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Prognostic implications of coronary artery disease and stress tests in patients with elevated left ventricular filling pressure and preserved ejection fraction

BACKGROUND: The prognostic role of myocardial ischemia in patients with heart failure with preserved ejection fraction (HFpEF) has not been fully elucidated. Therefore, we investigated the change in echocardiographic parameters and clinical outcomes based on the presence of epicardial coronary arter...

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Autores principales: Seo, Jeong Hun, Hong, David, Youn, Taeho, Lee, Seung Hun, Choi, Ki Hong, Kim, Darae, Park, Taek Kyu, Lee, Joo Myung, Song, Young Bin, Choi, Jin-Oh, Hahn, Joo-Yong, Choi, Seung-Hyuk, Gwon, Hyeon-Cheol, Jeon, Eun-Seok, Yang, Jeong Hoon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9421048/
https://www.ncbi.nlm.nih.gov/pubmed/36046188
http://dx.doi.org/10.3389/fcvm.2022.955731
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author Seo, Jeong Hun
Hong, David
Youn, Taeho
Lee, Seung Hun
Choi, Ki Hong
Kim, Darae
Park, Taek Kyu
Lee, Joo Myung
Song, Young Bin
Choi, Jin-Oh
Hahn, Joo-Yong
Choi, Seung-Hyuk
Gwon, Hyeon-Cheol
Jeon, Eun-Seok
Yang, Jeong Hoon
author_facet Seo, Jeong Hun
Hong, David
Youn, Taeho
Lee, Seung Hun
Choi, Ki Hong
Kim, Darae
Park, Taek Kyu
Lee, Joo Myung
Song, Young Bin
Choi, Jin-Oh
Hahn, Joo-Yong
Choi, Seung-Hyuk
Gwon, Hyeon-Cheol
Jeon, Eun-Seok
Yang, Jeong Hoon
author_sort Seo, Jeong Hun
collection PubMed
description BACKGROUND: The prognostic role of myocardial ischemia in patients with heart failure with preserved ejection fraction (HFpEF) has not been fully elucidated. Therefore, we investigated the change in echocardiographic parameters and clinical outcomes based on the presence of epicardial coronary artery disease (CAD) and positive stress tests in HFpEF patients. METHODS: Symptomatic patients with left ventricular end diastolic pressure ≥15 mmHg who underwent coronary angiography were analyzed between January 2000 and August 2019 after exclusion of patients with acute coronary syndrome. RESULTS: A total of 555 HFpEF patients were invasively confirmed, 285 (51%) had angiographically-proven CAD. HFpEF patients with CAD displayed greater deterioration in left ventricular ejection fraction (p = 0.002) over time but this was not observed in those without CAD (p = 0.99) on follow-up echocardiography; however, the mitral annulus early diastolic velocity (e') was significantly decreased in both groups (p < 0.001 and p = 0.003, respectively). Among 274 patients that received stress tests, those with positive stress tests showed a decline in e' (p 0.001), but this was not found in subjects with negative stress tests (p = 0.44). There was no significant difference in all-cause mortality between patients with CAD and without CAD (p = 0.26) with a median follow-up of 10.6 years. CONCLUSION: In HFpEF patients, CAD was associated with greater deterioration in the left ventricular systolic function but not with mortality during the follow-up. In addition, myocardial ischemia with a positive stress test may contribute to greater deterioration of diastolic dysfunction.
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spelling pubmed-94210482022-08-30 Prognostic implications of coronary artery disease and stress tests in patients with elevated left ventricular filling pressure and preserved ejection fraction Seo, Jeong Hun Hong, David Youn, Taeho Lee, Seung Hun Choi, Ki Hong Kim, Darae Park, Taek Kyu Lee, Joo Myung Song, Young Bin Choi, Jin-Oh Hahn, Joo-Yong Choi, Seung-Hyuk Gwon, Hyeon-Cheol Jeon, Eun-Seok Yang, Jeong Hoon Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: The prognostic role of myocardial ischemia in patients with heart failure with preserved ejection fraction (HFpEF) has not been fully elucidated. Therefore, we investigated the change in echocardiographic parameters and clinical outcomes based on the presence of epicardial coronary artery disease (CAD) and positive stress tests in HFpEF patients. METHODS: Symptomatic patients with left ventricular end diastolic pressure ≥15 mmHg who underwent coronary angiography were analyzed between January 2000 and August 2019 after exclusion of patients with acute coronary syndrome. RESULTS: A total of 555 HFpEF patients were invasively confirmed, 285 (51%) had angiographically-proven CAD. HFpEF patients with CAD displayed greater deterioration in left ventricular ejection fraction (p = 0.002) over time but this was not observed in those without CAD (p = 0.99) on follow-up echocardiography; however, the mitral annulus early diastolic velocity (e') was significantly decreased in both groups (p < 0.001 and p = 0.003, respectively). Among 274 patients that received stress tests, those with positive stress tests showed a decline in e' (p 0.001), but this was not found in subjects with negative stress tests (p = 0.44). There was no significant difference in all-cause mortality between patients with CAD and without CAD (p = 0.26) with a median follow-up of 10.6 years. CONCLUSION: In HFpEF patients, CAD was associated with greater deterioration in the left ventricular systolic function but not with mortality during the follow-up. In addition, myocardial ischemia with a positive stress test may contribute to greater deterioration of diastolic dysfunction. Frontiers Media S.A. 2022-08-15 /pmc/articles/PMC9421048/ /pubmed/36046188 http://dx.doi.org/10.3389/fcvm.2022.955731 Text en Copyright © 2022 Seo, Hong, Youn, Lee, Choi, Kim, Park, Lee, Song, Choi, Hahn, Choi, Gwon, Jeon and Yang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Seo, Jeong Hun
Hong, David
Youn, Taeho
Lee, Seung Hun
Choi, Ki Hong
Kim, Darae
Park, Taek Kyu
Lee, Joo Myung
Song, Young Bin
Choi, Jin-Oh
Hahn, Joo-Yong
Choi, Seung-Hyuk
Gwon, Hyeon-Cheol
Jeon, Eun-Seok
Yang, Jeong Hoon
Prognostic implications of coronary artery disease and stress tests in patients with elevated left ventricular filling pressure and preserved ejection fraction
title Prognostic implications of coronary artery disease and stress tests in patients with elevated left ventricular filling pressure and preserved ejection fraction
title_full Prognostic implications of coronary artery disease and stress tests in patients with elevated left ventricular filling pressure and preserved ejection fraction
title_fullStr Prognostic implications of coronary artery disease and stress tests in patients with elevated left ventricular filling pressure and preserved ejection fraction
title_full_unstemmed Prognostic implications of coronary artery disease and stress tests in patients with elevated left ventricular filling pressure and preserved ejection fraction
title_short Prognostic implications of coronary artery disease and stress tests in patients with elevated left ventricular filling pressure and preserved ejection fraction
title_sort prognostic implications of coronary artery disease and stress tests in patients with elevated left ventricular filling pressure and preserved ejection fraction
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9421048/
https://www.ncbi.nlm.nih.gov/pubmed/36046188
http://dx.doi.org/10.3389/fcvm.2022.955731
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