JAMA Cardiology,
Год журнала:
2022,
Номер
7(9), С. 891 - 891
Опубликована: Июль 13, 2022
Diagnosis
of
heart
failure
with
preserved
ejection
fraction
(HFpEF)
among
dyspneic
patients
without
overt
congestion
is
challenging.
Multiple
diagnostic
approaches
have
been
proposed
but
are
not
well
validated
against
the
independent
gold
standard
for
HFpEF
diagnosis
an
elevated
pulmonary
capillary
wedge
pressure
(PCWP)
during
exercise.To
evaluate
H2FPEF
and
HFA-PEFF
scores
a
PCWP/cardiac
output
(CO)
slope
more
than
2
mm
Hg/L/min
to
diagnose
HFpEF.This
retrospective
case-control
study
included
unexplained
dyspnea
from
6
centers
in
US,
Netherlands,
Denmark,
Australia
March
2016
October
2020.
(cases)
was
definitively
ascertained
by
presence
PCWP
exertion;
control
individuals
were
those
normal
rest
exercise
hemodynamics.Logistic
regression
used
accuracy
discriminate
controls.Among
736
patients,
563
(76%)
diagnosed
(mean
[SD]
age,
69
[11]
years;
334
[59%]
female)
173
(24%)
represented
controls
60
[15]
109
[63%]
female).
discriminated
controls,
score
had
greater
area
under
curve
(0.845;
95%
CI,
0.810-0.875)
compared
(0.710;
0.659-0.756)
(difference,
-0.134;
-0.177
-0.094;
P
<
.001).
Specificity
robust
both
scores,
sensitivity
poorer
HFA-PEFF,
false-negative
rate
55%
low-probability
25%
using
score.
Use
PCWP/CO
redefine
rather
reclassified
20%
(117
583)
this
metric
clinical,
echocardiographic,
hemodynamic
features
typical
HFpEF,
including
resting
66%
(46
70)
patients.In
study,
despite
requiring
fewer
data,
superior
performance
evaluation
outpatient
setting.
European Heart Journal,
Год журнала:
2019,
Номер
40(40), С. 3297 - 3317
Опубликована: Авг. 27, 2019
Abstract
Making
a
firm
diagnosis
of
chronic
heart
failure
with
preserved
ejection
fraction
(HFpEF)
remains
challenge.
We
recommend
new
stepwise
diagnostic
process,
the
‘HFA–PEFF
algorithm’.
Step
1
(P=Pre-test
assessment)
is
typically
performed
in
ambulatory
setting
and
includes
assessment
for
HF
symptoms
signs,
typical
clinical
demographics
(obesity,
hypertension,
diabetes
mellitus,
elderly,
atrial
fibrillation),
laboratory
tests,
electrocardiogram,
echocardiography.
In
absence
overt
non-cardiac
causes
breathlessness,
HFpEF
can
be
suspected
if
there
normal
left
ventricular
fraction,
no
significant
valve
disease
or
cardiac
ischaemia,
at
least
one
risk
factor.
Elevated
natriuretic
peptides
support,
but
levels
do
not
exclude
HFpEF.
The
second
step
(E:
Echocardiography
Natriuretic
Peptide
Score)
requires
comprehensive
echocardiography
by
cardiologist.
Measures
include
mitral
annular
early
diastolic
velocity
(e′),
(LV)
filling
pressure
estimated
using
E/e′,
volume
index,
LV
mass
relative
wall
thickness,
tricuspid
regurgitation
velocity,
global
longitudinal
systolic
strain,
serum
peptide
levels.
Major
(2
points)
Minor
(1
point)
criteria
were
defined
from
these
measures.
A
score
≥5
points
implies
definite
HFpEF;
≤1
point
makes
unlikely.
An
intermediate
(2–4
uncertainty,
which
case
3
(F1:
Functional
testing)
recommended
echocardiographic
invasive
haemodynamic
exercise
stress
tests.
4
(F2:
Final
aetiology)
to
establish
possible
specific
cause
alternative
explanations.
Further
research
needed
better
classification
Circulation,
Год журнала:
2018,
Номер
138(9), С. 861 - 870
Опубликована: Май 23, 2018
Diagnosis
of
heart
failure
with
preserved
ejection
fraction
(HFpEF)
is
challenging
in
euvolemic
patients
dyspnea,
and
no
evidence-based
criteria
are
available.
We
sought
to
develop
then
validate
noninvasive
diagnostic
that
could
be
used
estimate
the
likelihood
HFpEF
present
among
unexplained
dyspnea
guide
further
testing.
