Document Detail

Systolic and diastolic heart failure in the community.
MedLine Citation:
PMID:  17090767     Owner:  NLM     Status:  MEDLINE    
CONTEXT: The heart failure (HF) syndrome is heterogeneous. While it can be defined by ejection fraction (EF) and diastolic function, data on the characteristics of HF in the community are scarce, as most studies are retrospective, hospital-based, and rely on clinically indicated tests. Further, diastolic function is seldom systematically assessed based on standardized techniques.
OBJECTIVE: To prospectively measure EF, diastolic function, and brain natriuretic peptide (BNP) in community residents with HF.
MAIN OUTCOME MEASURES: Echocardiographic measures of EF and diastolic function, measurement of blood levels of BNP, and 6-month mortality.
DESIGN, SETTING, AND PARTICIPANTS: Olmsted County residents with incident or prevalent HF (inpatients or outpatients) between September 10, 2003, and October 27, 2005, were prospectively recruited to undergo assessment of EF and diastolic function by echocardiography and measurement of BNP.
RESULTS: A total of 556 study participants underwent echocardiography at HF diagnosis. Preserved EF (> or =50%) was present in 308 (55%) and was associated with older age, female sex, and no history of myocardial infarction (all P<.001). Isolated diastolic dysfunction (diastolic dysfunction with preserved EF) was present in 242 (44%) patients. For patients with reduced EF, moderate or severe diastolic dysfunction was more common than when EF was preserved (odds ratio, 1.67; 95% confidence interval [CI], 1.11-2.51; P = .01). Both low EF and diastolic dysfunction were independently related to higher levels of BNP. At 6 months, mortality was 16% for both preserved and reduced EF (age- and sex-adjusted hazard ratio, 0.85; 95% CI, 0.61-1.19; P = .33 for preserved vs reduced EF).
CONCLUSIONS: In the community, more than half of patients with HF have preserved EF, and isolated diastolic dysfunction is present in more than 40% of cases. Ejection fraction and diastolic dysfunction are independently related to higher levels of BNP. Heart failure with preserved EF is associated with a high mortality rate, comparable to that of patients with reduced EF.
Francesca Bursi; Susan A Weston; Margaret M Redfield; Steven J Jacobsen; Serguei Pakhomov; Vuyisile T Nkomo; Ryan A Meverden; Véronique L Roger
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  296     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-11-08     Completed Date:  2006-11-14     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2209-16     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Cardiac Output, Low / blood,  epidemiology*,  physiopathology*,  ultrasonography
Echocardiography, Doppler
Logistic Models
Middle Aged
Natriuretic Peptide, Brain / blood
Prospective Studies
Stroke Volume
Survival Analysis
Ventricular Dysfunction, Left* / diagnosis,  epidemiology
Ventricular Dysfunction, Right* / diagnosis,  epidemiology
Grant Support
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain
Comment In:
JAMA. 2007 Mar 14;297(10):1058-9; author reply 1059   [PMID:  17356024 ]
JAMA. 2006 Nov 8;296(18):2259-60   [PMID:  17090774 ]

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