Heart failure with preserved ejection fraction: the role of diastolic stress test in diagnostic algorithms

Павлюкова, Е. Н.; Kuzhel, D. A.

doi:10.15829/1560-4071-2021-4147

Russ J Cardiol

2021

DOI: 10.15829/1560-4071-2021-4147

|View full text |Cite

Heart failure with preserved ejection fraction: the role of diastolic stress test in diagnostic algorithms

Е. Н. Павлюкова¹,

D. A. Kuzhel

Abstract: Heart failure (HF) with preserved ejection fraction (HFpEF) is currently the most common type of this condition, especially among elderly patients. Despite the preserved left ventricular (LV) and a moderate increase in natriuretic peptide, patients with HFpEF have the same out-of-hospital mortality as those with HF with reduced ejection fraction (HFrEF). Diagnosis of HFpEF is difficult due to nonspecific symptoms, expensive blood tests, and questionable rest echocardiographic data on diastolic function. In ad… Show more

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2022

Publication Types

Select...

Article2

Relationship

Self Cite0

Independent2

Authors

Journals

Cited by 2 publications

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Left atrial strain in assessing heart failure with preserved ejection fraction in hypertensive patients

Мазур

Bazhenov

et al. 2022

Russ J Cardiol

View full text Add to dashboard Cite

Aim. To compare the results of diagnosing heart failure with preserved ejection fraction (HFpEF) in patients with hypertension (HTN) according left atrial (LA) strain values with the results obtained using the H2FPEF score and diastolic stress testing (DST).Material and methods. The study included 293 patients with previously established HTN who were examined due to complaints of shortness of breath and/or palpitations (men, 97 (33,5%), mean age, 62,0 (55,0; 67,0) years). All patients underwent transthoracic echocardiography with the assessment of LA strain parameters and probability of HFpEF using the H2FPEF score. Eighty five patients with an intermediate probability of HFpEF underwent DST.Results. A low probability of HFpEF according to the H2FPEF score was registered in 35 (11,9%) patients, uncertain — in 206 (70,3%), high — in 52 (17,7%). DST was negative in 43 (50,6%) and positive in 42 (49,4%) patients with an intermediate probability of HFpEF. LA strain in the reservoir phase in patients with a low probability of HFpEF averaged (median and interquartile interval) 28,0 (23,6; 31,5)%, while in patients with an intermediate probability and negative DST — 24,0 (22,0; 26,8)%, with an intermediate probability and positive DST — 20,0 (18,0; 21,0)%, and with a high probability of HFpEF — 19,6 (16,9; 21,8)%. HFpEF was diagnosed in 94 patients, including 52 with a high probability on the H2FPEF score and 42 with an intermediate probability and positive DST. The diagnosis of HFpEF was ruled out in 78 patients, including 35 with a low probability on the H2FPEF score and 43 with an intermediate probability and negative DST. Further, 172 patients with confirmed or excluded HFpEF were randomly divided into two equal cohorts. In the training cohort, HFpEF was diagnosed in 44 (51,2%) patients, in the validation cohort — in 50 (58,1%). ROC analysis performed on the training cohort for the LA strain in reservoir phase showed AUC of 0,920 (95% confidence interval (CI), 0,842-0,968) and cut-off point of 21,5%. In the training cohort, the results of HFpEF diagnosis using the indicated criterion coincided with those using H2FPEF score and DST in 86,1% (95% CI, 77,2-91,8) of cases. The Cohen’s kappa was 0,721 (95% C,I 0,575-0,868). In the validation cohort, agreement was observed in 84,9% (95% CI 75,8-91,0) of cases with Cohen’s kappa of 0,702 (95% CI 0,553-0,851).Conclusion. In hypertensive patients, the diagnosis of HFpEF made on the basis of a decrease in the LA strain in reservoir phase to ≤21,5%, is in good agreement with the diagnosis made using the H2FPEF score and DST.

show abstract

Left atrial strain in assessing heart failure with preserved ejection fraction in hypertensive patients

Мазур

Bazhenov

et al. 2022

Russ J Cardiol

View full text Add to dashboard Cite

show abstract

Left Atrial Strain as a Predictor of Diastolic Stress Test Results in Patients With Arterial Hypertension

Мазур

Bazhenov

et al. 2022

Kardiologiia

View full text Add to dashboard Cite

Aim To study a possibility of using the left atrial strain (LAS) for predicting results of the noninvasive diastolic stress test (DST) in patients with arterial hypertension (AH).Material and methods The study included 98 patients previously diagnosed with AH. As a part of evaluation for complaints of dyspnea, palpitation or pain in the area of the heart, DST and transthoracic echocardiography were performed. Echocardiography included measurements of LAS in the reservoir phase, left atrial volume index (LAVI), pulmonary artery systolic pressure (PASP), and ratio of early filling transmitral flow velocity to mitral annular velocity (Е / е’).Results The DST was negative in 52 patients (group 1) and positive in 46 patients (group 2). Group 2 had greater values of mean Е / е’ (11.0 [9.4; 12.6] vs 9.0 [7.9; 11.1], р=0.0003); LAVI (33.8 [29.0; 40.0] ml /m2 vs 28.0 ml /m2 [25.0; 32.9], р=0.0001); and PASP (29.0 mm Hg [28.0; 30.0] vs 26.0 mm Hg [25.0; 28.0], р<0.0001 were greater, but LAS values were lower (19.0 % [18.0; 21.0] vs 24.0 % [22.0; 28.0], р<0.0001. The predictive capability of LAS with respect of heart failure was higher than of other echocardiographic parameters. The area under the ROC curve (AUC) for the reservoir strain was 0.922 (95 % confidence interval, CI, 0.851–0.967), which was significantly greater than for Е / е’: 0.713 (0.613–0.800); the LAVI was 0.724 (0.624–0.809); and the PASP was 0.764 (0.668–0.844). A LAS value in the reservoir phase less than 22 % predicts a positive result of DST with a probability of 88.9 % (76.5–95.2 %). Higher values of the strain allow expecting a negative DST result with a probability of 88.7 % (77.4–94.7 %).Conclusion If the DST cannot be performed for a noninvasive diagnosis of heart failure with preserved ejection fraction, a positive result of this test can be predicted by a decrease of LAS in the reservoir phase to 21 % or lower. The diagnostic accuracy of this criterion is 88.8 % (81.0–93.6 %).

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Heart failure with preserved ejection fraction: the role of diastolic stress test in diagnostic algorithms

Cited by 2 publications

References 40 publications

Left atrial strain in assessing heart failure with preserved ejection fraction in hypertensive patients

Left atrial strain in assessing heart failure with preserved ejection fraction in hypertensive patients

Left Atrial Strain as a Predictor of Diastolic Stress Test Results in Patients With Arterial Hypertension

Contact Info

Product

Resources

About