Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience

Abstract

Background Limited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function. Methods We linked 15 years of TTE report data (1/6/2003-5/3/2018) at Beth Israel Deaconess Medical Center to complete Medicare claims. In those with recent HF, we evaluated the relationship between variables on baseline TTE and HF readmission, stratified by LVEF. Results After excluding TTEs with uninterpretable diastology, 5,900 individuals (mean age: 76.9 years; 49.1% female) were included, of which 2545 individuals (41.6%) were admitted for HF. Diastolic variables augmented prediction compared to demographics, comorbidities, and echocardiographic structural variables (p < 0.001), though discrimination was modest (c-statistic = 0.63). LV dimensions and eccentric hypertrophy predicted HF in HF with reduced (HFrEF) but not preserved (HFpEF) systolic function, whereas LV wall thickness, NT-proBNP, pulmonary vein D- and Ar-wave velocities, and atrial dimensions predicted HF in HFpEF but not HFrEF (all interaction p < 0.10). Prediction of HF readmission was not different in HFpEF and HFrEF (p = 0.93). Conclusions In this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF. Regardless of LVEF, diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone. The additional role of medication adherence, readmission history, and functional status in differential prediction of HF readmission by LVEF category should be considered for future study.

The Concept of "Heart Failure with Preserved Ejection Fraction": Time for a Critical Reappraisal

“…In a prospective HFpEF registry, only patients with moderate to severe diastolic dysfunction showed poor prognosis over short term follow-up [ 18 ]. A more recent retrospective analysis among elderly individuals with heart failure has shown that specific parameters such as wall thickness, atrial dimensions, NT-proBNP, and pulmonary vein velocities better predicted HF readmission in HFpEF than HFrEF; further echocardiographic structural and diastolic variables augmented prediction of HF readmission compared with comorbidities alone, regardless of LVEF, though predictive accuracy remained modest [ 19 ].…”

Machine Learning Augmented Echocardiography for Diastolic Function Assessment

“…Significant mitral regurgitation raises the e' velocity, again uncoupling it from the intrinsic state and rendering it unreliable ( 31 ). Analysis of 161,468 echocardiograms excluded from diastolic classification due to confounding factors showed that mild or more mitral stenosis was present in 1.6% of these scans, moderate or greater mitral annular calcification in 1.2% and more than moderate mitral regurgitation in 3.3% ( 33 ). Given the huge quantity of echocardiograms performed annually globally, this represents confounding of a significant number of scans.…”