Prognostic value of echocardiography and ECG in heart failure with preserved ejection fraction

Abstract

OBJECTIVE: The aim of this study was to evaluate characteristics of patients with heart failure (HF) with preserved ejection fraction (HFPEF) and to assess prognostic predictors in 2-year follow-up. METHODS: We included prospectively 109 patients admitted to the internal department for HF, grouped into HFPEF (EF>40 %, n = 63) and HF with reduced EF (HFREF) (EF ≤ 40 %, n = 46). Preserved right ventricular systolic function (PRV) was defi ned as the peak systolic tricuspid annular velocity (S') > 10.8 cm/s. RESULTS: HFPEF and HFREF patients had non-signifi cantly different 2-year all-cause and CV mortality (28.6 % vs 37.0 %, 17.5 % vs 21.7 %). Patients with HFPEF and PRV vs dysfunctional RV had a better survival (76.6 % vs 56.3 %, p=0.045). In HFPEF, the patients who survived had a trend to better S' (13.6 ± 3.1 cm/s vs 11.9 ± 3.4 cm/s, p=0.055), shorter QTc (427 ± 42ms vs 454 ± 42ms, p = 0.058), and all-cause mortality was lowered only by anticoagulants (12.0 % vs 39.5 %, p = 0.02). QTc interval and PRV emerged as predictors of all-cause mortality (HR 1.7 per 40 ms change, 95 % CI 1.1-2.6, p = 0.02, HR 0.38, 95 % CI 0.15-0.93, p = 0.03). CONCLUSIONS: In HFPEF, we observed a trend to lower all-cause and CV mortality compared to HFREF and anticoagulants were the only therapy that signifi cantly lowered mortality. PRV and QTc interval emerged as independent predictors of survival (Tab. 6, Fig. 2 Limitations:The results of our study are limited by the relatively small groups of patients with both HFPEF and HFREF and by the mid-term follow-up period. The assessment of the RV systolic function was limited to just one parameter -the peak systolic velocity of the lateral tricuspid annulus in tissue Doppler imaging.

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

“…There is limited literature which has investigated the clinical relevance of ECG changes in HFpEF 21,22 . The study carried out by Cenkerova et al .…”

“…There is limited literature which has investigated the clinical relevance of ECG changes in HFpEF 21,22 . The study carried out by Cenkerova et al demonstrated that HFpEF patients who died during the course of FU, had a tendency to have a prolonged QTc interval (427 ± 42 ms vs. 454 ± 42 ms, P = 0.058) 21 .…”

“…There is limited literature which has investigated the clinical relevance of ECG changes in HFpEF 21,22 . The study carried out by Cenkerova et al demonstrated that HFpEF patients who died during the course of FU, had a tendency to have a prolonged QTc interval (427 ± 42 ms vs. 454 ± 42 ms, P = 0.058) 21 . Another study comparing HFpEF with HF because of reduced ejection fraction (HFrEF) for ECG changes, demonstrated that higher resting heart rate, abnormal P-wave axis, and abnormal QRS-T axis were associated with HFpEF 22 .…”

Electrocardiographic characteristics in patients with heart failure and normal ejection fraction: A systematic review and meta‐analysis

“…The definition of HeFNEF varied among studies (Appendix II). In addition, different cutoffs for left ventricular ejection fraction (LVEF) were used to define HeFNEF: ≥40% (Cenkerova, Dubrava, Pokorna, Kaluzay, & Jurkovicova, ; Danciu et al, ; Hendry, Krisdinarti, & Erika, ), >40% (Hawkins et al, ; Olsson et al, ), ≥45% (Adabag et al, ; Donal et al, ; Joseph et al, ; Komajda et al, ; Nikolaidou et al, ; Shah et al, ), >45% (Ho et al, ; Lee et al, ; Park et al, ; Zile et al, ), ≥50% (Gigliotti et al, ; Gijsberts et al, ; Hummel, Skorcz, & Koelling, ; Khan et al, ; Lund et al, ; Martinez Santos et al, ; Masoudi et al, ; Menet et al, ; O'Neal et al, ; Pascual‐Figal et al, ; Peyster, Norman, & Domanski, ; Senni et al, ; Shenkman et al, ; Yap et al, ), >50% (Eicher et al, ; Oskouie, Prenner, Shah, & Sauer, ; Sanchis et al, ; Selvaraj et al, ; Shah et al, ), and ≥55% (Varadarajan & Pai, ). The following methods were used to measure ejection fraction: echocardiography, nuclear scintigraphy, and contrast ventriculography.…”

“…In the studies we identified, the prevalence of atrial fibrillation or atrial flutter on ECG was 12%–46% (Adabag et al, ; Cenkerova et al, ; Donal et al, ; Ho et al, ; Khan et al, ; Lee et al, ; Masoudi et al, ; Nikolaidou et al, ; Olsson et al, ; Oskouie et al, ; Pascual‐Figal et al, ; Peyster et al, ; Sanchis et al, ; Selvaraj et al, ; Senni et al, ; Shah et al, ; Yap et al, ). The percentage of patients with a history of atrial fibrillation (where reported) was greater (Lee et al, ; Shah et al, ).…”