Abstract
IntroductionThe diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. In this study, a novel echocardiography index based on three-dimensional and tissue Doppler echocardiography for diagnosing and estimating prognosis in HFpEF.Materials and MethodsPatients with symptoms and/or signs of heart failure and normal left ventricular ejection fraction (LVEF ≥50%) who underwent right heart catheterization were screened. Patients were divided based on pulmonary capillary wedge pressure (PCWP) of ≥15 mmHg and PCWP <15 mmHg. A diagnosis of HFpEF was confirmed by PCWP of ≥15 mmHg according to ESC guidelines. A novel index was calculated by the ratio between stroke volume standardized to body surface area (SVI) and tissue Doppler mitral annulus systolic peak velocity S' (SVI/S'). Its diagnostic and prognostic values were determined.ResultsA total of 104 patients (mean age 64 ± 12 years) were included. Of these, 63 had PCWP ≥15 mmHg and 41 patients had PCWP <15 mmHg. Compared to the PCWP <15 mmHg group, the ≥15 mmHg group had a significantly lower SVI/S' (P < 0.001). Logistic regression showed that SVI/S' was associated with high PCWP measured invasively. The SVI/S' had an area under the curve of 0.761 for diagnosing classifying between PCWP ≥15 mmHg and <15 mmHg. Kaplan–Meier analysis showed that the lower SVI/S' group showed a poorer prognosis.ConclusionsSVI/S' is a non-invasive index calculated by three-dimensional and tissue Doppler echocardiography. It is a surrogate measure of PCWP and can be used to diagnose and determine prognosis in HFpEF.
Highlights
The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging
The study flowchart for subject inclusion and exclusion is shown in Figure 1. 122 patients with typical symptoms and/or signs of heart failure and normal ejection fraction (LVEF ≥50%) underwent right heart catheterization examination were screened for this study
The study cohort had a mean age of 64 ± 12 years, 57% were male, with a mean LVEF of 60 ± 7% and mean pulmonary capillary wedge pressure (PCWP) of 18 ± 8 mmHg. 63 (61%) patients were identified as having increased PCWP (≥15 mmHg; HFpEF group), with the remaining 41 (39%) patients showing normal PCWP (
Summary
The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. A novel echocardiography index based on three-dimensional and tissue Doppler echocardiography for diagnosing and estimating prognosis in HFpEF. Heart failure (HF) with preserved ejection fraction (HFpEF), previously known as diastolic heart failure, is a complex clinical syndrome, characterized by normal or near normal left ventricular ejection fraction (LVEF > 50%) [1]. The diagnosis of HFpEF requires clinical symptoms and/or signs of HF, as well as evidence of preserved LVEF and diastolic dysfunction [1]. A wide variety of echocardiography parameters have been used to assess diastolic function, including mitral valve inflow velocities (E), mitral annular velocity (e’), ratio of early diastolic mitral valve inflow velocity and early diastolic mitral annulus tissue velocity (E/e’), peak velocity of tricuspid regurgitation (TR) jet and left atrial maximum volume index (LAVI) [1, 6]. The assessment of invasive hemodynamic using cardiac catheterization continues to serve as the gold standard for diagnosing diastolic dysfunction [8]
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