Incident HFpEF and time-dependent changes in markers of LVDD severity in women and men with preclinical LVDD

TL;DR

This study examines how preclinical left ventricular diastolic dysfunction progresses to heart failure with preserved ejection fraction in men and women over five years.

Contribution

The study provides sex-specific insights into the progression of LVDD to HFpEF and identifies blood pressure and kidney function as key factors.

Findings

Only 10% of participants with preclinical LVDD developed heart failure, with most cases being HFpEF.

Higher blood pressure and reduced kidney function were linked to increased NT-proBNP levels over time.

Sex differences were observed in how blood pressure affected NT-proBNP levels.

Abstract

The progression of left ventricular diastolic dysfunction (LVDD) over time may lead to the development of heart failure with preserved ejection fraction (HFpEF). HFpEF is twice as common in women compared with men; however, the sex-specific progression from LVDD towards HFpEF is poorly described. Therefore, we aim to evaluate changes over time in markers of LVDD severity and HFpEF in women and men with preclinical LVDD.

We reassessed 146 participants from the HELPFul study (58% women and 42% men) with preclinical LVDD after a median follow-up of 4.3 (IQR: 3.9–4.7) years. The follow-up measurements mirrored baseline measurements, encompassing clinical examination, blood draw for biomarkers and echocardiography. We determined HFpEF incidence and report changes over time in echocardiography. Additionally, we studied how blood pressure and kidney function affected LVDD progression, including plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, using generalised mixed models. All analyses were performed for women and men combined, and sex stratified. Out of 146 participants, 15 (10%) developed HF of whom 13 had HFpEF (9 women and 4 men). Over time, mean kidney function (estimated glomerular filtration rate, eGFR) declined from 89±14.4 to 81±16.9 mL/min/1.73 m2 and median NT-proBNP plasma levels increased from 71 (IQR: 44–120) to 100 (IQR: 51–157) pg/mL. In women, a higher systolic and in men a higher diastolic blood pressure were associated with an increase in NT-proBNP plasma levels over time. Lower eGFR levels were related to increased NT-proBNP plasma levels over time in both men and women.

Our study demonstrates that only a small proportion of women and men with preclinical LVDD develop incident HF over a roughly 5-year follow-up period. High blood pressure and decreased kidney function were associated with higher levels of NT-proBNP. This highlights the need to further explore cardiorenal protection as a method to prevent HFpEF.

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