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(Circulation. 2008;118:S_1020-S_1021.)
© 2008 American Heart Association, Inc.

Diastolic Heart Failure: Diagnosis, Mechanisms and Comorbidities

Abstract 5879: Diagnostic Approach to Heart Failure with Normal Ejection Fraction in the Community

Carolyn S Lam; Veronique L Roger; Richard J Rodeheffer; Barry A Borlaug; Margaret M Redfield

Mayo Clinic & Foundation, Rochester, MN

Patients with heart failure and normal EF (HFNEF) from the community often present with non-specific symptoms. To aid in the diagnosis of HFNEF, recent guidelines proposed several markers of pulmonary venous hypertension (E/e', BNP) or cardiac remodeling (LV mass, LA volume). However, these criteria were largely derived from referral-based studies, and community-dwelling elderly hypertensives (HTN) frequently display these abnormalities in the absence of clinical HF.

Hypotheses

1. Pulmonary artery systolic pressure (PASP) may be a useful marker of clinically significant pulmonary venous hypertension distinguishing HFNEF from HTN
   
2. A combination of markers may offer the best diagnostic approach
   

Methods Population-based study in Olmsted County, MN of 244 consecutive HF patients (Framingham criteria) with EF50% (HFNEF, 76±13y, 45% male) and 719 randomly sampled hypertensive adults without HF (HTN, EF50%, 66±10y, 44% male), followed from baseline Doppler-echo and phlebotomy for a median of 3.1 years. PASP was derived from the tricuspid regurgitation velocity.

Results In univariate analysis (Table) significant diagnostic markers of HFNEF were PASP, BNP, E/e' and LA volume, but LV mass was not. While PASP correlated strongly with E/e' and BNP (r>0.5; p<0.001 for both), the largest area under curve was obtained with PASP. In multivariate analysis, only PASP, BNP and E/e' remained significant. A simple "HFNEF score" awarding 1 point each for PASP35, BNP100 or E/e' 12.5 (score range 0–3) provided excellent diagnostic utility. Increasing score predicted mortality in HFNEF (hazards ratio 1.0, 2.2, 2.3 and 3.2 for scores of 0, 1, 2, and 3 respectively).

Conclusions: These population-based data suggest that PASP is a sensitive and specific marker of clinically significant pulmonary venous hypertension. A "HFNEF score" combining hemodynamic data from echo and BNP may offer diagnostic and prognostic utility in HFNEF, and warrants validation in other populations.

Receiver Operating Curve Characteristics

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Lam, C. S Articles by Redfield, M. M PubMed Articles by Lam, C. S Articles by Redfield, M. M