Abstract 16967: A Clinical Assessment in Diastolic Heart Failure: The Correlation Between a Combination of Clinical Findings and Indices with Echocardiography in Hemodialysis Outpatients

Abstract

Purpose: Ideal design of non-invasive assessments for diastolic heart failure (DHF) remains limited due to the lack of modest clinical criteria to describe the patients. Numerical scoring systems to evaluate patients’ physical conditions have been induced in Japanese Traditional Medicine (Kampo-medicine) using medical score with questionnaire and physical examinations. Suitai-score (S-score or a scoring system for water stagnation) is one of so-called Kampo-scores. It consists of 18 diagnostic criteria, which shows pathologic conditions, caused by excessive fluids, are of great importance in predicting the stage of DHF. This study sought to evaluate the relationship between Kampo-scores, indices with Doppler echocardiography, and the severity of congestive heart failure (CHF).

Methods: We studied 43 outpatients with chronic CHF at the hemodialysis unit with simultaneous S-scores and cardiological indices with echocardiography. We also measured and compared them by linear regression with E/A (transmitral early to late filling velocity ratio), E/Ea (or E/e’: transmitral to mitral annular early diastolic velocity ratio), and other indices.

Results: S-scores had strong correlation to some of the echocardiographic indices. E/Ea had a high correlation to S-scores [r=+0.71, p<0.001, E/Ea=-8.0+0.58×(S-score)] and a low correlation to cardiothoracic ratio (CTR) [r=+0.37, p<0.005]. There was a modest correlation between E/A and S-score [r=+0.49, p<0.005]. In a group of EF>50% (n = 14), a strong positive correlation was found between E/Ea and S-score [r=+0.91, p<0.001]. At a 3-year follow-up, there were 8 (24%) deaths. On Cox proportional hazards analysis, S-score was a predictor of 3-year mortality [Chi-square statistic 9.0, p=0.003]. Empirical cost of clinically diagnosed with Kampo-scores as HF was more cost effective than testing everyone with echocardiography and chest X-ray and then treating only those who were HF-positive.

Conclusions: Our data and some reports suggested that noninvasive and cost-effective clinical assessments, Kampo-scores especially S-score, can be supportive for physicians to evaluate congestive DHF in early stage.