Diagnostic challenges of heart failure with preserved ejection fraction: focus on echocardiography

Aim. To assess the features of diagnosing heart failure with preserved ejection fraction (HFpEF) using echocardiographic markers and diastolic stress test (DST) according to a survey of ultrasound and functional diagnostics specialists in the Russian Federation.

Materials and methods. As part of the study, an anonymous survey of 155 ultrasound and functional diagnostic specialists from various Russian regions was conducted. We proposed to answer whether they routinely assess certain echocardiographic parameters necessary for diagnosing HFpEF. The specialists also indicated whether they conduct DST and whether they have the opportunity to refer the patient to this study.

Results. A frequency analysis of the responses received was carried out. In routine practice, 83,2% of specialists measure the left ventricular (LV) ejection fraction by Simpson method, 76,1% — by Teichholz method. In addition, 80% of responders analyses LV mass index, 76,1% — relative LV wall thickness, 60% — tricuspid annular plane systolic excursion, 56,8% — left atrial volume index, 51.6% — E/e´ ratio, 94,8% — pulmonary artery systolic pressure, left ventricular global longitudinal strain — 16,1%, 7,7% — left atrial longitudinal strain. Also, 9,7% of specialists conduct DST on their own, while 41,3% have the opportunity to refer patients.

Conclusion. The low assessment rate of some ultrasonic HFpEF mar­kers and DST among functional diagnostics specialists in the Russian Federation reduces the detection rate of HFpEF. It is necessary to develop diagnostic algorithms based mainly on clinical and anam­nestic data and available for use by doctors of any specialty.

1. Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.) doi:10.15829/1560-4071-2020-4083.

2. Balanova YuA, Shalnova SA, Deev AD, et al. Obesity in russian population — prevalence and association with the non-communicable diseases risk factors. Russian Journal of Cardiology. 2018;(6):123-30. (In Russ.) doi:10.15829/1560-4071-2018-6-123-130.

3. Fomin IV. Сhronic heart failure in russian federation: what do we know and what to do. Russian Journal of Cardiology. 2016;(8):7-13. (In Russ.) doi:10.15829/1560-4071-2016-8-7-13.

4. Pieske B, Tschöpe C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) [published correction appears in Eur Heart J. 2021;42(13):1274]. Eur Heart J. 2019;40(40):3297-317. doi:10.1093/eurheartj/ehz641.

5. Ageev FT, Yarovaya EB, Ovchinnikov AG. Рossibility of using European (HFA-PEFF) and American (H2FPEF) algorithms for diagnosing heart failure with preserved ejection fraction in Russian clinical practice. Kardiologiia. 2022;62(12):4-10. (In Russ.) doi:10.18087/cardio.2022.12.n2280.

6. Ovchinnikov AG, Ageev FT, Alekhin MN, et al. The role of diastolic transthoracic stress echocardiography with incremental workload in the evaluation of heart failure with preserved ejection fraction: indications, methodology, interpretation. Expert consensus developed under the auspices of the National Medical Research Center of Cardiology, Society of Experts in Heart Failure (SEHF), and Russian Association of Experts in Ultrasound Diagnosis in Medicine (REUDM). Kardiologiia. 2020;60(12):48-63. (In Russ.) doi:10.18087/cardio.2020.12.n1219.