Phenotypic Presentations of Heart Failure Among Patients With Chronic Inflammatory Diseases

Abstract

ObjectiveCharacterize incident heart failure (HF) phenotypes among patients with various chronic inflammatory diseases (CIDs).BackgroundSeveral CIDs are associated with increased HF risk, but differences in HF phenotypes across CIDs are incompletely understood. No prior studies to our knowledge have manually adjudicated HF phenotypes across a CID spectrum.MethodsWe screened for patients with—and controls without—CIDs who had possible HF, then hand-adjudicated HF endpoints. Possible HF resulted from a single HF administrative code; HF was deemed definite/probable vs. absent using standardized, validated criteria. We queried adjudicated HF patients' charts to define specific HF phenotypes, then compared clinical, demographic, and HF phenotypic characteristics for HF patients with specific CIDs vs. non-CID controls using Fisher's exact test.ResultsOut of 415 possible HF patients, 192 had definite/probable HF. Significant differences in HF phenotypes existed across CIDs. Isolated right-sided HF was present in 27.8% of patients with SSc and adjudicated HF, which is more than twice as common as it was in any other CID. Left ventricular systolic dysfunction was most common in patients with HIV and lupus (SLE); mean LVEF was 45.0% ± 18.6% for HIV and 41.3% ± 17.1% for SLE, but was 57.7% ± 10.7% for SSc. Those with HIV and multiple CIDs were most likely to have coronary artery disease.ConclusionsDifferent CIDs present with different phenotypes of physician-adjudicated HF, potentially reflecting different underlying inflammatory pathophysiologies. Larger studies are needed to confirm these findings, as are mechanistic studies focused on understanding specific immunoregulatory contributors to HF.

Heart Failure in Chronic Infectious and Inflammatory Conditions: Mechanistic Insights from Clinical Heterogeneity

“…The phenotypic presentation of HF associated with SSc also appears to be distinct from that of other chronic inflammatory diseases. Isolated right-sided heart failure is quite common in SSc [63], which is perhaps not surprising given the high prevalence of pulmonary arterial hypertension in SSc [64]. Even in SSc patients without overt HF, abnormal cardiac tissue structure and mechanics are common: approximately 1/3 rd of SSc patients have late gadolinium enhancement on cardiac magnetic resonance imaging [65] and diastolic dysfunction is highly prevalent [66].…”