Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry

Abstract

Aims In hospitalized patients with a clinical diagnosis of acute heart failure (HF) with preserved ejection fraction (HFpEF), the aims of this study were (i) to assess the proportion meeting the 2016 European Society of Cardiology (ESC) HFpEF criteria and (ii) to compare patients with restrictive/pseudonormal mitral inflow pattern (MIP) vs. patients with MIP other than restrictive/pseudonormal. Methods and results We included hospitalized participants of the ESC-Heart Failure Association (HFA) EURObservational Research Programme (EORP) HF Long-Term Registry who had echocardiogram with ejection fraction (EF) ≥ 50% during index hospitalization. As no data on e', E/e' and left ventricular (LV) mass index were gathered in the registry, the 2016 ESC HFpEF definition was modified as follows: elevated B-type natriuretic peptide (BNP) (≥100 pg/mL for acute HF) and/or N-terminal pro-BNP (≥300 pg/mL) and at least one of the echocardiographic criteria: (i) presence of LV hypertrophy (yes/no), (ii) left atrial volume index (LAVI) of >34 mL/m 2), or (iii) restrictive/pseudonormal MIP. Next, all patients were divided into four groups: (i) patients with restrictive/pseudonormal MIP on echocardiography [i.e. with presumably elevated left atrial (LA) pressure], (ii) patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure), (iii) atrial fibrillation (AF) group, and (iv) 'grey area' (no consistent description of MIP despite no report of AF). Of 6365 hospitalized patients, 1848 (29%) had EF ≥ 50%. Natriuretic peptides were assessed in 28%, LV hypertrophy in 92%, LAVI in 13%, and MIP in 67%. The 2016 ESC HFpEF criteria could be assessed in 27% of the 1848 patients and, if assessed, were met in 52%. Of the 1848 patients, 19% had restrictive/pseudonormal MIP, 43% had MIP other than restrictive/pseudonormal, 18% had AF and 20% were grey area. There were no differences in long-term all-cause or cardiovascular mortality, or all-cause hospitalizations or HF rehospitalizations between the four groups. Despite fewer non-cardiac comorbidities reported at baseline, patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure) had more non-cardiovascular (14.0 vs.

On the search for the right definition of heart failure with preserved ejection fraction

“…1) [12,13]. In everyday clinical practice, confirming or excluding HFpEF poses a considerable challenge with a potential for both overdiagnosis (mostly in primary care and in patients hospitalized for acute dyspnea) and underdiagnosis (especially in stable, uncongested, elderly patients with exertional symptoms) [14][15][16][17][18][19][20][21][22][23][24]. The abundance of HFpEF definitions might cause even more confusion among non-HF specialists.…”

Electronic healthcare records and external outcome data for hospitalized patients with heart failure

“…For example, the ESC-Heart Failure Association (HFA) EURObservational Research Programme (EORP) generated a large dataset that contained specifically HF patients, and a large amount of data that are routinely collected during clinical practice were abandoned. To the best of our knowledge, this is the largest HF dataset in the world, including 337 cardiology centres from 33 ESC Member countries 12 . In essence, many trivial attributes may work together to influence the clinical outcome.…”

Assessment of prevalence and monitoring of outcomes in patients with heart failure in Russia

“…У пациентов с одышкой неясного генеза действующие критерии ХСНсФВ пока-зали низкую чувствительность при сопоставлении с "золотым" стандартом диагностики ХСН -оценкой внутрисердечной гемодинамики при нагрузке [16], а предложенные новые шкалы [17,18] не всегда согласуются между собой [19]. Несмотря на ожидаемо меньшую погрешность при диагностике острой СН с сохранной ФВ, анализ данных крупного европейского регистра (Heart Failure Association EURObservational Research Programme Heart Failure Long-Term Registry) свидетельствует, что после выписки ХСНсФВ подтверждается только в половине случаев [20]. Другой нерешенный клинический вопрос -это поиск эффективных доказанных методов лечения в данной группе ХСН.…”