Concentric vs. eccentric remodelling in heart failure with reduced ejection fraction: clinical characteristics, pathophysiology and response to treatment

Jan F. Nauta, Yoran M. Hummel, Jasper Tromp, Wouter Ouwerkerk, Peter van der Meer, Xuanyi Jin, Carolyn S. P. Lam, Jeroen J. Bax, Marco Metra, Nilesh J. Samani, Piotr Ponikowski, Kenneth Dickstein, Stefan D. Anker, Chim Lang, Leong Loke Ng, Faiez Zannad, Gerasimos S. Filippatos, Dirk Jan van Veldhuisen, Joost P. van Melle, Adriaan A. Voors (Lead / Corresponding author)

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Abstract

Aims: Heart failure is traditionally classified by left ventricular ejection fraction (LVEF), rather than by left ventricular (LV) geometry, with guideline-recommended therapies in heart failure with reduced ejection fraction (HFrEF) but not heart failure with preserved ejection fraction (HFpEF). Most patients with HFrEF have eccentric LV hypertrophy, but some have concentric LV hypertrophy. We aimed to compare clinical characteristics, biomarker patterns, and response to treatment of patients with HFrEF and eccentric vs. concentric LV hypertrophy. Methods and results: We performed a retrospective post-hoc analysis including 1015 patients with HFrEF (LVEF <40%) from the multinational observational BIOSTAT-CHF study. LV geometry was classified using two-dimensional echocardiography. Network analysis of 92 biomarkers was used to investigate pathophysiologic pathways. Concentric LV hypertrophy was present in 142 (14%) patients, who were on average older and more likely hypertensive compared to those with eccentric LV hypertrophy. Network analysis revealed that N-terminal pro-B-type natriuretic peptide was an important hub in eccentric hypertrophy, whereas in concentric hypertrophy, tumour necrosis factor receptor 1, urokinase plasminogen activator surface receptor, paraoxonase and P-selectin were central hubs. Up-titration of beta-blockers was associated with a mortality benefit in HFrEF with eccentric but not concentric LV hypertrophy (P-value for interaction ≤0.001). For angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, the hazard ratio for mortality was higher in concentric hypertrophy, but the interaction was not significant. Conclusion: Patients with HFrEF with concentric hypertrophy have a clinical and biomarker phenotype that is distinctly different from those with eccentric hypertrophy. Patients with concentric hypertrophy may not experience similar benefit from up.-titration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-blockers compared to patients with eccentric hypertrophy.

Original languageEnglish
Number of pages9
JournalEuropean Journal of Heart Failure
Early online date11 Nov 2019
DOIs
Publication statusE-pub ahead of print - 11 Nov 2019

Keywords

  • Biomarkers
  • Concentric hypertrophy
  • Eccentric hypertrophy
  • Echocardiography
  • Heart failure
  • Heart failure with reduced ejection fraction
  • Left ventricular geometry
  • Medical therapy

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    Nauta, J. F., Hummel, Y. M., Tromp, J., Ouwerkerk, W., van der Meer, P., Jin, X., Lam, C. S. P., Bax, J. J., Metra, M., Samani, N. J., Ponikowski, P., Dickstein, K., Anker, S. D., Lang, C., Ng, L. L., Zannad, F., Filippatos, G. S., van Veldhuisen, D. J., van Melle, J. P., & Voors, A. A. (2019). Concentric vs. eccentric remodelling in heart failure with reduced ejection fraction: clinical characteristics, pathophysiology and response to treatment. European Journal of Heart Failure. https://doi.org/10.1002/ejhf.1632