Screening for asymptomatic heart failure with preserved ejection fraction in mongolian population at high risk.

Tsolmon Unurjargal ,Ganchimeg Ulziisaikhan ,Naranchimeg Sodovsuren ,Ch Khorloo ,Altaisaikhan Khasag

doi:10.18087/cardio.2020.4.n788

Abstract

Objective The goals of the present study were to assess the prevalence of asymptomatic heart failure with preserved ejection fraction (HFpEF) in subjects at high risk of developing HF and to define the diagnostic accuracy of NT-pro BNP assay compared with echocardiography in this setting.Material and methods This cross-sectional study included subjects aged from 35 to 64 years, with high risk of HF, who had no clinical symptoms of HF. Risk factors of HF were detected by clinical examinations. NT-pro BNP determination was performed using immunoassay analyzer (FIA8000, Getein Bio Medical Inc, China),. The cut-off point for NT-pro BNP was 125 pg/ml. Diagnosis of HFpEF was based on criteria recommended by 2016 ESC heart failure guidelines. Diastolic dysfunction was assessed according to the algorithm proposed in the joint recommendations of the ASE/EACVI.Results 602 patients with risk factors of HF were included in the study, of which 256 (42.5 %) were males and 346 (57.5 %) females. The mean age was 51.71±8.07 years. 83 patients (13.8 %) showed elevated NT-pro BNP levels of ≥125 pg / ml. Our study has shown that NT-pro BNP concentration was positively correlating with age, both systolic and diastolic blood pressure, left ventricular mass and E / e' ratio and negatively correlating with waist circumference, body mass index, left ventricular EF and E / A ratio in asymptomatic population. The likelihood of positive NT-pro BNP test was independently (p<0.05) associated with age, hypertension and diabetes. The diagnosis of asymptomatic HFpEF was confirmed in 12.3 % of studied population. A cutoff value of 125 pg / ml for NT-proBNP concentration showed the following diagnostic re-abilities in identifying asymptomatic HFpEF: sensitivity 85.0 %, specificity 88.6 % and area under curve 0.92 (95 % CI 0.86-0.98).Conclusion Subjects with raised NT-pro BNP level (≥125 pg/ml) were more likely to have a confirmed diagnosis of asymptomatic HFpEF after screening. In summary, in at-risk population, natriuretic peptide based screening combined with echocardiography identifies high prevalence of asymptomatic HFpEF.

Highlights

The prevalence of cardiovascular diseases (CVD) amongMongolian population has increased 5 times during the last 20 years [1]
Our study has shown that NT-pro BNP concentration was positively correlating with age, both systolic and diastolic blood pressure, left ventricular mass and E / e’ ratio and negatively correlating with waist circumference, body mass index, left ventricular EF and E / A ratio in asymptomatic population
The heart failure (HF) has poor prognosis and high mortality rate (40–50 % after 5 years) especially if the symptoms are due to left ventricular (LV) systolic dysfunction [3]

Summary

Introduction

Mongolian population has increased 5 times during the last 20 years [1]. The prevalence of heart failure (HF) and its associated morbidity and mortality have increased exponentially over recent decades. The HF has poor prognosis and high mortality rate (40–50 % after 5 years) especially if the symptoms are due to left ventricular (LV) systolic dysfunction [3]. Given the growing epidemic of HF with preserved ejection fraction (HFpEF), it may be the time to broaden the aim of screening to focus on the identification of patients with asymptomatic LV diastolic dysfunction. According to the 2016 ESC acute and chronic heart failure guidelines, circulating levels of NT-proBNP (N-Terminal pro-B-type natriuretic peptide) can be used as an initial diagnostic test. The cutoff value of NT-proBNP for patients without acute HF is 125 pg / ml [4]

Methods

Results

Conclusion