Table 4

Echocardiographic Changes, Biomarkers, and Prognosis of Heart Failure With Preserved Ejection Fraction

Marker (Method)First Author ( Ref. #)PopulationOutcomePredictive Properties
HR (95% CI)
E/A (severity of DD) (echocardiography)Persson et al. (51)293 HF patients with LVEF >40% participating in CHARMESComposite CV mortality or HF admissionModerate or severe DD
3.27 (1.41–7.56)
e’ (echocardiography)Wang et al. (71)174 hypertensive individuals with LVHCardiac mortality0.49 (0.32–0.76)
LV mass (echocardiography)Zile et al. (52)745 HF patients with LVEF ≥45% participating in I-PRESERVEAll-cause mortality or hospitalization for worsening HF, MI, stroke, unstable angina, or ventricular or atrial dysrhythmia1.019 (1.009–1.029)§
LV mass/volume (echocardiography)1.296 (1.074–1.564) §
Enlarged LA|| (echocardiography)1.470 (1.029–2.101) §
LAD (echocardiography)Rossi et al. (69)183 HF patients with LVEF >45%All-cause mortality2.45 (1.12–5.41)#
Diastolic wall stress∗∗ (echocardiography)Ohtani et al. (70)327 HF patients with LVEF ≥50%Composite CV mortality or HF admission1.03 (1.01–1.06)††
Natriuretic peptides (blood sample analysis)Grewal et al. (68)181 HF patients with LVEF >40% participating in CHARMESComposite CV mortality or HF admission or MI or strokeNT-proBNP >300 pg/ml
5.8 (1.3–26.4)
NT-proBNP >600 pg/ml
8.0 (2.6–24.8)
BNP >100 pg/ml
3.1 (1.2–8.2)

CHARMES = CHARM Echocardiographic Substudy; CI = confidence interval; CV = cardiovascular; DD = diastolic dysfunction; HR = hazard ratio; I-PRESERVE = Irbesartan in Heart Failure With Preserved Systolic Function; LVH = left ventricular hypertrophy; MI; myocardial infarction.

  • After adjustment for age, sex, left ventricular ejection fraction (LVEF), diabetes mellitus, atrial fibrillation, previous heart failure (HF) admission, and treatment arm.

  • After adjustment for age, and interventricular septal thickness in diastole, LVEF, peak velocity during systole, peak velocity during late diastole, peak E-wave velocity to peak velocity during early diastole ratio (E/Em), and pseudonormal diastolic filling pattern or restrictive diastolic filling pattern.

  • Indexed to height2.7.

  • § After adjustment for log N-terminal pro–B-type natriuretic peptide (NT-proBNP), age, diabetes mellitus, hospitalization for worsening HF within 6 months preceding randomization, chronic obstructive pulmonary disease or asthma, neutrophils, and LVEF.

  • || Mildly enlarged left atrium (LA) if LA area was 20 to 30 cm2 and moderately to severely enlarged LA if LA area was >31 cm2.

  • LA diameter >5 cm used to define LA enlargement.

  • # After adjustment for clinical and echocardiographic parameters.

  • ∗∗ Diastolic wall stress was defined as the ratio of the posterior wall thickness at end-systole minus the posterior wall thickness at end-diastole to the posterior wall thickness at end-systole.

  • †† After adjustment for age, sex, echocardiographic variables, and log B-type natriuretic peptide (BNP).