Detection of Early Heart Failure with Preserved Ejection Fraction (HFpEF) in Metabolic Syndrome Patients Detected as Part of a National Screening Programme in Middle Aged Subjects

Authors

  • Jelena Čelutkienė Santariškių 2, LT-08661 Vilnius, Lithuania
  • Aistė Monika Jakštaitė Santariškių 2, LT-08661 Vilnius, Lithuania
  • Jolita Badarienė Santariškių 2, LT-08661 Vilnius, Lithuania
  • Svetlana Solovjova Santariškių 2, LT-08661 Vilnius, Lithuania
  • Ieva Slivovskaja Santariškių 2, LT-08661 Vilnius, Lithuania
  • Rokas Navickas Santariškių 2, LT-08661 Vilnius, Lithuania
  • Edita Kazėnaitė Santariškių 2, LT-08661 Vilnius, Lithuania
  • Egidija Rinkūnienė Santariškių 2, LT-08661 Vilnius, Lithuania
  • Alma Čypienė Santariškių 2, LT-08661 Vilnius, Lithuania
  • Jonas Misiūra Santariškių 2, LT-08661 Vilnius, Lithuania
  • Ligita Ryliškytė Santariškių 2, LT-08661 Vilnius, Lithuania
  • Aleksandras Laucevičius Santariškių 2, LT-08661 Vilnius, Lithuania
  • Andrew Coats Editor-in-Chief, Academic Vice-President, Monash University, Australia and University of Warwick, UK http://orcid.org/0000-0002-2771-4260

DOI:

https://doi.org/10.17987/icfj.v13i0.550

Keywords:

heart failure with preserved ejection fraction, metabolic syndrome, arterial stiffness, early detection

Abstract

Aims: To investigate if community detected Metabolic Syndrome (MetS) is associated with the burden of incipient HFpEF in the community. Methods and Results: We prospectively studied 148 consecutive MetS patients identified from the Lithuanian High Cardiovascular Risk primary prevention programme and investigated them further for unknown HFpEF through cardiopulmonary stress testing as well as assessment of BNP levels and of arterial stiffness. Subjects with a peak VO2 value lower than 90% of predicted and/or BNP≥35 ng/l were categorized as having early phase HFpEF. For comparison of this early phase HFpEF with others already clinically diagnosed with HFpEF, patients with both established HFpEF and MetS were selected retrospectively from patients attending our cardiopulmonary stress testing laboratory (n=38). Two thirds of the screening programme-derived MetS population (n=96) demonstrated a reduced exercise capacity and/or an elevated BNP, indicating signs of early HFpEF. Both the clinically diagnosed HFpEF and the screening programme detected MetS group with early HFpEF demonstrated similarly decreased exercise tolerance evaluated by peak oxygen uptake (79.8 ± 22.1% vs 82.7 ± 14.0%, p>0.05). Analysis of arterial markers in the screening programme group revealed statistically significant differences of augmentation index values between groups with and without signs of early HFpEF (p=0.016).Conclusion: A considerable proportion of patients having MetS may be diagnosed with previously undetected early stage HFpEF. The use of objective parameters of exercise capacity and neurohormonal activation might be effectively used for the early detection of HFpEF. Also early HFpEF in this setting is found to be associated with increased arterial stiffness.

 

Author Biography

Andrew Coats, Editor-in-Chief, Academic Vice-President, Monash University, Australia and University of Warwick, UK

Andrew holds a MB and BChir from Cambridge, an MA and DM from Oxford, a DSc. from Imperial College, and an MBA from London Business School. Andrew served as the Inaugural Viscount Royston Professor of Cardiology at the National Heart and Lung Institute in London, as Director of Cardiology of the Royal Brompton and Harefield NHS trust as Head of Clinical Cardiology at Imperial College, as Dean of Medicine at the University of Sydney, as Deputy Vice-Chancellor of Sydney, and as CEO of the Norwich Research Park. He is presently Academic Vice-President of Monash University, Australia and the University of Warwick, UK and Director of the Monash-Warwick Alliance.

Andrew has published in excess of 1400 publications and has more than 52,000 career citations, and a personal H-index of 106. He has been Editor-in-Chief of the International Journal of Cardiology since 1999 and has received the Linacre Medal of the Royal College of Physicians and the inaugural Michael L Pollock award of the American Heart Association. He has been Chairman or Committee member of the following major Cardiovascular Trials: CHRISTMAS, CHARM, COPERNICUS, OXAM, OPTIMAAL, OVERTURE, REPLACE and SENIORS. Andrew also has more than 20 patents, and has two successful spin-out companies which have generated more than £30Million in investment.  

