PREDICTORS OF HEART FAILURE WITH PRESERVED EJECTION FRACTION IN ELDERLY HYPERTENSIVE OUTPATIENTS WITH DYSPNEA

Background. Dyspnea is the most frequent, but not specific manifestation of the chronic heart failure (CHF). The arterial hypertension (HTN) is one of the causes of CHF. Its verification requires an echocardiography with tissue Doppler, which is not always available in routine practice. Identification of easily estimable CHF predictors in hypertensive patients with dyspnea is an important task. Objective of our study was the identification of the predictors of CHF with preserved ejection fraction (EF) among hypertensive outpatients with dyspnea. Design and methods. We included 116 outpatients with HTN and dyspnea over 60 years old with EF ≥ 50 %. Exclusion criteria were concomitant diseases which might lead to CHF. All patients performed the 6-minute walk test and echocardiography with tissue Doppler. Results. CHF was confirmed in 52,6 % patients. Palpitations, right-sided heaviness below the ribs, swollen feet, as well as reduced tolerance to physical activity were more frequent in older patients with HTN and dyspnea and did not allow to confirm CHF. Patients with confirmed CHF showed higher levels of systolic blood pressure (SBP). They had longer disease anamnesis and lower financial resources. Conclusions. Among elderly hypertensive outpatients with dyspnea every second one has no echocardiographic signs of CHF. SBP ≥ 140 mm Hg according to home measurements is associated with the 6-fold higher probability of CHF with preserved ejection fraction. In the elderly hypertensive outpatients with dyspnea, the duration of HTN more than 20 years and limited financial resources for medications are associated with the increased probability of CHF.

arterial hypertension, dyspnea, heart failure with preserved ejection fraction, tissue Doppler, systolic blood pressure, elderly patients

1. Yang H, Negishi K, Otahal P, Marwick TH. Clinical prediction of incident heart failure risk: a systematic review and meta-analysis. Open Heart. 2015;2(1): e000222. doi:10.1136/openhrt-2014000222

2. Штегман О. А., Петрова М. М., Вырва П. В. Генез одышки у амбулаторных пациентов с подозрением на хроническую сердечную недостаточность. Сибирское медицинское обозрение. 2013;4(82):63–66. [Shtegman OA, Petrova MM, Virva PV. The genesis of dyspnea in outpatients with suspected chronic heart failure. Sibirskoye Medicinskoye Obozreniye = Siberian Medical Review. 2013;4(82):63–66. In Russian].

3. Gaspard D, Kass J, Akers S, Hunter K, Pratter M. Patientreported dyspnea correlates poorly with aerobic exercise capacity measured during cardiopulmonary exercise testing. Lung. 2017;195 (5):613–617. doi:10.1007/s00408-017-0043-0

4. Штарик С. Ю., Петрова М. М., Кутумова О. Ю., Кононова Л. И. Распространенность курения и артериальной гипертонии среди взрослых жителей Красноярска, находящихся под наблюдением в городских поликлиниках. Профилактическая медицина. 2007;10(2):39. [Shtarik SY, Petrova MM, Kutumova OY, Kononova LI. The prevalence of smoking and hypertension among adults in Krasnoyarsk under observation in urban clinics. Profilakticheskaya Medicina = Preventive Medicine. 2007;10(2):39. In Russian].

5. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441–50. doi:10.1161/CIRCULATIONAHA.115.018912

6. Rogers FJ, Gundala T, Ramos JE, Serajian A. Heart failure with preserved ejection fraction. J Am Osteopath Assoc. 2015;115 (7):432–42. doi:10.7556/jaoa.2015.089

7. Либис Р. А., Душина А. Г., Олейник Е. А. Особенности течения хронической сердечной недостаточности с сохраненной фракцией выброса у пациентов с эссенциальной артериальной гипертензией. Артериальная гипертензия. 2013;19 (6):513–519. [Libis RA, Dushina AG, Oleynik EA. Features of chronic heart failure with preserved ejection fraction in patients with essential hypertension. Arterial’naya Gipertenziya = Arterial Hypertension. 2013;19(6):513–9. In Russian].

8. Negri F, Sala C, Valerio C, Mancia G, Cuspidi C. Role of tissue Doppler imaging for detection of diastolic dysfunction in the elderly: a study in clinical practice. High Blood Press Cardiovasc Prev. 2011;18(4):187–93. doi:10.2165/11593610-00000000000000

9. Trullàs JC, Casado J, Morales-Rull JL. Difficulties in the diagnosis of heart failure in patients with comorbidities. Rev Clin Esp. 2016;216(5):276–85. doi:10.1016/j.rce.2015.10.001

10. Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П., Коротеев А. В., Мареев Ю. В., Овчинников А. Г. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Утверждены на Конгрессе ОССН 7 декабря 2012 года, на Правлении ОССН 31 марта 2013 и Конгрессе РКО 25 сентября 2013 года. Журн. Сердечная недостаточность. 2013;14(7):379–472. doi:10.18087/rhfj.2013.7.1860 [Mareev VYu, Ageev FT, Arutyunov GP, Koroteev VA, Mareev YuV, Ovchinnikov AG et al. National guidelines for diagnosis and treatment of chronic heart failure (fourth revision). Zhurnal Serdechnaya Nedostatochnost = Journal Heart Failure. 2013;14 (7):379–472. doi:10.18087/rhfj.2013.7.1860. In Russian].

11. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57(6):450–458. doi:http://dx.doi.org/10.1016/0002-9149 (86)90771-X

12. Nielsen WB, Lindenstrom E, Vestbo J, Jensen GB. Is diastolic hypertension an independent risk factor for stroke in the presence of normal blood pressure in the middle-aged and elderly? Am J Hypertens. 1997;10(6):634–663.

13. Franklin SS, Wong ND. Hypertension and cardiovascular disease: contributions of the Framingham Heart Study. Global Heart. 2013;8(149):49–57. doi:10.1016/j.gheart.2012.12.004

14. Nakanishi K, Jin Z, Homma S, Elkind MSV, Rundek T, Tugcu A et al. Association of blood pressure control level with left ventricular morphology and function and with subclinical cerebrovascular disease. J Am Heart Assoc. 2017;6(8):e006246. doi:10.1161/JAHA.117.006246

15. Staessen JA, Wang J, Bianchi G, Birkenhäger WH. Essential hypertension. Lancet. 2003;361(9369):1629–41. doi:10.1016/S0140-6736(03)13302-8

16. Васюк Ю. А., Иванова С. В., Школьник Е. Л., Котовская Ю. В., Милягин В. А., Олейников В. Э. и др. Согласованное мнение российских экспертов по оценке артериальной жесткости в клинической практике. Кардиоваскулярная терапия и профилактика. 2016;15(2):4–19. doi:10.15829/1728-8800-20162-4-19. [Vasyuk YA, Ivanova SV, Shkolnik EL, Kotovskaya YV, Milyagin VA, Oleynikov VE et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Kardiovaskulyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention. 2016;15(2):4–19. doi:10.15829/17288800-2016-2-4-19. In Russian].