Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems

Parcha, Vibhu; Malla, Gargya; Kalra, Rajat; Patel, Nirav; Wijk, Sandra Sanders‐van; Pandey, Ambarish; Shah, Sanjiv J.; Arora, Garima; Arora, Pankaj

doi:10.1002/ehf2.13288

Cited by 26 publications

(36 citation statements)

References 33 publications

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“…HFpEF represents approximately 50% of HF cases and increasingly recognized as a leading cause of morbidity and mortality, confirmed by the research [6] [35]. The prevalence distribution in the Cardio-Phoenix database between the three categories of HF confirms this 50%, moreover it shows that HFmrEF has double the prevalence compared to HFrEF patients.…”

Section: Typical Characteristics Of Hf Categoriessupporting

confidence: 52%

“…The categorization of HF was done according to criteria described in Table 2, using all the available patient data and ground truth. The definition of HFpEF is compatible with the TOPCAT, RELAX, and ARIC studies [35].…”

Section: Cardio Phoenix Database Analysis and Hf Categoriesmentioning

confidence: 99%

“…Comorbidity for the diagnosis and prognostication of HFpEF is still widely debated, and research introduces various criteria and scoring systems [35].…”

Section: Prevalence Comorbidity Statisticsmentioning

confidence: 99%

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Unraveling diagnostic co-morbidity makeup of each HF category as characteristically derived by ECG- and ECHO-findings

Zaman

Calcagno

Zoccai

et al. 2021

Preprint

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Heart Failure (HF) relies mainly on measurements from Echocardiography, in particular Echo-Findings, to estimate Left Ventricle Ejection Fraction (LVEF) and evaluating structural heart disease criteria. As Echocardiography is not available in primary care, the key structural (heart chamber enlargements) and functional abnormality related measurements are not available precluding the ability to diagnose HF other than through mainly symptomatic means. The opportunity for earlier detection of HF is lost. In this work, we first explore each of the three HF categories, preserved EF, mild-reduced EF, and reduced EF, using various morphological and functional etiology-specific characteristics supported by a literature review and an extensive analysis of a large, dedicated database accumulated over 8 years. We then explore the typical signs and co-morbidities of HF using prevalence analysis to unravel the diagnostic makeup of each HF category as characteristically derived by ECG- and ECHO-findings. From this, we then conduct a principal component analysis (PCA) of the data to interpret patterns of comorbidities, showing groups of comorbidities frequently associated with each other. Lastly, we delve into the role of breakthrough methods for the analysis of bio-signals to replicate common ECHO-findings, as alternatives for detecting and diagnosing HF similarly to Echocardiography, thereby providing a simple device for the effective detection of HF for use in Primary Care.

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Section: Typical Characteristics Of Hf Categoriessupporting

confidence: 52%

Section: Cardio Phoenix Database Analysis and Hf Categoriesmentioning

confidence: 99%

See 1 more Smart Citation

Unraveling diagnostic co-morbidity makeup of each HF category as characteristically derived by ECG- and ECHO-findings

Zaman

Calcagno

Zoccai

et al. 2021

Preprint

View full text Add to dashboard Cite

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“… 35 , 36 In addition, misclassification has been reported, especially in those patients with low HFpEF scores, potentially due to the fact that both scores use resting parameters in a phenotype in which physiological abnormalities augment during exercise. 33 , 37 Nevertheless, both scores have been shown to have prognostic utility in human patients, 38 , 39 suggesting that they capture key pathophysiologic components that determine outcomes in HFpEF.…”

Section: Hfpef: a Heterogeneous Disease With Multiple Disease Mechanismsmentioning

confidence: 99%

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

Withaar

Lam

Schiattarella

et al. 2021

European Heart Journal

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Heart failure (HF) with preserved ejection fraction (HFpEF) is a multifactorial disease accounting for a large and increasing proportion of all clinical HF presentations. As a clinical syndrome, HFpEF is characterized by typical signs and symptoms of HF, a distinct cardiac phenotype and raised natriuretic peptides. Non-cardiac comorbidities frequently co-exist and contribute to the pathophysiology of HFpEF. To date, no therapy has proven to improve outcomes in HFpEF, with drug development hampered, at least partly, by lack of consensus on appropriate standards for pre-clinical HFpEF models. Recently, two clinical algorithms (HFA-PEFF and H2FPEF scores) have been developed to improve and standardize the diagnosis of HFpEF. In this review, we evaluate the translational utility of HFpEF mouse models in the context of these HFpEF scores. We systematically recorded evidence of symptoms and signs of HF or clinical HFpEF features and included several cardiac and extra-cardiac parameters as well as age and sex for each HFpEF mouse model. We found that most of the pre-clinical HFpEF models do not meet the HFpEF clinical criteria, although some multifactorial models resemble human HFpEF to a reasonable extent. We therefore conclude that to optimize the translational value of mouse models to human HFpEF, a novel approach for the development of pre-clinical HFpEF models is needed, taking into account the complex HFpEF pathophysiology in humans.

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“…Imaging parameters are included in the H2FPEF and HFA-PEFF scores, designed initially as diagnostic score systems. A recent study based on more than 900 HFpEF patients could not validate their prognostic utility ( 6 ). The diagnostic use of NT-proBNP in HFpEF is well-established ( 7 ), and the data are convincing about its predictive value ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

Morvai-Illes

Polestyuk-Németh

Szabó

et al. 2021

Front. Cardiovasc. Med.

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Background: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Lung ultrasound (LUS) is a promising screening and prognostic tool in the heart failure population. However, more information on its value in predicting outcome is needed.Aims: The aim of our study was to assess the prognostic performance of LUS B-lines compared to traditional and novel clinical and echocardiographic parameters and natriuretic peptide levels in patients with newly diagnosed HFpEF in an ambulatory setting.Methods: In our prospective cohort study, all ambulatory patients with clinical suspicion of HFpEF underwent comprehensive echocardiography, lung ultrasound and NT-proBNP measurement during their first appointment at our cardiology outpatient clinic. Our endpoint was a composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death.Results: We prospectively enrolled 75 consecutive patients with HFpEF who matched our inclusion and exclusion criteria. We detected 11 events on a 26 ± 10-months follow-up. We found that the predictive value of B-lines is similar to the predictive value of NT-proBNP (AUC 0.863 vs. 0.859), with the best cut-off at >15 B-lines. Having more B-lines than 15 significantly increased the likelihood of adverse events with a hazard ratio of 20.956 (p = 0.004). The number of B-lines remained an independent predictor of events at multivariate modeling. Having more than 15 B-lines lines was associated with a significantly worse event-free survival (Log-rank: 16.804, p < 0.001).Conclusion: The number of B-lines seems to be an independent prognostic factor for adverse outcomes in HFpEF. Since it is an easy-to-learn, feasible and radiation-free method, it may add substantial value to the commonly used diagnostic and risk stratification models.

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Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems

Cited by 26 publications

References 33 publications

Unraveling diagnostic co-morbidity makeup of each HF category as characteristically derived by ECG- and ECHO-findings

Unraveling diagnostic co-morbidity makeup of each HF category as characteristically derived by ECG- and ECHO-findings

Heart failure with preserved ejection fraction in humans and mice: embracing clinical complexity in mouse models

The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

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