Detection of early heart failure with preserved ejection fraction in metabolic syndrome patients detected as part of a national screening program in middle aged subjects

Background: We wished to investigate if community detected Metabolic Syndrome (MetS) is associated with the burden of incipient heart failure with preserved ejection fraction (HFpEF) in the community.
Methods and Results: We prospectively studied 148 consecutive MetS patients identified from the Lithuanian High Cardiovascular Risk primary prevention program and investigated them further for unknown HFpEF through cardiopulmonary stress testing as well as assessment of brain natriuretic peptide (BNP) levels and of arterial stiffness. Subjects with a peak oxygen consumption value lower than 90% of predicted and/or BNP≥35 ng/L were categorized as having early phase HFpEF. For comparison of this early phase HFpEF with others already clinically diagnosed with HFpEF, patients with both established HFpEF and MetS were selected retrospectively from patients attending our cardiopulmonary stress testing laboratory (n=38). Two thirds of the screening program derived MetS population (n=96) demonstrated a reduced exercise capacity and/or an elevated BNP, indicating signs of early HFpEF. Both the clinically diagnosed HFpEF and the screening program detected MetS group with early HFpEF demonstrated similarly decreased exercise tolerance evaluated by peak oxygen uptake (79.8±22.1% vs 82.7±14.0%, p>0.05). Analysis of arterial markers in the screening program group revealed statistically significant differences of augmentation index values between groups with and without signs of early HFpEF (p=0.016).
Conclusions: A considerable proportion of patients having MetS may be diagnosed with previously undetected early stage HFpEF. The use of objective parameters of exercise capacity and neurohormonal activation might be effectively used for the early detection of HFpEF. Also, early HFpEF in this setting is found to be associated with increased arterial stiffness.