The risk of heart failure with preserved ejection fraction in Arctic shift-workers: the role of adaptation potential index and average daily blood pressure variability

Objective. We aimed to assess the impact of the adaptation index in relation to dosed physical activity and average daily blood pressure (BP) variability on the risk of heart failure with preserved ejection fraction (HFpEF) in Arctic shift-workers (both men (M) and women (W)), based on the study of 24-hour ambulatory BP monitoring (ABPM), treadmill ergometry, calculation of the adaptation potential (AP) index and echocardiography indicators in groups with low and intermediate probability according to the H2FPEF algorithm.

Design and methods. In the Arctic settlement of Yamburg (68° 21' 40" N), 99 M and 81 W with stage 1–2 arterial hypertension (HTN) and normotensive individuals were examined in the medical unit of Gazprom Dobycha Yamburg. They were comparable by age (p = 0,450), shift work experience (p = 0,824), office systolic BP (SBP) (p = 0,251) and diastolic BP (DBP) (p = 0,579). We performed ABPM (BPLab v.3.2, Russia), echocardiography (Phillips CX 50, Netherlands), and a treadmill test (Schiller Cardiovit CS-200, Switzerland) with AP index calculation. Patients were divided into subgroups with low and intermediate probability of HFpEF based on the H2FPEF algorithm (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure) with scoring.

Results. Group 1 included 95 patients (52 M and 43 W) with H₂FPEF score of 0–1, group 2 consisted of 85 patients (47 M and 38 W) with a score of 2–5. In group 2, M and W were more likely to experience tension or poor adaptation to dosed physical activity, and a hypertensive response to exercise was more common. Significantly increased average daily variability in SBP (SBP24) and DBP (DBP24) was observed due to both average daytime and nighttime values. W in group 2 had significantly reduced left ventricular ejection fraction and increased right atrial volume. M of group 2 showed significantly reduced movement velocities of the mitral valve fibrous ring. According to the logistic regression analysis, M in group 2 with a poor adaptation to physical activity and AP index value ≥ 3,1 had a 7,5-fold increased risk of developing HFpEF, and each 1 mmHg increase in DBP24 variability increased the risk by 76  %. In W with an AP index value ≥ 3,1, the probability of developing HFpEF increased by 3,9 times. An increase of 1 mmHg in the SBP24 variability increased the risk of HFpEF by 44,4 %. An increase in nighttime DBP variability also increased the risk by 37,2 %. The model correctly identified distinctive features that increased the likelihood of HFpEF development in M with sensitivity of 76,6 % and specificity of 75,0 %. In W, the model had a sensitivity of 84,2 % and specificity of 81,4 %.

Conclusion. In Arctic shifts-workers with HTN, poor adaptation to physical activity and increased average daily BP variability are important factors that increase the risk of HFpEF according to the H₂FPEF algorithm. These findings suggest a significant role for the autonomic nervous system dysfunction in the development of the disease and warrant further investigation. Our data indicate the need for regular monitoring of high-risk groups in a medical facility and the implementation of preventive and therapeutic measures.

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