Comparison of Predictors of Heart Failure With Preserved Versus Reduced Ejection Fraction in a Multiracial Cohort of Preclinical Left Ventricular Diastolic Dysfunction

Preclinical diastolic dysfunction (PDD) is a well-known but poorly understood risk factor for heart failure. We aimed to investigate risk factors contributing to progression of PDD to heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Patients with echocardiogram from 2003 to 2008 with left ventricular ejection fraction ≥50%, grade I diastolic dysfunction, and free of clinical heart failure were included. The end point was incident HFpEF or HFrEF. Cumulative probabilities were estimated and multivariable adjusted Cox proportional hazards regressions were performed to examine predictors of incident HFpEF and HFrEF. In total, 7,878 patients with PDD (79.2% nonwhite) were included. At the end of follow-up (median 5.9 years), 146 patients developed HFrEF, and 635 patients developed HFpEF. The 10-year cumulative probabilities of HFrEF and HFpEF were 3.1% and 12.6%, respectively. Incidence of HFrEF was significantly lower in non-Hispanic blacks (2.2%) compared with non-Hispanic whites (4.5%). Age, diabetes, myocardial infarction, and renal disease were independent predictors of both HFrEF and HFpEF. Male gender, cerebrovascular accident, and low baseline left ventricular ejection fraction were associated with HFrEF only; whereas pulmonary disease, blood urea nitrogen, and anemia were predictors of HFpEF only. In conclusion, our results revealed a distinct set of predictors of HFrEF and HFpEF in patients with PDD and underscored a differential approach of risk stratification, prevention, and early treatment based on heart failure subtypes.