Andrew has more than 30 board years of experience as a director across the health and biotechnology, sectors (including Myotec, PsiOxus, Cardiodirect, Primary Heart Care, Lone Star Heart Inc, the Harley Street Group) and in the not-for-profit sector (including the George Institute, the Centenary Institute, ANZAC Institute of Medical Research, Sydney Cancer Centre Foundation, Colney Innovations Limited, and the Woolcock Institute of Medical Research).

References

Berghöfer, A., Pischon, T., Reinhold, T., Apovian, C. M., Sharma, A. M., Willich, S. N. Obesity prevalence from a European perspective: a systematic review. BMC public health 2008; 8.1: 200.

Tamariz L, Hassan B, Palacio A, Arcement L, Horswell R, Hebert K. Metabolic syndrome increases mortality in heart failure. Clin Cardiol 2009; 32.6: 327-331.

Ferrari R, Böhm M, Cleland G.F. J, Paulus J.S. W, Pieske B, Rapezzi C, Tavazzi L. Heart failure with preserved ejection fraction: uncertainties and dilemmas. Eur J Heart Fail 2015; 17.7: 665-671.

Horwich TB, Fonarow GC. Glucose, Obesity, Metabolic Syndrome, and Diabetes. Relevance to Incidence of Heart Failure. JACC 2010; 55.4: 283-293.

Perrone-Filardi P, Paolillo S, Costanzo P, Savarese G, Trimarco B, Bonow RO. The role of metabolic syndrome in heart failure. Eur Heart J 2015; 36.39: 2630-2634.

De Las Fuentes L, Brown AL, Mathews SJ, Waggoner AD, Soto PF, Gropler RJ, Dávila-Román VG. Metabolic syndrome is associated with abnormal left ventricular diastolic function independent of left ventricular mass. Eur Heart J 2007; 28.5: 553-559.

Penjaskovic D, Sakac D, Dejanovic J, Zec R, Zec PN, Stojsic MA. Left ventricular diastolic dysfunction in patients with metabolic syndrome. Med Pregl 2012; 65.1-2: 18-22.

La Carrubba S, Todaro MC, Zito C, Antonini-Canterin F, Monte IP, Caso P, Colonna P, Gregorio C, Pezzano A, Benedetto F, Salvo GD, Carerj S, Bello VD. Asymptomatic left ventricular Dysfunction and metabolic syndrome: results from an Italian multicenter study. J Cardiovasc Echography 2013; 23: 96-101.

Beaver, W. L., Wasserman, K. A. R. L. M. A. N., Whipp, B. J. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 1986; 60.6: 2020-2027.

Caiozzo VJ, Davis JA, Ellis JF, Azus JL, Vandagriff R, Prietto CA, McMaster WC. A comparison of gas exchange indices used to detect the anaerobic threshold. J Appl Physiol 1982; 53.5: 1184-1189.

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J-Cardiovascular Imaging 2015; 16.3: 233-271.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37.27: 2129-2200.

Coats AJS, Clark AL, Piepoli M, Volterrani M, Poole-Wilson PA. Symptoms and quality of life in heart failure: the muscle hypothesis. British Heart Journal 1994;72(2 Suppl):S36-S39.

Miura Y, Fukumoto Y, Shiba N, Miura T, Shimada K, Iwama Y, Takagi A, Matsusaka H, Tsutsumi T, Yamada A, Kinugawa S, Asakura M, Okamatsu S, Tsutsui H, Daida H, Matsuzaki M, Tomoike H, Shimokawa H. Prevalence and Clinical Implication of Metabolic Syndrome in Chronic Heart Failure. Circ J 2010; 74: 2612-2621.

Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, Kannel WB, Vasan RS. Obesity and the risk of heart failure. N Engl J Med 2002; 347.5: 305-313.

Solovjova S, Ryliskyte L, Celutkiene J, Badariene J, Navickas R, Puronaite R, Bieliauskaite G, Skiauteryte E, Lisaite G, Laucevicius A. Aortic stiffness is an independent determinant of left ventricular diastolic dysfunction in metabolic syndrome patients. Blood Press 2016;25(1):11–20.

Farkas J, Nabb S, Zaletel-Kragelj L, Cleland JGF, Lainscak M. Self-rated health and mortality in patients with chronic heart failure. Eur J Heart Fail 2009; 11.5: 518-524.

