Abstract 5879: Diagnostic Approach to Heart Failure with Normal Ejection Fraction in the Community
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.
Pulmonary artery systolic pressure (PASP) may be a useful marker of clinically significant pulmonary venous hypertension distinguishing HFNEF from HTN
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 EF≥50% (HFNEF, 76±13y, 45% male) and 719 randomly sampled hypertensive adults without HF (HTN, EF≥50%, 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 PASP≥35, BNP≥100 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.