Comprehensive diagnostic workup in patients with suspected heart failure and preserved ejection fraction

Albani, Stefano; Zilio, Filippo; Scicchitano, Pietro; Musella, Francesca; Ceriello, Laura; Marini, Marco; Gori, Mauro; Khoury, Georgette; D'Andrea, Antonello; Campana, Marco; Iannopollo, Gianmarco; Fortuni, Federico; Ciliberti, Giuseppe; Gabrielli, Domenico; Oliva, Fabrizio; Colivicchi, Furio

doi:10.1016/j.hjc.2023.09.013

Hellenic Journal of Cardiology

2024

DOI: 10.1016/j.hjc.2023.09.013

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Comprehensive diagnostic workup in patients with suspected heart failure and preserved ejection fraction

Stefano Albani,

Filippo Zilio,

Pietro Scicchitano

et al.

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2024

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Cited by 2 publications

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Clustering Based on Laboratory Data in Patients With Heart Failure Admitted to the Intensive Care Unit

Nemati,

Mohammadi,

Hooshanginezhad

2024

Clinical Laboratory Analysis

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BackgroundHeart failure (HF) is a common condition that imposes a significant burden on healthcare systems. We aimed to identify subgroups of patients with heart failure admitted to the ICU using routinely measured laboratory biomarkers.MethodsA large dataset (N = 1176) of patients with heart failure admitted to the ICU at the Beth Israel Deaconess Medical Center in Boston, USA, between June 1, 2001, and October 31, 2012, was analyzed. We clustered patients to identify laboratory phenotypes. Cluster profiling was then performed to characterize each cluster, using a binary logistic model.ResultsTwo distinct clusters of patients were identified (N = 679 and 497). There was a significant difference in the mortality rate between Clusters 1 and 2 (50 [7.4%] vs. 109 [21.9%], respectively, p < 0.001). Patients in the Cluster 2 were significantly older (mean [SD] age = 72.35 [14.40] and 76.37 [11.61] years, p < 0.001) with a higher percentage of chronic kidney disease (167 [24.6%] vs. 262 [52.7%], respectively, p < 0.001). The logistic model was significant (Log‐likelihood ratio p < 0.001, pseudo R2 = 0.746) with an area under the curve of 0.905. The odds ratio for leucocyte count, mean corpuscular volume (MCV), red blood cell (RBC) distribution width, hematocrit (HcT), lactic acid, blood urea nitrogen (BUN), serum potassium, magnesium, and sodium were significant (all p < 0.05).ConclusionLaboratory data revealed two phenotypes of ICU‐admitted patients with heart failure. The two phenotypes are of prognostic importance in terms of mortality rate. They can be differentiated using blood cell count, kidney function status, and serum electrolyte concentrations.

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Clustering Based on Laboratory Data in Patients With Heart Failure Admitted to the Intensive Care Unit

Nemati,

Mohammadi,

Hooshanginezhad

2024

Clinical Laboratory Analysis

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Variability in approach to exercise stress echocardiography for diagnosis of heart failure with preserved ejection fraction: an international survey on real-world practice

Tani,

Reddy,

Verbrugge

et al. 2024

European Heart Journal - Imaging Methods and Practice

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Aims The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging based on resting assessments. Exercise echocardiography is often used to unmask abnormalities that develop during exercise, but the diagnostic criteria have not been standardized. This study aimed to elucidate how cardiologists utilize exercise echocardiography to diagnose HFpEF in real-world practice. Methods and results An international web-based survey involving 87 cardiologists was performed. We also performed a retrospective cross-sectional study to investigate the impact of different exercise echocardiographic diagnostic criteria in 652 dyspnoeic patients who underwent exercise echocardiography. The HFA-PEFF algorithm was the most commonly used exercise echocardiography criterion for HFpEF diagnoses (48%), followed by the ASE/EACVI criteria (24%) and other combinations of multiple parameters (22%). Among 652 patients, the proportion of HFpEF diagnosis varied substantially according to the criteria used ranging from 20.1% (ASE/EACVI criteria) to 44.3% (HFA-PEFF algorithm). Many cases (49.4–70.5%) remained indeterminate after exercise echocardiography, but only 41% of surveyed cardiologists would utilize exercise right heart catheterization to resolve an indeterminate result. Despite these diagnostic uncertainties, 54% of surveyed cardiologists would utilize exercise echocardiography results to initiate sodium–glucose co-transporter 2 inhibitors. Conclusion In real-world practice, exercise echocardiographic criteria utilized across cardiologists vary, which meaningfully impacts the frequency of HFpEF diagnoses, with indeterminate results being common. Despite these diagnostic uncertainties, many cardiologists initiate pharmacotherapy based on exercise echocardiography. The lack of consensus on universal diagnostic criteria for exercise echocardiography and approaches to indeterminate results may limit the delivery of evidence-based treatment for HFpEF.

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Comprehensive diagnostic workup in patients with suspected heart failure and preserved ejection fraction

Cited by 2 publications

References 114 publications

Clustering Based on Laboratory Data in Patients With Heart Failure Admitted to the Intensive Care Unit

Clustering Based on Laboratory Data in Patients With Heart Failure Admitted to the Intensive Care Unit

Variability in approach to exercise stress echocardiography for diagnosis of heart failure with preserved ejection fraction: an international survey on real-world practice

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