Katarína Cenkerová, Juraj Dúbrava, Jozef Kalužay, Oľga Jurkovičová
Background: Data related to heart failure with preserved ejection fraction (HFPEF) are limited, even though the prevalence is high and the prognosis is similarly poor in comparison with heart failure with reduced ejection fraction (HFREF). Objective: To examine differences in demographic, clinical, laboratory and ECG characteristics and pre-hospital medication between patients with HFPEF and HFREF. Methods: A total of 228 patients hospitalized in internal department for heart failure (HF) within one year period (2010-2011) were included. All patients were echocardiographically examined. They were divided into two groups based on left ventricular ejection fraction (LVEF); HFPEF with EF > 40 % (n = 117; 51.3 %) and HFREF with LVEF ≤ 40 % (n = 111; 48.7 %). The clinical, biochemical, ECG and echocardiographic data were analysed. Results: A total of 13 % of all hospital admissions were due to HF. Prevalence of HFPEF was 51.3 % and HFREF 48.7 %. Patients with HFPEF were more likely to be female (61 % vs 34 %; p < 0,001), to have arterial hypertension (95 % vs 81 %; p = 0.001), atrial fibrillation (56 % vs 39 %; p < 0.01), obesity (BMI 30.7 vs 27.7; p < 0.01) and oncological disease (18 % vs 8 %; p < 0.05). Patients with HFPEF were significantly older (74.9 vs 69.0 years, p < 0.001) and smaller percentage of them had history of myocardial infarction (42 % vs 26 %; p < 0.05). There was no difference between groups in the prevalence of coronary artery disease (CAD), diabetes mellitus and stroke. Etiology of HFPEF was more frequently associated with arterial hypertension (56 % vs 31 %, p < 0.001), compared to HFREF that was more frequently associated with CAD (44 % vs 80 %; p < 0.001). Systolic and diastolic blood pressure on admission was higher in patients with HFPEF compared to those with HFREF (159.1 vs 136.5 mmHg, resp. 87.8 vs 81.5 mmHg; p < 0,001). Analyses of laboratory parameters showed significantly lower level of NT-proBNP in HFPEF patients (median 4627 vs 6637 ng/l; p < 0.05), worse glomerular filtration rate (0.94 vs 1.07 ml/s; p < 0.05) and lower level of haemoglobin (124 vs 130 g/l; p < 0.05). Patients with HFREF had wider QRS complex (103.7 vs 90.4 ms; p < 0.001) and longer QTc interval (455 vs 427 ms; p < 0.001). There was a nonsignificant trend to higher hospital mortality in HFPEF (8.5 % vs 4.5 %). There was no difference in pre-hospital treatment between the groups. The effective dose of beta-blockers on admission (8 % in HFPEF vs 11 % in HFREF) and at discharge (5 % vs 6 %) was surprisingly very low in both groups. Conclusion: We observed multiple differences in demography, etiology, clinical, biochemical and ECG characteristics between patients with HFPEF and HFREF. We did not identify any significant differences regarding pre-hospital therapy and hospital mortality between the groups.