# Cardiac Remodeling and Functional Alterations in Heart Failure With Preserved Ejection Fraction (HFpEF): An Echocardiographic Assessment at a Tertiary Hospital in Bangladesh

## TL;DR

This study examines heart structure and function in Bangladeshi patients with heart failure and normal ejection fraction, finding widespread diastolic dysfunction and structural changes.

## Contribution

The study provides a detailed echocardiographic assessment of HFpEF in a Bangladeshi cohort, highlighting the prevalence of diastolic dysfunction and structural remodeling.

## Key findings

- 94% of patients showed left ventricular diastolic dysfunction.
- 52% of patients exhibited structural alterations in the left ventricle.
- 44% of patients had pulmonary hypertension.

## Abstract

Background

Heart failure with preserved ejection fraction (HFpEF) is a complex pathophysiological entity characterized by varying degrees of cardiac structural and functional changes. This study evaluated the prevalence and pattern of cardiac remodeling and functional alterations in an HFpEF cohort in Bangladesh.

Methods

This study was conducted among 50 hospitalized HFpEF patients from December 2017 to March 2019 at Bangladesh Medical University. Echocardiographic evaluations were performed to assess left ventricular (LV) structure, systolic and diastolic function, and right ventricular (RV) systolic function. The LV global longitudinal strain (GLS) was measured to detect subclinical systolic dysfunction.

Results

The mean (SD) age of the participants was 65 (10) years, and 30 (60%) were male. Most patients had multiple comorbidities and presented in a decompensated state. Despite a mean LV ejection fraction of 60.4% (6.0%), the majority of cases, 28 (68%), showed reduced GLS after excluding nine cases of permanent atrial fibrillation (AF). Structural alterations of the LV were observed in 26 (52%) patients. Concentric LV hypertrophy and concentric remodeling were present in 21 (42%) of the assessed patients. LV diastolic dysfunction was found in 47 (94%) cases; however, diastolic dysfunction grading could not be performed in nine (19%) cases due to permanent AF. Six (13%) patients had grade I diastolic dysfunction, while 32 (68%) had grade II to III dysfunction. After excluding cases with permanent AF and moderate mitral valve regurgitation, the left atrial volume index (LAVi) was increased in 32 (91%) patients. Pulmonary hypertension was observed in 22 (44%) cases, and RV systolic impairment in five (10%) cases.

Conclusions

All patients in this study exhibited evidence of either cardiac remodeling or diastolic dysfunction. LV remodeling was less common, whereas diastolic dysfunction and LAVi enlargement were more prevalent. However, large-scale epidemiological studies are needed for better characterization of the HFpEF cohort in Bangladesh.