Van der Linde RM, Mavaddat N, Luben R, Brayne C, Simmons RK, Khaw KT, Kinmonth AL. Self-Rated Health and Cardiovascular Disease Incidence: Results from a Longitudinal Population-Based Cohort in Norfolk, UK. PLoS One 2013; 8.6: e65290.

Ahmadi NS, Bennet L, Larsson CA, Andersson S, Månsson J, Lindblad U. Clinical characteristics of asymptomatic left ventricular diastolic dysfunction and its association with self-rated health and N-terminal B-type natriuretic peptide: a cross-sectional study. Eur J Heart Fail 2016; 3.3: 205-211.

Chang HR, Hsieh JC, Hsu BG, Wang LY, Yu M, Chen MYC, Wang JH. Inverse Association of N-Terminal Pro-B-Type Natriuretic Peptide with Metabolic Syndrome in Patients with Congestive Heart Failure PloS one 2013; 8.11: e79096.

Griffin KA, Kramer H, Bidani AK. Adverse renal consequences of obesity. Am J Physiol Ren Physiol 2008; 294:685–96.

Madamanchi C, Alhosaini H, Sumida A, Runge MS. Obesity and natriuretic peptides, BNP and NT-proBNP: Mechanisms and diagnostic implications for heart failure. Int J Cardiol 2014; 176.3: 611-617.

Christenson RH, Azzazy HME, Duh S-H, Maynard S, Seliger SL, Defilippi CR. Impact of Increased Body Mass Index on Accuracy of B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP for Diagnosis of Decompensated Heart Failure and Prediction of All-Cause Mortality. Clin Chem 2010; 56.4: 633-641.

Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Wilson PWF, Vasan RS. Impact of Obesity on Plasma Natriuretic Peptide Levels. Circulation 2004; 109.5: 594-600.

Das SR, Drazner MH, Dries DL, Vega GL, Stanek HG, Abdullah SM, Canham RM, Chung AK, Leonard D, Wians FH, de Lemos JA. Impact of body mass and body composition on circulating levels of natriuretic peptides. Circulation 2005; 112.14: 2163-2168.

Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 2013; 62.4: 263-271.

Della-Morte D, Gardener H, Denaro F, Boden-Albala B, Elkind MS V, Paik MC, Sacco RL, Rundek T. Metabolic syndrome increases carotid artery stiffness: The Northern Manhattan Study. Int J Stroke 2010; 5.3: 138-144.

Roes SD, Dehnavi RA, Westenberg JJM, Lamb HJ, Mertens BJA, Tamsma JT, de Roos A. Assessment of Aortic Pulse Wave Velocity and Cardiac Diastolic Function in Subjects With and Without the Metabolic Syndrome. Diabetes Care 2008; 31.7: 1442-1444.

Kosmala W, Jellis CL, Marwick TH. Exercise limitation associated with asymptomatic left ventricular impairment: Analogy with Stage B heart failure. J Am Coll Cardiol 2015; 65.3: 257-266.

Ng AC, Goo SY, Roche N, van der Geest RJ, Wang WY. Epicardial Adipose Tissue Volume and Left Ventricular Myocardial Function Using 3-Dimensional Speckle Tracking Echocardiography. Can J Cardiol 2016; 32.12: 1485-1492.

Packer M, Kitzman DW. Obesity-Related Heart Failure With a Preserved Ejection Fraction: The Mechanistic Rationale for Combining Inhibitors of Aldosterone, Neprilysin, and Sodium-Glucose Cotransporter-2. JACC Heart Fail. 2018 Mar 7. pii: S2213-1779(18)30062-3. doi: 10.1016/j.jchf.2018.01.009.

Paulus WJ, Dal Canto E. Diastole Tracks Cardiometabolic Risk. JACC Heart Fail. 2018 Apr;6(4):326-328. doi: 10.1016/j.jchf.2018.01.008. Epub 2018 Mar 7.

Shewan L.G., Coats A.J.S., Henein M. Requirements for Ethical Publishing in Biomedical Journals. International Cardiovascular Forum Journal. 2015;2:2. http://dx.doi.org/10.17987/icfj.v2i1.4

Downloads

Additional Files

Published

2018-08-31

Issue

Vol. 13 (2018)

Section

Original Article

License

Authors who publish with this journal agree to the following terms:


a. The authors will retain copyright under a Creative Commons Attribution License (CC-BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).