Heart Failure With Preserved Ejection Fraction Among Symptomatic Patients With High-Risk Hypertension: Differences in New Diagnostic Algorithms

Abstract

Objective: We aimed to assess diagnostic scales (H2FPEF, HFA-PEFF) on a frequency of revealing HFpEF in patients with arterial hypertension (AH) and symptoms of heart failure (HF). Design and method: Study included 180 high risk hypertensive patients with at least one symptom or sign of HF and left ventricular ejection fraction (LV EF) more or equal 50%, 54,4 % female, 72.3 ± 9.4 years (M ± SD), obesity 54.4 %, diabetes mellitus 38.9 %, atrial fibrillation 61 %, chronic kidney disease 60 %, estimated glomerular filtration rate (eGFR) 57.5 ± 16.33 ml/min/1.73 m2, NT-proBNP level 121 (51.7; 287.7) pg/ml. Patients with significant valvular heart disease, acute coronary syndrome, acute infections, pulmonary embolism, neoplasm, eGFR < 30 ml/min/1.73 m2, body mass index > 40 kg/m2 were not included. HFpEF was assessed by ESC HFA-PEFF and H2FPEF algorithms. Stress-echo with passive leg raising (PLR) was used to detect impaired LV diastolic function reserve and the increase in LV filling pressure. Results: Using ESC HFA-PEFF score patients were divided into 3 groups: low probability/absence of HF in 8.6 % of cases (<2 points), 37.9% of patients have confirmed HF (5 points), patients with intermediate risk of HF and required for stress echocardiography – 53.6 % (2–4 points). After the stress-ECHO HFpEF was additionally detected in 13.3% of patients. Low (<2 points), intermediate (2–5 points) and high probability (>5 points) of HFpEF was identified in 7.4, 60 and 32.6 % of patients according to H2FPEF score. Conclusions: Thus, the frequency of HFpEF using HFA-PEFF was 60%. Stress - ECHO with PLR increases the verifying of HFpEF in 13.3%. High probability of HFpEF according to H2FPEF score was 32.6%. Considering the differences in HFpEF detection using different algorithms, further research are recommended.