PUFAs and Left Ventricular Function in Heart Failure

The results of the GISSI-HF trial indicate that in patients with chronic HF on evidence-based medical therapy and New York Heart Association (NYHA) functional class II-IV, long term treatment with n-3 PUFAs 1 g daily reduces mortality and hospitalizations for cardiovascular reasons. Several potential mechanisms may underlie the beneficial effects of n-3 polyunsaturated fatty acids (PUFAs) in HF patients, including, but not limited to, antiarrhythmic, and hemodynamic actions. The current investigation was therefore designed to test the hypothesis that treatment with n-3 PUFAs improves LV systolic function expressed as EF in patients with stable chronic HF secondary to a nonischemic dilated cardiomyopathy (NICM). Additionally, we sought to determine if n-3 PUFAs also exert positive effects on LV diastolic function assessed by echocardiography; functional capacity assessed by cardiopulmonary stress testing (CPET); and New York Heart Association (NYHA) functional class.

Inclusion criteria

• patients with a diagnosis of non ischemic cardiomyopathy (the absence of coronary artery disease,defined as the absence of stenosis > 50%, was confirmed by angiography performed at the time of the diagnostic workup of the cardiomyopathy)
• LV systolic dysfunction (defined as an EF < 45%)
• Stable clinical conditions with minimal or no symptoms for at least three month
• Evidence-based medical treatment at maximum tolerated target doses for at least six month

Exclusion criteria

• presence of symptoms or evidence of CAD diagnosed through noninvasive tests;
• peripheral arterial disease;
• presence of congenital or primary valvular heart disease;
• persistent atrial fibrillation;
• inability to perform bicycle ergometry for noncardiac causes;
• moderately to severely reduced functional capacity;
• NYHA functional class IV;
• poor acoustic windows limiting the ability to assess echocardiographic measurements;
• chronic lung disease;
• advanced renal disease (eGFR < 30 mL/min/1.73 m2);
• advanced liver disease;
• any disease limiting life expectancy to one year or less;
• contraindications to study drugs;
• concomitant participation in other research studies