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

ESC Heart Failure

Antonio Lara‐Padrón¹  Gerasimos Filippatos²  Camilla Hage³  Frank Ruschitzka⁴  Aldo P. Maggioni⁵  Agnieszka Kapłon‐Cieślicka⁶  Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the ESC Heart Failure Long‐Term Registry Investigators⁷  Theresa McDonagh⁸  Alexandre Mebazaa⁹  Stefan D. Anker^1,10  Jarosław Drożdż^1,11  Cécile Laroche^1,11  Mitja Lainscak^1,12  Andrew J.S. Coats^1,13  Lars H. Lund^1,13  Alessandro Fucili^1,14  Maria G. Crespo‐Leiro^1,15  Giuseppe M.C. Rosano^1,16  Petar Seferovic^1,17 

[1] Charité Universitätsmedizin Berlin, Germany & Department of Cardiology and Pneumology University Medicine Göttingen (UMG) Göttingen Germany;Department of Cardiology (CVK);German Centre for Cardiovascular Research (DZHK) partner site Berlin;Serbian Academy of Sciences and Arts Belgrade Serbia;and Berlin‐Brandenburg Center for Regenerative Therapies (BCRT);1st Chair and Department of Cardiology Medical University of Warsaw Warsaw Poland;Department of Anaesthesia and Critical Care University Hospitals Saint Louis‐Lariboisière, APHP;Department of Cardiology Medical University of Lodz Lodz Poland;Department of Medical Sciences University of Ferrara Ferrara Italy;Division of Cardiology and Metabolism;EURObservational Research Programme (EORP) European Society of Cardiology Sophia‐Antipolis France;Faculty of Medicine University of Belgrade;IRCCS San Raffaele, Pisana Rome Italy;School of Medicine, University of Cyprus & Heart Failure Unit, Department of Cardiology University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece;Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco Complexo Hospitalario Universitario A Coruna (CHUAC), INIBIC, UDC, CIBERCV A Coruña Spain;Unidad de Insuficiencia Cardiaca, Servicio de Cardiología Complejo Hospital Universitario de Canarias San Cristóbal de La Laguna, Santa Cruz de Tenerife Spain;Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden;

关键词: Comorbidity;    Death;    Diastolic dysfunction;    Heart failure with preserved ejection fraction;    Hospitalization;    Overdiagnosis;   

DOI  :  10.1002/ehf2.12817

来源: DOAJ

【 摘 要 】

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/m2), 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. 6.7 per 100 patient‐years, P < 0.001) and cardiovascular non‐HF (13.2 vs. 8.0 per 100 patient‐years, P = 0.016) hospitalizations in long‐term follow‐up than patients with restrictive/pseudonormal MIP. Conclusions Acute HFpEF diagnosis could be assessed (based on the 2016 ESC criteria) in only a quarter of patients and confirmed in half of these. When assessed, only one in three patients had restrictive/pseudonormal MIP suggestive of elevated LA pressure. Patients with MIP other than restrictive/pseudonormal (suggestive of normal LA pressure) could have been misdiagnosed with acute HFpEF or had echocardiography performed after normalization of LA pressure. They were more often hospitalized for non‐HF reasons during follow‐up. Symptoms suggestive of acute HFpEF may in some patients represent non‐HF comorbidities.

【 授权许可】

Unknown