Diagnosis of Heart Failure with Preserved Ejection Fraction among Patients with Unexplained Dyspnea

Autor: Yogesh N. V. Reddy, David M. Kaye, M. Louis Handoko, Arno A. van de Bovenkamp, Ryan J. Tedford, Carson Keck, Mads J. Andersen, Kavita Sharma, Rishi K. Trivedi, Rickey E. Carter, Masaru Obokata, Frederik H. Verbrugge, Margaret M. Redfield, Barry A. Borlaug
Přispěvatelé: Cardiology, ACS - Heart failure & arrhythmias, APH - Personalized Medicine, ACS - Pulmonary hypertension & thrombosis, Clinical sciences, Intensive Care
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: JAMA cardiology, 7(9), 891-899. American Medical Association
Reddy, Y N V, Kaye, D M, Handoko, M L, van de Bovenkamp, A A, Tedford, R J, Keck, C, Andersen, M J, Sharma, K, Trivedi, R K, Carter, R E, Obokata, M, Verbrugge, F H, Redfield, M M & Borlaug, B A 2022, ' Diagnosis of Heart Failure With Preserved Ejection Fraction Among Patients With Unexplained Dyspnea ', JAMA cardiology, vol. 7, no. 9, pp. 891-899 . https://doi.org/10.1001/jamacardio.2022.1916
Reddy, Y N V, Kaye, D M, Handoko, M L, Van De Bovenkamp, A A, Tedford, R J, Keck, C, Andersen, M J, Sharma, K, Trivedi, R K, Carter, R E, Obokata, M, Verbrugge, F H, Redfield, M M & Borlaug, B A 2022, ' Diagnosis of Heart Failure with Preserved Ejection Fraction among Patients with Unexplained Dyspnea ', JAMA cardiology, vol. 7, no. 9, pp. 891-899 . https://doi.org/10.1001/jamacardio.2022.1916
ISSN: 2380-6583
DOI: 10.1001/jamacardio.2022.1916
Popis: Importance: Diagnosis of heart failure with preserved ejection fraction (HFpEF) among dyspneic patients without overt congestion is challenging. Multiple diagnostic approaches have been proposed but are not well validated against the independent gold standard for HFpEF diagnosis of an elevated pulmonary capillary wedge pressure (PCWP) during exercise. Objective: To evaluate H 2FPEF and HFA-PEFF scores and a PCWP/cardiac output (CO) slope of more than 2 mm Hg/L/min to diagnose HFpEF. Design, Setting, and Participants: This retrospective case-control study included patients with unexplained dyspnea from 6 centers in the US, the Netherlands, Denmark, and Australia from March 2016 to October 2020. Diagnosis of HFpEF (cases) was definitively ascertained by the presence of elevated PCWP during exertion; control individuals were those with normal rest and exercise hemodynamics. Main Outcomes and Measures: Logistic regression was used to evaluate the accuracy of HFA-PEFF and H 2FPEF scores to discriminate patients with HFpEF from controls. Results: Among 736 patients, 563 (76%) were diagnosed with HFpEF (mean [SD] age, 69 [11] years; 334 [59%] female) and 173 (24%) represented controls (mean [SD] age, 60 [15] years; 109 [63%] female). H 2FPEF and HFA-PEFF scores discriminated patients with HFpEF from controls, but the H 2FPEF score had greater area under the curve (0.845; 95% CI, 0.810-0.875) compared with the HFA-PEFF score (0.710; 95% CI, 0.659-0.756) (difference, -0.134; 95% CI, -0.177 to -0.094; P 2FPEF score. Use of the PCWP/CO slope to redefine HFpEF rather than exercise PCWP reclassified 20% (117 of 583) of patients, but patients reclassified from HFpEF to control by this metric had clinical, echocardiographic, and hemodynamic features typical of HFpEF, including elevated resting PCWP in 66% (46 of 70) of reclassified patients. Conclusions and Relevance: In this case-control study, despite requiring fewer data, the H 2FPEF score had superior diagnostic performance compared with the HFA-PEFF score and PCWP/CO slope in the evaluation of unexplained dyspnea and HFpEF in the outpatient setting..
Databáze: OpenAIRE
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