Early Identification of Patients at Risk for Incident Heart Failure With Preserved Ejection Fraction: Novel Approach to Echocardiographic Trends
Section snippets
Design and Study Population
In this single-center retrospective cohort study, patients were identified by International Classification of Diseases, 9th Revision, codes and further screened and confirmed to have HFpEF by applying the European Society of Cardiology definition for HFpEF.16 Patients were selected by a primary diagnosis of incident (first episode) HFpEF as identified by the International Classification of Diseases, 9th revision, Clinical Modification, code book with codes for 428.30 (diastolic heart failure,
Study Population
The longest interval of echocardiography availability before incident HFpEF admission was 19.9 years (median 2.6, Q1–Q3 0.05–6.40 years). The potential sample for this study included 876 patients whose charts were screened and 634 patients who were excluded, leaving 242 patients in the incident HFpEF cohort. The most common reasons for exclusion were (a) history of an echocardiographic EF of less than 50% (n = 296 [47%]), (b) no HFpEF (did not meet European Society of Cardiology diagnostic
Discussion
Unique and clinically relevant increases were detected in echocardiographic markers trends at time intervals well before acute incident HFpEF decompensation. For the echocardiographic markers Ea, RAest, and RVSP, increases were noted across multiple time intervals, whereas E/e’, Ees, Ees/Ea, and left atrial diameter demonstrated progressive increases at individual clinically relevant time intervals leading to HFpEF. RAest increases were noted up to 10 to 20 years before HFpEF and continued to
Limitations
A control group would have strengthened our study results; however, prior studies have demonstrated the usefulness of Ees as an early marker for incident HFpEF within a case-control analysis showing the control group had a 40% higher odds of being in the case group (incident HFpEF) with every 1-unit increase in the Ees.19 In addition, other studies report on the normal progression of echocardiographic markers with aging, but our results suggest that interval increases in echocardiographic
Conclusions
This study illustrates that significant increases in echocardiographic markers (Ea, E/e’, Ees, Ees/Ea, left atrial diameter, RAest, and RVSP) are detectable well before patients develop acute HFpEF decompensation and coincide with trackable physiologic changes that have been proven to be associated with HFpEF. Granted not all of the echocardiographic markers in this study are routinely reported; however, all of the echocardiographic markers analyzed in this study are measurable from routinely
Lay Summary
Heart failure with preserved ejection fraction is a common type of heart failure, in which the heart muscle is strong, but too stiff, not allowing for enough relaxation to fill the heart.
We may be able to identify this condition early, and this may be especially helpful to patients with high blood pressure, overweight, or diabetes.
An echocardiogram may provide information to identify who is at risk for developing heart failure with preserved ejection fraction and provide us a window of
Acknowledgments
The authors thank Melissa LeFevre, BA, RDCS, for her contributions with echocardiography image measurement for arterial and Ees calculations.
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