New England Journal of Medicine,
Год журнала:
2023,
Номер
389(12), С. 1069 - 1084
Опубликована: Авг. 25, 2023
BackgroundHeart
failure
with
preserved
ejection
fraction
is
increasing
in
prevalence
and
associated
a
high
symptom
burden
functional
impairment,
especially
persons
obesity.
No
therapies
have
been
approved
to
target
obesity-related
heart
fraction.MethodsWe
randomly
assigned
529
patients
who
had
body-mass
index
(the
weight
kilograms
divided
by
the
square
of
height
meters)
30
or
higher
receive
once-weekly
semaglutide
(2.4
mg)
placebo
for
52
weeks.
The
dual
primary
end
points
were
change
from
baseline
Kansas
City
Cardiomyopathy
Questionnaire
clinical
summary
score
(KCCQ-CSS;
scores
range
0
100,
indicating
fewer
symptoms
physical
limitations)
body
weight.
Confirmatory
secondary
included
6-minute
walk
distance;
hierarchical
composite
point
that
death,
events,
differences
KCCQ-CSS
C-reactive
protein
(CRP)
level.Download
PDF
Research
Summary.ResultsThe
mean
was
16.6
8.7
(estimated
difference,
7.8
points;
95%
confidence
interval
[CI],
4.8
10.9;
P<0.001),
percentage
−13.3%
−2.6%
−10.7
CI,
−11.9
−9.4;
P<0.001).
distance
21.5
m
1.2
20.3
m;
8.6
32.1;
In
analysis
point,
produced
more
wins
than
(win
ratio,
1.72;
1.37
2.15;
CRP
level
–43.5%
–7.3%
treatment
0.61;
0.51
0.72;
Serious
adverse
events
reported
35
participants
(13.3%)
group
71
(26.7%)
group.ConclusionsIn
obesity,
led
larger
reductions
limitations,
greater
improvements
exercise
function,
loss
placebo.
(Funded
Novo
Nordisk;
STEP-HFpEF
ClinicalTrials.gov
number,
NCT04788511.)
Quick
Take
Semaglutide
Heart
Failure
Obesity
2m
5s
JAMA,
Год журнала:
2023,
Номер
329(10), С. 827 - 827
Опубликована: Март 14, 2023
Heart
failure
with
preserved
ejection
fraction
(HFpEF),
defined
as
HF
an
EF
of
50%
or
higher
at
diagnosis,
affects
approximately
3
million
people
in
the
US
and
up
to
32
worldwide.
Patients
HFpEF
are
hospitalized
1.4
times
per
year
have
annual
mortality
rate
15%.Risk
factors
for
include
older
age,
hypertension,
diabetes,
dyslipidemia,
obesity.
Approximately
65%
patients
present
dyspnea
physical
examination,
chest
radiographic,
echocardiographic,
invasive
hemodynamic
evidence
overt
congestion
(volume
overload)
rest.
35%
"unexplained"
on
exertion,
meaning
they
do
not
clear
physical,
echocardiographic
signs
HF.
These
elevated
atrial
pressures
exercise
measured
stress
testing
estimated
Doppler
echocardiography
testing.
In
unselected
presenting
unexplained
dyspnea,
H2FPEF
score
incorporating
clinical
(age,
obesity,
fibrillation
status)
resting
(estimated
pulmonary
artery
systolic
pressure
left
pressure)
variables
can
assist
diagnosis
(H2FPEF
range,
0-9;
>5
indicates
more
than
95%
probability
HFpEF).
Specific
causes
syndrome
normal
other
should
be
identified
treated,
such
valvular,
infiltrative,
pericardial
disease.
First-line
pharmacologic
therapy
consists
sodium-glucose
cotransporter
type
2
inhibitors,
dapagliflozin
empagliflozin,
which
reduced
hospitalization
cardiovascular
death
by
20%
compared
placebo
randomized
trials.
Compared
usual
care,
training
diet-induced
weight
loss
produced
clinically
meaningful
increases
functional
capacity
quality
life
Diuretics
(typically
loop
diuretics,
furosemide
torsemide)
prescribed
improve
symptoms.
Education
self-care
(eg,
adherence
medications
dietary
restrictions,
monitoring
symptoms
vital
signs)
help
avoid
decompensation.Approximately
HFpEF.
exercise,
self-care,
diuretics
needed
maintain
euvolemia,
obesity