Characteristics of heart failure with a preserved ejection fraction in black South African patients

M van Hoogland-van Heerden; L H Böhmer; O Heyneke; T Lechaba; L Scott; G Norton; A Woodiwiss; P Mntla; Ohi Majane

doi:10.1016/j.ijcha.2024.101408

Characteristics of heart failure with a preserved ejection fraction in black South African patients

Int J Cardiol Heart Vasc. 2024 Apr 11:52:101408. doi: 10.1016/j.ijcha.2024.101408. eCollection 2024 Jun.

Authors

M van Hoogland-van Heerden¹, L H Böhmer¹, O Heyneke¹, T Lechaba¹, L Scott¹, G Norton², A Woodiwiss², P Mntla³, Ohi Majane¹

Affiliations

¹ Sefako Makgatho Health Sciences University, South Africa.
² University of the Witwatersrand, South Africa.
³ Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, South Africa.

Abstract

Background: Heart failure with a preserved ejection fraction (HFpEF) is common in the elderly (≥75 years) and associated with arterial stiffness. The mean age of HFpEF presentation is lower (40-55 years) in sub-Saharan Africa. No clinical study has been conducted on HFpEF in identifying and characterising this phenotype at a younger age, moreover in a South African black population where the risk of HFpEF is two times higher than in other ethnic groups. This study investigated the characteristics of HFpEF in a black South African population, the biochemical markers that predict HFpEF and cardiac structural changes in this HF phenotype.

Methods: Sixty-six participants with HFpEF and 213 controls were enrolled. All participants gave informed consent and completed a standardised questionnaire. Echocardiographic, anthropometric, central haemodynamic measurements, pulse wave velocity (PWV) and biomarker analysis were done.

Results: The mean age of HFpEF participants was 54.88 ± 13.51 years. Most of the participants (76 %) were between 20 and 64 years, while only 24 % were older. HFpEF participants were hypertensive, and more obese with increased incidence of alcohol consumption. PWV was increased in HFpEF (9.97 ± 2.78 m/s) when compared to participants without HFpEF (6.11 ± 2.18 m/s), p < 0.0001. There were no significant associations between central haemodynamic parameters, N-terminal pro B-type natriuretic peptide (NT-proBNP) (p = 0.9746), and galectin-3 (p = 0.2166). NT-proBNP, but not galectin-3, was associated with left ventricular hypertrophy (p = 0.0002) and left atrial diameter (p = 0.0005).

Conclusion: HFpEF in South Africa is predominant in obese young to middle-age individuals with arterial stiffness and who consume alcohol regularly. NT-proBNP could be used to diagnose HFpEF, however, should be interpreted with caution in populations with a high prevalence of obesity.

Keywords: Biomarkers; Cardiovascular disease; Haemodynamics; Heart failure with a preserved ejection fraction; Hypertension; Risk factors.