Diagnosing heart failure with preserved ejection fraction in 2019: the search for a gold standard

2019 ◽  
Vol 22 (3) ◽  
pp. 422-424 ◽  
Author(s):  
Peder L. Myhre ◽  
Muthiah Vaduganathan ◽  
Stephen J. Greene
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Gold Standard ◽  
Preserved Ejection Fraction

The diagnostic value of passive leg raise during right heart catheterization in diagnosing heart failure with preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.A Van De Bovenkamp ◽  
N Wijkstra ◽  
N.J Braams ◽  
M.A Jansen ◽  
F.P.T Oosterveer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Gold Standard ◽  
Diagnostic Value ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Preserved Ejection Fraction ◽  
Right Heart ◽  
Passive Leg Raise ◽  
Invasive Measurement

Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a frequent and disabling disease, but can be difficult to diagnose. Due to limited sensitivity of non-invasive evaluation of left ventricular (LV) diastolic dysfunction, invasive measurement may be warranted. The gold standard for diagnosing HFpEF is invasive measurement of LV end-diastolic pressure or its surrogate pulmonary capillary wedge pressure (PCWP). In case of normal LV filling pressures at rest (PCWP@rest <16 mmHg), patients should undergo stress testing to unmask occult HFpEF (early HFpEF if PCWP@exercise ≥25mmHg). Performing exercise during a right heart catheterization is time-consuming and logistically challenging. Passive leg raise increases venous return and can lead to an abnormal increase in LV filling pressures in case of diastolic dysfunction. Whether this leg raise maneuver (PCWP@legraise) can be used as an accurate method to diagnose or exclude HFpEF and what cut-off values should be used is unknown. Purpose To assess the diagnostic value of PCWP@legraise during right heart catheterization for HFpEF. Methods We reviewed all consecutive patients who received a diagnostic right heart catheterization with PCWP-measurements at rest, passive leg raise and during exercise (minimally >40% peak VO2) between 2017 and 2020 in a tertiary medical center (n=124). Zero reference point was defined mid-thorax. PCWP was measured end-expiratory mid A-wave. Patients with insufficient data (n=17), uninterpretable tracings (n=13) or PCWP@rest >16 mmHg were excluded (n=19). The diagnostic value of PCWP@legraise was compared to the gold standard for HFpEF (PCWP@exercise). Results We analyzed 75 patients, with a mean age of 58 (±16) years, female (60%), mean BMI 27.8 (±5.5). HFpEF was diagnosed in 47% of the cases, non-HFpEF existed of pulmonary arterial hypertension (23%), chronic thrombo-embolic disease (15%) or other (15%). Figure 1A shows PCWP@rest, PCWP@legraise, PCWP@exercise for HFpEF and non-HFpEF. The diagnostic performance of PCWP@legraise was higher than PCWP@rest (Figure 1B; AUC 0.83 vs 0.75). PCWP@legraise ≥22 mmHg had a specificity of 100% and a positive predictive value of 100% for diagnosing HFpEF and could be used as a cut-off for diagnosing HFpEF. PCWP@legraise of ≥13 mmHg had a sensitivity of 98% and a negative predictive value of 93%, and could be used as a cut-off for excluding HFpEF. If these cut-offs were used to refute or diagnose HFpEF, 17 patients (23%) could have been differed from exercise during right heart catheterization. The change in PCWP due to passive leg raise was of lower diagnostic value than the absolute value of PCWP@legraise. Conclusion In our cohort, the leg raise maneuver is of diagnostic value. With the proposed PCWP@legraise criteria for HFpEF - validated against the gold standard (PCWP@exercise) - the exercise could have been omitted in almost a quarter of the cases. More (external) validation is warranted. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Heart Failure with Preserved Ejection Fraction (HFpEF): A Case Report

2021 ◽  
Vol 42 (2) ◽  
Author(s):  
Amanda Halimi ◽  
Nani Hersunarti
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Gold Standard ◽  
Ace Inhibitor ◽  
Signs And Symptoms ◽  
Preserved Ejection Fraction ◽  
Case Presentation ◽  
Reduced Ejection Fraction ◽  
Cardiovascular Comorbidities ◽  
Appropriate Therapy

Background: The prevalence of Heart Failure with Preserved Ejection Fraction (HFpEF) currently reaches 50% of heart failure cases and continues to increase every year. HFpEF is an important clinical condition, but the diagnosis is far more challenging than HFrEF (Heart Failure with Reduced Ejection Fraction), and there has not been any proven effective treatment. In this case presentation, the latest HFpEF diagnosis and therapy will be discussed. Case illustration and discussion: A man and a woman came to the emergency room with signs and symptoms of congestion suggestive of heart failure. Additional examination was performed to support the working diagnosis of HFpEF, namely ECG, NTproBNP and echocardiography. HFA-PEFF scores of the first and second patient was 3 and 4 respectively. During hospitalization, diuretics was given to overcome congestion according to guidelines, as well as ACE-inhibitor and beta-blocker. Both patients were also screened for cardiovascular and non-cardiovascular comorbidities, and were given appropriate therapy. Conclusion: The diagnosis of HFpEF does not have a gold standard yet, meanwhile, the HFA-PEFF scoring can be used. Recommended HFpEF therapy includes diuretics for congestion and management of comorbidities. Several studies of HFpEF treatment are ongoing. Keywords: heart failure with preserved ejection fraction, HFpEF

Acute heart failure with preserved ejection fraction and long-term Readmisions

2008 ◽  
Vol 7 ◽  
pp. 62-63
Author(s):  
J NUNEZ ◽  
L MAINAR ◽  
G MINANA ◽  
R ROBLES ◽  
J SANCHIS ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Preserved Ejection Fraction

Galectin-3 in Heart Failure – Linking Fibrosis, Remodelling and Progression

2010 ◽  
Vol 6 (2) ◽  
pp. 33 ◽  
Author(s):  
Christopher R deFilippi ◽  
G Michael Felker ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Cardiac Fibrosis ◽  
The Elderly ◽  
Preserved Ejection Fraction ◽  
Heart Failure Patients ◽  
Large Populations ◽  
Galectin 3

For many with heart failure, including the elderly and those with a preserved ejection fraction, both risk stratification and treatment are challenging. For these large populations and others there is increasing recognition of the role of cardiac fibrosis in the pathophysiology of heart failure. Galectin-3 is a novel biomarker of fibrosis and cardiac remodelling that represents an intriguing link between inflammation and fibrosis. In this article we review the biology of galectin-3, recent clinical research and its application in the management of heart failure patients.

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