Evaluation of Cardiorenal Metabolic Syndrome in Patients with Heart Failure with Preserved Ejection Fraction. How Aware Are We?

Yıl 2025, Cilt: 15 Sayı: 3, 192 - 199

Hüseyin Ali Öztürk , Erdinc Gulumsek , Dilan Damla Ozturk , Fatih Necip Arıcı , Cigdem Erhan , Bektaş Işık , Mehmet Can Erişen , Berçem Berent Kaya , Ugur Can Izlimek , Cahit Dincer , Ahmet Gazi Mustan , Çisem Yılmaz , Tayyibe Saler , Hilmi Erdem Sümbül

https://doi.org/10.31832/smj.1684457

Öz

Aim: Despite the prevalence of cardiorenal metabolic diseases (CRMD) in heart failure with preserved ejection fraction (HFpEF) patients and their significant complications, they are thought to be under-recognized and under-screened. In our study, we aimed to evaluate patients with HFpEF who were followed up in our internal medicine clinic.
Methods: Our retrospective and cross-sectional study included 348 patients with HFpEF. Patients were evaluated according to laboratory, demographic, clinical, electrocardiographic and ultrasonographic findings.
Results: Of the patients, 37.95% had diabetes mellitus, 23.3% had chronic kidney disease, 70.1% had hypertension and 59.2% had metabolic dysfunction-associated steatotic liver disease. The mean NT-proBNP level was 360.7 ± 13.7.
Conclusion: We recommend that HFpEF, which is associated with increased cardiovascular mortality and morbidity in patients with CRMD, should be screened clinically and with NT-proBNP and evaluated with transthoracic echocardiography if necessary.

Anahtar Kelimeler

CRMD , Diabetes mellitus , HFpEF , Hypertension , MASLD

Kaynakça

• McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure [published correction appears in Eur Heart J. 2021 Dec 21;42(48):4901. doi:10.1093/eurheartj/ehab670.]. Eur Heart J. 2021;42(36):3599-3726. doi:10.1093/eurheartj/ehab368
• Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: A report from the American Heart association. Circulation. 2020;141(9):e139-e596. doi:10.1161/CIR.0000000000000757
• Shah SJ, Borlaug BA, Kitzman DW, McCulloch AD, Blaxall BC, Agarwal R, et al. Research priorities for heart failure with preserved ejection fraction: National heart, lung, and blood institute working group summary. Circulation. 2020;141(12):1001-1026. doi:10.1161/CIRCULATIONAHA.119.041886
• Reddy YNV, Rikhi A, Obokata M, Shah SJ, Lewis GD, AbouEzzedine OF, et al. Quality of life in heart failure with preserved ejection fraction: Importance of obesity, functional capacity, and physical inactivity. Eur J Heart Fail. 2020;22(6):1009-1018. doi:10.1002/ejhf.1788
• Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-271. doi:10.1016/j.jacc.2013.02.092
• Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: An individual patient data meta-analysis. Eur Heart J. 2012;33(14):1750-1757. doi:10.1093/eurheartj/ehr254
• Ostrominski JW, Claggett BL, Miao ZM, McCausland FR, Anand IS, Desai AS, et al. Cardiovascular-kidney-metabolic overlap in heart failure with mildly reduced or preserved ejection fraction: A trial-level analysis. J Am Coll Cardiol. 2024;84(2):223-228. doi:10.1016/j.jacc.2024.05.005
• Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail. 2020;22(8):1342-1356. doi:10.1002/ejhf.1858
• Upadhya B, Kitzman DW. Heart failure with preserved ejection fraction: New approaches to diagnosis and management. Clin Cardiol. 2020;43(2):145-155. doi:10.1002/clc.23321
• American Diabetes Association Professional Practice Committee. 10. Cardiovascular disease and risk management: Standards of care in diabetes-2024. Diabetes care. 2024;47(Suppl 1):S179–S218. doi:10.2337/dc24-S010
• European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of hepatology. 2024;81(3):492–542. doi:10.1016/j.jhep.2024.04.031
• Savji N, Meijers WC, Bartz TM, et al. The association of obesity and cardiometabolic traits with incident HFpEF and HFrEF. JACC Heart Fail. 2018;6(8):701-709. doi:10.1016/j.jchf.2018.05.018
• Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251-259. doi:10.1056/NEJMoa052256
• Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: A comprehensive and updated review of epidemiology [published correction appears in Cardiovasc Res. 2023 Jun 13;119(6):1453. doi: 10.1093/cvr/cvad026.]. Cardiovasc Res. 2023;118(17):3272-3287. doi:10.1093/cvr/cvac013
• Kitzman DW, Gardin JM, Gottdiener JS, Arnold A, Boineau R, Aurigemma G, et al. Importance of heart failure with preserved systolic function in patients > or = 65 years of age. CHS Research Group. Cardiovascular Health Study. Am J Cardiol. 2001;87(4):413-419. doi:10.1016/s0002-9149(00)01393-x
• Potter EL, Hopper I, Sen J, Salim A, Marwick TH. Impact of socioeconomic status on incident heart failure and left ventricular dysfunction: Systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2019;5(2):169-179. doi:10.1093/ehjqcco/qcy047
• Vaduganathan M, Patel RB, Michel A, Shah SJ, Senni M, Gheorghiade M, Butler J. Mode of death in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2017;69(5):556-569. doi:10.1016/j.jacc.2016.10.078
• Borlaug BA. The pathophysiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2014;11(9):507-515. doi:10.1038/nrcardio.2014.83
• Sengul S, Akpolat T, Erdem Y, et al. Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. J Hypertens. 2016;34(6):1208-1217. doi:10.1097/HJH.0000000000000901
• Jackson AM, Rørth R, Liu J, Kristensen SL, Anand IS, Claggett BL, et al. Diabetes and pre-diabetes in patients with heart failure and preserved ejection fraction. Eur J Heart Fail. 2022;24(3):497-509. doi:10.1002/ejhf.2403
• Abudureyimu M, Luo X, Wang X, Sowers JR, Wang W, Ge J, et al. Heart failure with preserved ejection fraction (HFpEF) in type 2 diabetes mellitus: From pathophysiology to therapeutics. J Mol Cell Biol. 2022;14(5):mjac028. doi:10.1093/jmcb/mjac028
• Reddy YNV, Lewis GD, Shah SJ, Obokata M, Abou-Ezzedine OF, Fudim M, et al. Characterization of the obese phenotype of heart failure with preserved ejection fraction: A RELAX trial ancillary study. Mayo Clin Proc. 2019;94(7):1199-1209. doi:10.1016/j.mayocp.2018.11.037
• Löfman I, Szummer K, Dahlström U, Jernberg T, Lund LH. Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction. Eur J Heart Fail. 2017;19(12):1606-1614. doi:10.1002/ejhf.821
• Lian LY, Huang CX, Chen QF, Zhou XD. Heart failure with preserved ejection fraction and metabolic dysfunction-associated steatotic liver disease: Twin challenges, one metabolic solution. World J Cardiol. 2025;17(2):103845. doi:10.4330/wjc.v17.i2.103845
• Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: The CHARM-Preserved Trial. Lancet. 2003;362(9386):777–781. doi:10.1016/S0140-6736(03)14285-7