated BNP levels, in 39%; and pulmonary congestion on chest X-ray, in 41%. Independent predictors of HFPEF were age, systolic blood pressure of 140 mmHg or higher, type 2 diabetes, coronary artery disease, and an estimated glomerular filtration rate of less than 60 ml/min/1.73 m(2). In diabetic patients, a positive correlation was found between an insulin dose (> 80 units/day) and BNP levels. CONCLUSIONS Patients with isolated relaxation abnormalities constitute a clinically heterogeneous group because some of these individuals present with symptoms of HFPEF and a simultaneous increase in BNP levels. Therefore, the question of whether diastolic dysfunction is mild should be readdressed, and it should be emphasized that these patients have a serious prognosis with the risk of HF. In diabetic patients, a positive correlation between high insulin doses and BNP levels requires further research.