Diagnosis of heart failure with preserved ejection fraction: which parameters and diagnostic strategies are more valuable?

• Published in: European journal of heart failure Vol. 13; no. 7; pp. 737 - 745
• Main Authors: Shuai, Xin-Xin, Chen, Yu-Yuan, Lu, Yong-Xin, Su, Guan-Hua, Wang, Yu-Hui, Zhao, Hong-Liang, Han, Jun
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-07-2011; Oxford University Press
• Subjects: Aged; Biomarkers - blood; Case-Control Studies; Diagnosis; Diastolic dysfunction; Echocardiography; Exercise Test; Female; Heart Failure - blood; Heart Failure - diagnosis; Heart Failure - diagnostic imaging; Heart failure with preserved ejection fraction; Humans; Male; Middle Aged; Natriuretic peptide; Natriuretic Peptide, Brain - blood; Natriuretic Peptide, Brain - metabolism; Peptide Fragments - blood; Peptide Fragments - metabolism; Prospective Studies; ROC Curve; Statistics, Nonparametric; Stroke Volume - physiology; Ultrasonography, Doppler; Ventricular Function, Left; Heart failure with preserved ejection fraction; Diastolic dysfunction; Echocardiography; Diagnosis; Natriuretic peptide
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1093/eurjhf/hfr053

Aims
There are no unified criteria for diagnosing heart failure with preserved ejection fraction (HFpEF). The aim of this study was to evaluate the present main diagnostic criteria and to discover which parameters and strategies are more valuable.
Methods and results
Echocardiographic data and plasma N-terminal pro-brain natriuretic peptide  levels were assessed in a derivation cohort (n= 236) and a validation cohort (n= 98). Both cohorts included normal controls, patients with hypertensive heart disease without heart failure and patients with HFpEF. In the derivation cohort, the ratio of early mitral inflow velocity to tissue Doppler velocity at lateral mitral annulus (lateral E/e'≥12), left atrial volume index (LAVI≥34 mL/m2), and the difference between duration of reversed pulmonary vein atrial systole flow and duration of mitral A wave flow (Ard-Ad>30 ms) had the greatest diagnostic value among all the single parameters. A brief strategy that consisted of either: (i) lateral E/e'≥12; or (ii) 12>lateral E/e'≥8, with either LAVI≥34 mL/m2 or Ard-Ad>30 ms, provided good diagnostic accuracy for identifying diastolic dysfunction in HFpEF, with a sensitivity of 77% and specificity of 81%. These observations were confirmed in the validation cohort.
Conclusion
Echocardiographic parameters including lateral E/e', LAVI, and Ard-Ad have the greatest value in diagnosing HFpEF. A brief strategy that included these three parameters had great diagnostic value and would be simple to use in clinic practice.