Myth and facts of the relation between ischemic cardiopaty and heart failure with preserved ejection fraction in Argentina: analysis of the ArFey-Preser registry

Abstract Introduction There is controversial evidence about the pathophysiological relationship between coronary artery disease (CAD) and heart failure with preserved ejection fraction (HFpEF). The diagnostic methodology used (coronary angiography), its results, and the treatment of CAD in this population further fuel this controversy. Objective To study the phenotypic differences, methodology of diagnosis, and indicated treatment in patients with CAD and HFpEF. Material and methods ArFey-Preser is a multicenter, prospective, observational registry of the Heart Failure and Pulmonary Hypertension Committee, Argentinian Federation of Cardiology that included outpatients or patients at the time of hospital discharge with a diagnosis of HF who meet the following criteria: left ventricular ejection fraction (LVEF) ≥50%, current or previous signs and symptoms, evidence of structural heart disease (at least one of the following: ventricular hypertrophy or left atrial dilatation or elevated natriuretic peptides). Patients with acute coronary syndrome, coronary revascularization or valve replacement <3 months, confirmed diagnosis of infiltrative or hypertrophic cardiomyopathy or severe valvular disease, severe disease with a prognosis <1 year, or chronic renal failure on permanent dialysis were excluded. For CAD, at least one pericardial vessel obstruction ≥70%, history of angioplasty or myocardial revascularization surgery was required. Results Between December/22 and May/24, 47 investigators (18 provinces) included 639 patients, aged 72.4±11.3 years (range 26-99), 62.1% women, LVEF 60.5±6.4% (range 50-84%). Coronary angiography was requested in 366 cases (57.3%), and 214 (58.5%) had normal coronary arteries. CAD was identified in 162 (25.4%). The groups with and without CAD were different in age (75.3 vs. 71.4; p<0.001), smoking (51.2 vs. 26.2,3%; p<0.001), female sex (41.4 vs. 69.2%; p<0.001), chronic kidney disease (64.1 vs. 51.2%; p=0.005) and atrial fibrillation/atrial flutter (32.1 vs. 46.1%; p=0.002). The LVEF in CAD was 58.9 vs. 61% without CAD (p<0.001). In patients with and without CAD, functional class (FC III 30.2 vs 29.3%, p=NS) and previous hospitalizations (59.3 vs 58.5%; p=NS) were similar. Treatment in subjects with and without CAD included: antiplatelet agents (69.1 vs 24.3%, p<0.001), statins (83.3 vs 46.8%, p<0.001), diuretics (76.5 vs 78.6%, p=NS), gliflozins (51.9 vs 38.6%, p=0.003), ACEI (21.6 vs 16.4%, p=NS), ARB (58.6 vs 61.8%, p=NS), MRA (45.7 vs 41.3%, p=NS) and ARNI (4.9 vs 3.6%, p=NS) and beta-blockers (90.7 vs 75.7%, p<0.001). Conclusions HFpEF and CAD share clinical characteristics, with more risk factors in the CAD group but with similar symptoms and treatment in both groups. More than a half of the population was evaluated once with coronary angiography, although the prevalence of coronary artery disease is lower than expected in relation to age and comorbidities.