Markers of heart failure with preserved ejection fraction in patients with unexplained dyspnea
https://doi.org/10.15829/1728-8800-2023-3769
EDN: FSJDXW
Abstract
Aim. To evaluate the prevalence of clinical, history, laboratory and ultrasound markers of heart failure with preserved ejection fraction (HFpEF) in patients with unexplained dyspnea, as well as to identify markers of structural myocardial remodeling in this group of patients.
Material and methods. This retrospective study included 504 patients aged 18 to 84 years who were hospitalized from July 1, 2022 to March 31, 2023. Patients were divided into two groups depending on the presence of dyspnea. A comparative analysis of ultrasound parameters was carried out in order to identify myocardial structural remodeling.
Results. A number of associated conditions and metabolic disorders, which are known to be risk factors for HFpEF, were detected more often in patients with unexplained dyspnea and myocardial remodeling. A model to determine the probability of structural remodeling was developed. Two most significant indicators were dyspnea and diabetes.
Conclusion. This study demonstrated the relationship between unexplained dyspnea and structural myocardial remodeling. Identification of certain clinical and morphological signs of HFpEF in such patients requires apprehensive attitude and in-depth examination in order to rule out it.
About the Authors
A. A. Ivanova
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Moscow
E. A. Rogozhkina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Moscow
Yu. S. Timofeev
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Moscow
O. N. Dzhioeva
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Moscow
O. M. Drapkina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Moscow
References
1. Belenkov Yu N, Mareev VYu, Ageev FT, et al. The true prevalence of CHF in the European part of the Russian Federation (hospital stage). Zhurnal serdechnaya nedostatochnost 2011;12(2): 63-8. (In Russ.)
2. 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.
3. Paulus WJ. H2FPEF Score: At Last, a Properly Validated Diagnostic Algorithm for Heart Failure With Preserved Ejection Fraction. Circulation. 2018;138(9):871-3. doi:10.1161/CIRCULATIONAHA.118.035711.
4. Mareev VYu, Fomin IV, Ageev FT, et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8-158. (In Russ.). doi:10.18087/cardio.2475.
5. Selvaraj S, Myhre PL, Vaduganathan M, et al. Application of Diagnostic Algorithms for Heart Failure With Preserved Ejection Fraction to the Community. JACC Heart Fail. 2020;8(8):640-53. doi:10.1016/j.jchf.2020.03.013.
6. Ivanova AA, Dzhioeva ON, Lavrenova EA, et al. Diagnostic challenges of heart failure with preserved ejection fraction: focus on echocardiography. Cardiovascular Therapy and Prevention. 2023;22(5):3565. (In Russ.) doi:10.15829/17288800-2023-3565.
7. Reddy YNV, Kaye DM, et al. Diagnosis of Heart Failure With Preserved Ejection Fraction Among Patients With Unexplained Dyspnea. JAMA Cardiol. 2022;7(9):891-9. doi:10.1001/jamacardio.2022.1916.
8. Gavryushina SV, Ageev FT. Heart failure with preserved left ventricular ejection fraction: epidemiology, patient "portrait", clinic and diagnostics. Kardiologiia. 2018;58(S4):55-64. (In Russ.) doi:10.18087/cardio.2467.
9. Venkatesh Y, Anjan M, Loftus M, et al. Prevalence, clinical phenotype and outcomes associated with normal B-type natriuretic peptide levels in heart failure with preserved ejection fraction. Am J Cardiol. 2012;110(6):870-6. doi:10.1016/j.amjcard.2012.05.014.
10. Farajidavar N, O'Gallagher K, Bean D, et al. Diagnostic signature for heart failure with preserved ejection fraction (HFpEF): a machine learning approach using multi- modality electronic health record data. BMC Cardiovasc Disord. 2022;22(1):567. doi:10.1186/s12872-022-03005-w.
11. 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.
Supplementary files
What is already known about the subject?
- Unexplained dyspnea in a significant number of cases is caused by heart failure with preserved ejection fraction (HFpEF).
- HFpEF detection is difficult due to the lack of unified diagnostic algorithms and the variety of patient phenotypes.
- Structural myocardial remodeling is one of the main criteria for HFpEF.
What might this study add?
- The very fact of the presence of unexplained dyspnea makes it possible to suspect structural myocardial remodeling.
- Identification of simple clinical and morphological criteria for HFpEF helps to increase the alertness of specialists regarding HFpEF.
Review
For citations:
Ivanova A.A., Rogozhkina E.A., Timofeev Yu.S., Dzhioeva O.N., Drapkina O.M. Markers of heart failure with preserved ejection fraction in patients with unexplained dyspnea. Cardiovascular Therapy and Prevention. 2023;22(10):3769. (In Russ.) https://doi.org/10.15829/1728-8800-2023-3769. EDN: FSJDXW
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