Perception of symptoms is out of proportion to cardiac pathology in patients with "diastolic heart failure"

Ingle, Lee; Cleland, John G.F.; Clark, Andrew L.

doi:10.1136/hrt.2007.131144

Cited by 31 publications

(23 citation statements)

References 32 publications

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“…Patients with an average age 75 and with a clinical diagnosis of HF were studied with 6-min walk test, echocardiogram, and BNP. Although patients with diagnosed HFPEF had the same reported symptoms as the HFREF group, BNP levels were no different than the age-matched control population [26]. NT-proBNP levels have to be interpreted with caution in the elderly as even the reference values increase with age.…”

Section: The Challenge Of Diagnosing Hfpef In the Elderlymentioning

confidence: 95%

Heart failure with preserved ejection fraction in the elderly: scope of the problem

et al. 2011

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Heart failure is an epidemic in the elderly and has become a leading cause for hospitalization and death. Heart failure with preserved ejection fraction (HFPEF) is more common than heart failure with reduced ejection fraction (HFREF) but disease identification remains challenging. Current criteria rely on symptoms of poor exercise tolerance, preserved ejection fraction and laboratory evidence for elevated filling pressures. Each of these clinical parameters is difficult to evaluate in the elderly and reduce the certainty of diagnosis. Aging is associated with changes in the peripheral vasculature, pulmonary function, oxygen transport and skeletal muscle function, all key determinants of exercise capacity. Furthermore, co-morbid conditions such as chronic obstructive pulmonary disease are common in the elderly and cloud the interpretation of symptoms. The choice of ejection fraction (EF) 45-50% as preserved appears arbitrary as there is evidence that the lower limit for EF in elderly women is much higher. B-type natriuretic peptide has emerged as a popular blood biomarker of heart failure and increased filling pressures but appears to have trouble discriminating HFPEF from normal elderly controls. Regardless of the difficulties in diagnosis, several population studies show that HFPEF incidence and prevalence are on the rise especially in those >70 years of age. Co-morbid diseases are common in HFPEF, and these patients often die from non-cardiac causes. Future studies need to emphasize a holistic approach to HFPEF and identify whether there are diagnostic or therapeutic targets outside of the heart.

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Section: The Challenge Of Diagnosing Hfpef In the Elderlymentioning

confidence: 95%

Heart failure with preserved ejection fraction in the elderly: scope of the problem

et al. 2011

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“…Overall Jehn et al 50 Radke et al 24 Alahdab et al 18 Alahdab et al 18 Rostagno et al 13 Rostagno et al 45 Ingle et al 26 Jehn et al 36 Ingle et al 26 Deuschle et al 52 Rostagno et al 46 Bagur et al 48 Zugck et al 21 Pepera et al 32 Goode et al 18 Deuschle et al 52 Faggiano et al 47 Leszek et al 35 Rostagno et al 13 Goode et al 7 Zugck et al 21 Ingle et al 26 Ingle et al 26 Rostagno et al 45 Tay et al 49 Jankowska et al 29 Bagur et al 48 Ates et al 30 Rostagno et al 46 Gary et al 25 Jehn et al 36 Karavidaset al 28 Souza et al 53 Jehn et al 50 Bosnak Güçlü et al 27 Alahdab et al 18 Forman et al 20 Zaidi et al Goscinska-Bis et al 37 Alahdab et al 18 Forman et al 20 Keast et al 31 Vrtovec et al 51 Rostagno et al 45 Souza et al 53 Tay et al 49 Jaski et al 34 Zugck et al …”

Section: Discussionmentioning

confidence: 99%

“…Ingle et al reported similar 6MWD between both groups of patients. 26 Second, we would ideally have liked to compare both NYHA and 6MWD to cardiopulmonary exercise testing or clinical outcomes, but these were not available in all studies. Other limitations included lack of information on clinical significance of repeated measurements within each study.…”

Section: Study Limitationsmentioning

confidence: 99%

Correlation of the New York Heart Association Classification and the 6‐Minute Walk Distance: A Systematic Review

Yap

Lim

Gao

et al. 2015

Clinical Cardiology

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Background: Functional status assessment is the cornerstone of heart failure management and trials. The New York Heart Association (NYHA) classification and 6-minute walk distance (6MWD) are commonly used tools; however, the correlation between them is not well understood. Hypothesis: We hypothesised that the relationship between the NYHA classification and 6MWD might vary across studies. Methods: A systematic literature search was performed to identify all studies reporting both NYHA class and 6MWD. Two reviewers independently assessed study eligibility and extracted data. Thirty-seven studies involving 5678 patients were included. Results: There was significant heterogeneity across studies in 6MWD within all NYHA classes: I (n = 16, Q = 934.2; P < 0.001), II (n = 25, Q = 1658.3; P < 0.001), III (n = 30, Q = 1020.1; P < 0.001), and IV (n = 6, Q = 335.5; P < 0.001). There was no significant difference in average 6MWD between NYHA I and II (420 m vs 393 m; P = 0.416). There was a significant difference in average 6MWD between NYHA II and III (393 m vs 321 m; P = 0.014) and III and IV (321 m vs 224 m; P = 0

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“…2 Which of these abnormalities is responsible for these patients' exercise intolerance? Although their symptoms and survival are largely determined by their comorbid conditions, 3,4 physicians frequently focus on the heart in their pursuit of a cause of exertional symptoms and poor prognosis. Noninvasive cardiac imaging typically reveals a preserved left ventricular ejection fraction, occasionally shows left ventricular hypertrophy and left atrial enlargement, and often demonstrates changes in echocardiographic variables that suggest an increase in left ventricular filling pressure and a reduced rate of blood flow into the left ventricle during diastole.…”

Section: Article See P 569mentioning

confidence: 99%

Can Brain Natriuretic Peptide Be Used to Guide the Management of Patients With Heart Failure and a Preserved Ejection Fraction?

Packer

2011

Circ: Heart Failure

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Perception of symptoms is out of proportion to cardiac pathology in patients with "diastolic heart failure"

Abstract: Patients being treated for a clinical diagnosis of DHF have the same self-reported symptoms and 6-MWT performance as patients with SHF, yet have normal NT-proBNP levels. Their perception of their symptoms is out of proportion to their evidence of cardiac pathology.

Cited by 31 publications

References 32 publications

Heart failure with preserved ejection fraction in the elderly: scope of the problem

Heart failure with preserved ejection fraction in the elderly: scope of the problem

Correlation of the New York Heart Association Classification and the 6‐Minute Walk Distance: A Systematic Review

Can Brain Natriuretic Peptide Be Used to Guide the Management of Patients With Heart Failure and a Preserved Ejection Fraction?

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