Clinical and echocardiographic diversity associated with physical fitness in the Project Baseline Health Study: implications for heart failure staging. Journal of cardiac failure Cauwenberghs, N., Haddad, F., Daubert, M. A., Chatterjee, R., Salerno, M., Mega, J. L., Heidenreich, P., Hernandez, A., Amsallem, M., Kobayashi, Y., Mahaffey, K. W., Shah, S. H., Bloomfield, G. S., Kuznetsova, T., Douglas, P. S. 2023


Clinical and echocardiographic features may carry diverse information on the development of heart failure (HF). Therefore, we determined heterogeneity in clinical and echocardiographic phenotypes and its association with exercise capacity.In 2036 community-dwelling individuals, we defined echocardiographic profiles of left and right heart remodeling and dysfunction. We subdivided the cohort based on presence (+) or absence (-) of HF risk factors and echocardiographic abnormalities (RF-/Echo-, RF-/Echo+, RF+/Echo-, RF+/Echo+). Multivariable-adjusted associations between RF/Echo subgroups and physical performance metrics from 6-minute walk and treadmill exercise testing were assessed.Prevalence was: 35.3% for RF-/Echo-, 4.7% for RF-/Echo+, 39.3% for RF+/Echo- and 20.6% for RF+/Echo+. We observed large diversity in echocardiographic profiles in the Echo+ group. Participants with RF-/Echo+ (18.6% of Echo+) predominantly had echocardiographic abnormalities other than left ventricular (LV) diastolic dysfunction, hypertrophy and reduced ejection fraction, while their physical performance was similar to RF-/Echo-. In contrast, participants with RF+/Echo+ mostly presented LV hypertrophy or dysfunction, features that related to lower 6-minute walking distance and lower exercise capacity.Subclinical echocardiographic abnormalities suggest HF pathogenesis, but the presence of HF risk factors and type of echo abnormality should be considered to distinguish adverse from benign adaptation and stratify HF risk.

View details for DOI 10.1016/j.cardfail.2023.04.008

View details for PubMedID 37116641