Clinical and Echocardiographic Diversity Associated With Physical Fitness in the Project Baseline Health Study: Implications for Heart Failure Staging

Nicholas Cauwenberghs; Francois Haddad; Melissa A Daubert; Ranee Chatterjee; Michael Salerno; Jessica L Mega; Paul Heidenreich; Adrian Hernandez; Myriam Amsallem; Yukari Kobayashi; Kenneth W Mahaffey; Svati H Shah; Gerald S Bloomfield; Tatiana Kuznetsova; Pamela S Douglas; PROJECT BASELINE HEALTH STUDY INVESTIGATORS

doi:10.1016/j.cardfail.2023.04.008

Clinical and Echocardiographic Diversity Associated With Physical Fitness in the Project Baseline Health Study: Implications for Heart Failure Staging

J Card Fail. 2023 Nov;29(11):1477-1489. doi: 10.1016/j.cardfail.2023.04.008. Epub 2023 Apr 26.

Authors

Nicholas Cauwenberghs¹, Francois Haddad², Melissa A Daubert³, Ranee Chatterjee⁴, Michael Salerno⁵, Jessica L Mega⁶, Paul Heidenreich⁷, Adrian Hernandez³, Myriam Amsallem⁸, Yukari Kobayashi⁸, Kenneth W Mahaffey⁹, Svati H Shah¹⁰, Gerald S Bloomfield¹⁰, Tatiana Kuznetsova¹¹, Pamela S Douglas³; PROJECT BASELINE HEALTH STUDY INVESTIGATORS

Affiliations

¹ Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium. Electronic address: nicholas.cauwenberghs@kuleuven.be.
² Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
³ Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA.
⁴ Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
⁵ Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine and Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
⁶ Verily Inc., South San Francisco, CA, USA.
⁷ Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁸ Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Stanford Center for Clinical Research, Department of Medicine, Stanford, CA, USA.
¹⁰ Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹¹ Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.

PMID: 37116641
DOI: 10.1016/j.cardfail.2023.04.008

Abstract

Background: Clinical and echocardiographic features may carry diverse information about the development of heart failure (HF). Therefore, we determined heterogeneity in clinical and echocardiographic phenotypes and its association with exercise capacity.

Methods: 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 (RFs) and echocardiographic abnormalities (RF-/Echo-, RF-/Echo+, RF+/Echo-, RF+/Echo+). Multivariable-adjusted associations between subgroups and physical performance metrics from 6-minute walk and treadmill exercise testing were assessed.

Results: The 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+) had predominantly echocardiographic abnormalities other than left ventricular (LV) diastolic dysfunction, hypertrophy and reduced ejection fraction, whereas their physical performance was similar to RF-/Echo-. In contrast, participants with RF+/Echo+ presented primarily with LV hypertrophy or dysfunction, features that related to lower 6-minute walking distance and lower exercise capacity.

Conclusions: Subclinical echocardiographic abnormalities suggest HF pathogenesis, but the presence of HF risk factors and type of echo abnormality should be considered so as to distinguish adverse from benign adaptation and to stratify HF risk.

Keywords: Heart failure staging; echocardiography; exercise capacity; physical performance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Echocardiography
Heart Failure* / diagnostic imaging
Heart Failure* / epidemiology
Humans
Hypertrophy, Left Ventricular
Physical Fitness
Prognosis
Stroke Volume
Ventricular Dysfunction, Left*
Ventricular Function, Left