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Organ dysfunction implicated in increased risk for HF
Lam CS. Circulation. 2011;doi:10.1161/circulationaha.110.979203.
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For more than 1,000 patients, cardiac and noncardiac organ dysfunction was associated with an increased incidence of HF, which researchers said supports the belief that HF is a progressive syndrome while also highlighting the importance of noncardiac factors in its occurrence.
The 1,038 patients (mean age, 76 years; 61% women) included in the analysis were participants from the original cohort of the Framingham Heart Study. All had left ventricular systolic and diastolic function determined with use of echocardiographic ejection fraction, as well as major noncardiac organ systems assessed using several system-specific biomarkers and measurements.
During a mean follow-up of 11 years, 248 incident HF events were recorded, 146 of which occurred in women. After adjustment for HF risk factors, including age, sex, BMI and systolic BP, both LV systolic (HR=2.33; 95% CI, 1.43-3.78) and diastolic dysfunction (HR=1.32; 95% CI, 1.01-1.71) were linked with an increased risk for HF.
After adjusting for cardiac dysfunction, the researchers also found that higher serum creatinine (renal system), lower ratio of forced expiratory volume in 1 second to forced vital capacity (pulmonary system) and lower hemoglobin concentrations (hematologic system/oxygen-carrying capacity) were significantly associated with increased HF risk, whereas serum albumin (hepatic system) and white blood cell count (systemic inflammation) were not.
According to the researchers, these findings have particular consequence for elderly patients who have age-related decline in multi-organ function or multiple noncardiac comorbidities.
“Recognizing the contribution of noncardiac dysfunction to HF progression may carry important clinical implications for preventing and managing HF,” they wrote. “Further studies are warranted to validate these findings in other populations, to evaluate for potential effect modification by covariates such as sex, and to assess the potential impact of treatment of these risk factors on the risk of future HF.” – by Brian Ellis
The data provide confirmation of what we have long thought we knew, that the clinical syndrome of HF occurs in the setting of structural abnormalities of the left ventricle with a superimposed functional disorder that can be aggravated by non-cardiac disorders including renal disease, pulmonary disease and anemia. The weakness of this Framingham database is that the left ventricular structural abnormality is measured at infrequent intervals and therefore may not detect the impact of intervening myocardial damage, such as an infarct. This deficiency may weaken the association demonstrated between a reduced ejection fraction and subsequent HF with reduced ejection fraction. We have long known that the structural abnormality of the left ventricle is not linearly related to the clinical syndrome of HF. Non-cardiac organ dysfunction is clearly a contributor to the clinical syndrome but its influence is dependent on an underlying structural abnormality of the heart.
– Jay Cohn, MD
Cardiology
Today Editorial Board member
Disclosures: Dr. Cohn reports no relevant financial disclosures.
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