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HL084904"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous condition, and tissue congestion manifested by oedema is not present in all patients. We compared clinical characteristics, exercise capacity, and outcomes in patients with HFpEF with and without oedema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This study was a post hoc analysis of pooled data of patients with left ventricular ejection fraction of \u226550% enrolled in the DOSE, CARRESS-HF, RELAX, ATHENA, ROSE, INDIE, and NEAT trials. Patients were dichotomized by the severity of oedema. Cox proportional hazard regression and generalized linear regression models were used to assess associations between oedema, symptoms, and clinical outcomes. The ambulatory cohort included 393 patients (228 with and 165 without oedema), and the hospitalized cohort included 338 patients (249 with \u2265moderate oedema and 89 with mild or none). Among ambulatory patients, patients with oedema had a higher body mass index (35.2 kg\/m2 [inter-quartile range, IQR 30.5, 41.6] vs. 31.6 kg\/m2 [IQR 27.9, 36.3], P &amp;lt; 0.001), greater burden of co-morbidities, higher intravascular pressures estimated on physical examination (elevated jugular venous pressure: 50% vs. 24.7%, P &amp;lt; 0.001), poorer renal function (creatinine: 1.2 mg\/dL [IQR 0.9, 1.5] vs. 1 mg\/dL [IQR 0.8, 1.3], P = 0.003), and lower peak VO2 (adjusted mean difference \u22121.04 mL\/kg\/min, 95% confidence interval [\u22121.71, \u22120.37], P &amp;lt; 0.003). Among hospitalized patients, despite greater in-hospital fluid\/weight loss in the \u2265moderate oedema group, there was no difference in the improvement in dyspnoea by the visual analogue scale or well-being visual analogue scale from baseline to 3\u20134 days and no statistically significant difference in the rate of 60 day rehospitalization\/death (adjusted hazard ratio 1.44, 95% confidence interval [0.87, 2.39], P = 0.156).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with HFpEF and oedema display higher body mass, greater burden of co-morbidities, and more severe exercise intolerance, but clinical responses to treatment appear similar. Further research is required to better understand the nature of volume distribution in different HFpEF phenotypes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.13159","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T16:00:56Z","timestamp":1607616056000},"page":"662-669","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Implications of Peripheral Oedema in Heart Failure with Preserved Ejection Fraction: A Heart Failure Network Analysis"],"prefix":"10.1093","volume":"8","author":[{"given":"Marat","family":"Fudim","sequence":"first","affiliation":[{"name":"Department of Medicine, Duke University Medical Center , 2301 Erwin Road, Durham, NC, 27713 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Ashur","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University Medical Center , 2301 Erwin Road, Durham, NC, 27713 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron D.","family":"Jones","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew P.","family":"Ambrosy","sequence":"additional","affiliation":[{"name":"Kaiser Permanente , San Francisco, CA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley A.","family":"Bart","sequence":"additional","affiliation":[{"name":"Minneapolis VA Medical Center , Minneapolis, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Mississippi , Jackson, MS ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horng H.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J.","family":"Greene","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University Medical Center , 2301 Erwin Road, Durham, NC, 27713 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yogesh","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret M.","family":"Redfield","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhinav","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Cardiology, McGill University Health Centre, McGill University , Montreal, Quebec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian F.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University Medical Center , 2301 Erwin Road, Durham, NC, 27713 ,","place":["USA"]},{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary Michael","family":"Felker","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University Medical Center , 2301 Erwin Road, Durham, NC, 27713 ,","place":["USA"]},{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barry A.","family":"Borlaug","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Mentz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University Medical Center , 2301 Erwin Road, Durham, NC, 27713 ,","place":["USA"]},{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,12,9]]},"reference":[{"key":"2026012114041380000_ehf213159-bib-0001","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/j.ejheart.2005.06.003","article-title":"Clinical deterioration in established heart failure: what is the value of BNP and weight gain in aiding 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of early heart failure with preserved ejection fraction","volume":"3","author":"Borlaug","year":"2010","journal-title":"Circ Heart Fail"},{"key":"2026012114041380000_ehf213159-bib-0005","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.006817","article-title":"Role of volume redistribution in the congestion of heart failure","volume":"6","author":"Fudim","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2026012114041380000_ehf213159-bib-0006","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1056\/NEJMoa1005419","article-title":"Diuretic strategies in patients with acute decompensated heart failure","volume":"364","author":"Felker","year":"2011","journal-title":"N Engl J Med"},{"key":"2026012114041380000_ehf213159-bib-0007","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1056\/NEJMoa1210357","article-title":"Ultrafiltration in decompensated heart failure with cardiorenal syndrome","volume":"367","author":"Bart","year":"2012","journal-title":"N Engl J 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syndromes","volume":"7","author":"Yoshihisa","year":"2018","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2026012114041380000_ehf213159-bib-0014","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1161\/CIRCHEARTFAILURE.113.000284","article-title":"Predictors of postdischarge outcomes from information acquired shortly after admission for acute heart failure: a report from the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) study","volume":"7","author":"Cleland","year":"2014","journal-title":"Circ Heart Fail"},{"key":"2026012114041380000_ehf213159-bib-0015","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ijcard.2019.03.020","article-title":"Characteristics and outcome of acute heart failure patients according to the severity of peripheral oedema","volume":"285","author":"Shoaib","year":"2019","journal-title":"Int J Cardiol"},{"key":"2026012114041380000_ehf213159-bib-0016","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.115.002922","article-title":"Fluid volume overload and congestion in heart failure: time to reconsider pathophysiology and how volume is assessed","volume":"9","author":"Miller","year":"2016","journal-title":"Circ Heart Fail"},{"key":"2026012114041380000_ehf213159-bib-0017","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.mayocp.2018.11.037","article-title":"Characterization of the obese phenotype of heart failure with preserved ejection fraction: a RELAX trial ancillary study","volume":"94","author":"Reddy","year":"2019","journal-title":"Mayo Clin Proc"},{"key":"2026012114041380000_ehf213159-bib-0018","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.cardfail.2019.09.010","article-title":"Impact of obesity on volume status in patients with ambulatory 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