Online Appendix for the following January 16 JACC article
TITLE: Cardiovascular Features of Heart Failure With Preserved Ejection Fraction Versus
Nonfailing Hypertensive Left Ventricular Hypertrophy in the Urban Baltimore Community: The
Role of Atrial Remodeling/Dysfunction
AUTHORS: Vojtech Melenovsky, MD, Division of Cardiology, Department of Medicine, Johns
Hopkins University, Baltimore, Maryland, Laboratory of Cardiovascular Science, Baltimore,
Maryland, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic I,
Barry A. Borlaug, MD, Division of Cardiology, Department of Medicine, Johns Hopkins
University, Baltimore, Maryland, Boaz Rosen, MD, Division of Cardiology, Department of
Medicine, Johns Hopkins University, Baltimore, Maryland, Ilan Hay, MD, Division of
Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, Luigi
Ferruci, MD, PhD, Clinical Research Branch, Intramural Research Program, National Institute
on Aging, National Institutes of Health, Baltimore, Maryland, Christopher H. Morell, PhD,
Department of Mathematical Sciences, Loyola College in Maryland, Baltimore, Maryland,
Edward G. Lakatta, MD, Laboratory of Cardiovascular Science, Baltimore, Maryland Samer S.
Najjar, MD, Laboratory of Cardiovascular Science, Baltimore, Maryland, David A. Kass, MD,
Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore,
Maryland
APPENDIX
Supplemental Table A. Framingham Heart Failure Criteria*
_____________________________________________________________________________________________________________________
Heart failure is considered to be present if two major or one major plus two minor criteria were
present in the absence of an alternative explanation for the symptoms and signs.
Major criteria:
Paroxysmal nocturnal dyspnea
Orthopnea
Jugular venous distention
Hepatojugular reflux
Pulmonary rales
Radiographic evidence of cardiomegaly
Acute pulmonary edema
Third heart sound
Central venous pressure >16 cm of water
Weight loss >4.5 kg during first 5 days of treatment for suspected heart failure
Minor criteria:
Bilateral ankle edema
Nocturnal cough
Dyspnea on ordinary exertion
Hepatomegaly
Pleural effusion
Heart rate >120 beats/min
_____________________________________________________________________________________________________________________
*Adapted from McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of
congestive heart failure: the Framingham study. N Engl J Med1971;285:1441–6.
Supplemental Table B. Classification of Diastolic Dysfunction
Diastolic dysfunction was classified using a slightly modified version of the algorithm recently
employed by Prichett et al. (J Am Coll Cardiol 2005;45:87–92).
The ratio of mitral inflow early filling velocity (E) to atrial filling velocity (A) is
used for initial categorization. If E/A is <0.75, grade I diastolic dysfunction (DD)
is considered present.
If E/A falls in the normal range (0.75 to 1.5) and
deceleration time exceeds 140 ms, then additional Doppler indexes are used to
determine if filling is normal (normal diastolic function, = Grade 0 DD) or
“pseudonormal.” If flow and tissue Doppler analysis indicates elevated filling
pressures (pulmonary venous systolic/diastolic velocity ratio <1; or E/E’ ratio
>10), then grade II DD is considered to be present. If the E/A ratio is >1.5 and at
least two other Doppler indexes support elevated filling pressures (deceleration
time <140 ms, pulmonary venous systolic/diastolic velocity ratio <1, E/E’ ratio
>10), then the subject is considered to have grade III DD. Here, a deceleration
time less than 140 ms is considered one index of elevated filling pressures and
another index is required for confirmation.
Supplemental Table C. LV Mass, LV, LA, and Total Heart Volumes Indexed to Body
Surface Area or Height
Cardiac index, l/min/m2
Controls
(n = 56)
2.8 ± 0.5
HFpEF
(n = 37)
2.4 ± 0.5
H/LVH without HF
(n = 40)
2.5 ± 0.6
p Value
ANOVA
0.04
LV mass, g
144 ± 33
302 ± 95*†
223 ± 53†
< 0.001
LV mass/height, g/m
86 ± 29
185 ± 53*†
136 ± 29†
< 0.001
LV mass/BSA, g/m2
76 ± 17
144 ± 44*†
114 ± 21†
< 0.001
LV end-diastolic volume/BSA, ml/m2
59 ± 15
55 ± 14
57 ± 14
0.29
LV end-diastolic volume/height, ml/m
66 ± 14
70 ± 19
68 ± 18
0.45
LV mass/end-diastolic volume, g/ml
1.32 ± 0.3
2.77 ± 1.0*†
2.10 ± 0.6†
<0.001
LA Volmax/BSA, ml/m2
27.5 ± 7.0
40.4 ± 12.4*†
30.5 ± 8.5
<0.001
Total heart volume/BSA, ml/m2
320 ± 62
417 ± 104*†
357 ± 57
<0.001
p < 0.05 vs. H/LVH group; †p < 0.05 vs. control group, Bonferroni post-hoc test.
*