Jasper Tromp1,2,3, Michael R MacDonald4, Wan Ting Tay2, Tiew-Hwa K Teng2,5, Chung-Lieh Hung6, Calambur Narasimhan7, Wataru Shimizu8,9, Lieng Hsi Ling10, Tze Pin Ng10, Jonathan Yap2, John J V McMurray11, Michael R Zile12,13, A Mark Richards14,15, Inder S Anand16, Carolyn S P Lam1,2,3,14. 1. University Medical Center Groningen, Department of Cardiology, the Netherlands (J.T., C.S.P.L.). 2. National Heart Centre Singapore (J.T., W.T.T., T.-H.K.T., J.Y., C.S.P.L.). 3. Duke-National University Singapore Medical School (J.T., C.S.P.L.). 4. Changi General Hospital, Singapore (M.M.). 5. School of Population and Global Health, University of Western Australia, Perth (T.-H.K.T.). 6. Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.). 7. Care Hospital, Hyderabad, India (C.N.). 8. Nippon Medical School, Tokyo, Japan (W.S.). 9. National Cerebral and Cardiovascular Centre, Osaka, Japan (W.S.). 10. Yong Loo Lin School of Medicine, National University Singapore and Cardiac Department, National University Health System (L.H.L., T.P.N.). 11. Institute of Cardiovascular and Medical Sciences and School of Medicine, Dentistry and Nursing, University of Glasgow, UK (J.J.V.M.). 12. Medical University of South Carolina, Charleston (M.R.Z.). 13. Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z.). 14. National University Heart Centre, Singapore (A.M.R., C.S.P.L.). 15. Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.). 16. Veterans Affairs Medical Center, Minneapolis, MN (I.S.A.).
Abstract
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF), traditionally considered a disease of the elderly, may also affect younger patients. However, little is known about HFpEF in the young. METHODS: We prospectively enrolled 1203 patients with HFpEF (left ventricular ejection fraction ≥50%) from 11 Asian regions. We grouped HFpEF patients into very young (<55 years of age; n=157), young (55-64 years of age; n=284), older (65-74 years of age; n=355), and elderly (≥75 years of age; n=407) and compared clinical and echocardiographic characteristics, quality of life, and outcomes across age groups and between very young individuals with HFpEF and age- and sex-matched control subjects without heart failure. RESULTS: Thirty-seven percent of our HFpEF population was <65 years of age. Younger age was associated with male preponderance and a higher prevalence of obesity (body mass index ≥30 kg/m2; 36% in very young HFpEF versus 16% in elderly) together with less renal impairment, atrial fibrillation, and hypertension (all P<0.001). Left ventricular filling pressures and prevalence of left ventricular hypertrophy were similar in very young and elderly HFpEF. Quality of life was better and death and heart failure hospitalization at 1 year occurred less frequently ( P<0.001) in the very young (7%) compared with elderly (21%) HFpEF. Compared with control subjects, very young HFpEF had a 3-fold higher death rate and twice the prevalence of hypertrophy. CONCLUSIONS: Young and very young patients with HFpEF display similar adverse cardiac remodeling compared with their older counterparts and very poor outcomes compared with control subjects without heart failure. Obesity may be a major driver of HFpEF in a high proportion of HFpEF in the young and very young.
BACKGROUND:Heart failure with preserved ejection fraction (HFpEF), traditionally considered a disease of the elderly, may also affect younger patients. However, little is known about HFpEF in the young. METHODS: We prospectively enrolled 1203 patients with HFpEF (left ventricular ejection fraction ≥50%) from 11 Asian regions. We grouped HFpEF patients into very young (<55 years of age; n=157), young (55-64 years of age; n=284), older (65-74 years of age; n=355), and elderly (≥75 years of age; n=407) and compared clinical and echocardiographic characteristics, quality of life, and outcomes across age groups and between very young individuals with HFpEF and age- and sex-matched control subjects without heart failure. RESULTS: Thirty-seven percent of our HFpEF population was <65 years of age. Younger age was associated with male preponderance and a higher prevalence of obesity (body mass index ≥30 kg/m2; 36% in very young HFpEF versus 16% in elderly) together with less renal impairment, atrial fibrillation, and hypertension (all P<0.001). Left ventricular filling pressures and prevalence of left ventricular hypertrophy were similar in very young and elderly HFpEF. Quality of life was better and death and heart failure hospitalization at 1 year occurred less frequently ( P<0.001) in the very young (7%) compared with elderly (21%) HFpEF. Compared with control subjects, very young HFpEF had a 3-fold higher death rate and twice the prevalence of hypertrophy. CONCLUSIONS: Young and very young patients with HFpEF display similar adverse cardiac remodeling compared with their older counterparts and very poor outcomes compared with control subjects without heart failure. Obesity may be a major driver of HFpEF in a high proportion of HFpEF in the young and very young.
Entities:
Keywords:
Asia; heart failure; obesity; young adults
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