Author + information
- Masaru Obokata,
- Garvan Kane,
- Yogesh Reddy,
- Thomas Olson,
- Vojtech Melenovsky and
- Barry Borlaug
Background: Diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF) is challenging and relies largely on demonstration of elevated cardiac filling pressures (PCWP). Current guidelines recommend use of natriuretic peptides (NT-proBNP) and rest/exercise echocardiography (E/e’ ratio) to make this determination.
Methods: Simultaneous echocardiographic-catheterization studies were performed at rest and during exercise in subjects with invasively-proven HFpEF (n=50) and participants with dyspnea but no identifiable cardiac pathology (n=24).
Results: NT-proBNP levels were below the level considered to exclude disease (≤125 pg/ml) in 18% of subjects with HFpEF. E/e’ was modestly correlated with directly measured PCWP at rest (r=0.6, p<0.0001) and during exercise (r=0.5-0.6, p<0.0001). While specific, current guidelines were poorly sensitive, identifying only 34-60% of HFpEF based upon resting echocardiographic data alone. Addition of exercise echocardiographic data improved sensitivity and thus negative predictive value, but decreased specificity, with significant net reclassification improvement (NRI 0.26, 95% CI 0.01 to 0.50, p=0.038)
Conclusions: These results question the accuracy of current guidelines to exclude HFpEF based upon resting data alone and reinforce the value of exercise testing using invasive and noninvasive hemodynamic assessments to confirm or refute the diagnosis of HFpEF.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-266
- 2017 American College of Cardiology Foundation