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Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry

AIMS: In hospitalized patients with a clinical diagnosis of acute heart failure (HF) with preserved ejection fraction (HFpEF), the aims of this study were (i) to assess the proportion meeting the 2016 European Society of Cardiology (ESC) HFpEF criteria and (ii) to compare patients with restrictive/p...

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Autores principales: Kapłon‐Cieślicka, Agnieszka, Laroche, Cécile, Crespo‐Leiro, Maria G., Coats, Andrew J.S., Anker, Stefan D., Filippatos, Gerasimos, Maggioni, Aldo P., Hage, Camilla, Lara‐Padrón, Antonio, Fucili, Alessandro, Drożdż, Jarosław, Seferovic, Petar, Rosano, Giuseppe M.C., Mebazaa, Alexandre, McDonagh, Theresa, Lainscak, Mitja, Ruschitzka, Frank, Lund, Lars H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524216/
https://www.ncbi.nlm.nih.gov/pubmed/32618139
http://dx.doi.org/10.1002/ehf2.12817
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author Kapłon‐Cieślicka, Agnieszka
Laroche, Cécile
Crespo‐Leiro, Maria G.
Coats, Andrew J.S.
Anker, Stefan D.
Filippatos, Gerasimos
Maggioni, Aldo P.
Hage, Camilla
Lara‐Padrón, Antonio
Fucili, Alessandro
Drożdż, Jarosław
Seferovic, Petar
Rosano, Giuseppe M.C.
Mebazaa, Alexandre
McDonagh, Theresa
Lainscak, Mitja
Ruschitzka, Frank
Lund, Lars H.
author_facet Kapłon‐Cieślicka, Agnieszka
Laroche, Cécile
Crespo‐Leiro, Maria G.
Coats, Andrew J.S.
Anker, Stefan D.
Filippatos, Gerasimos
Maggioni, Aldo P.
Hage, Camilla
Lara‐Padrón, Antonio
Fucili, Alessandro
Drożdż, Jarosław
Seferovic, Petar
Rosano, Giuseppe M.C.
Mebazaa, Alexandre
McDonagh, Theresa
Lainscak, Mitja
Ruschitzka, Frank
Lund, Lars H.
author_sort Kapłon‐Cieślicka, Agnieszka
collection PubMed
description AIMS: In hospitalized patients with a clinical diagnosis of acute heart failure (HF) with preserved ejection fraction (HFpEF), the aims of this study were (i) to assess the proportion meeting the 2016 European Society of Cardiology (ESC) HFpEF criteria and (ii) to compare patients with restrictive/pseudonormal mitral inflow pattern (MIP) vs. patients with MIP other than restrictive/pseudonormal. METHODS AND RESULTS: We included hospitalized participants of the ESC‐Heart Failure Association (HFA) EURObservational Research Programme (EORP) HF Long‐Term Registry who had echocardiogram with ejection fraction (EF) ≥ 50% during index hospitalization. As no data on e', E/e' and left ventricular (LV) mass index were gathered in the registry, the 2016 ESC HFpEF definition was modified as follows: elevated B‐type natriuretic peptide (BNP) (≥100 pg/mL for acute HF) and/or N‐terminal pro‐BNP (≥300 pg/mL) and at least one of the echocardiographic criteria: (i) presence of LV hypertrophy (yes/no), (ii) left atrial volume index (LAVI) of >34 mL/m(2)), or (iii) restrictive/pseudonormal MIP. Next, all patients were divided into four groups: (i) patients with restrictive/pseudonormal MIP on echocardiography [i.e. with presumably elevated left atrial (LA) pressure], (ii) patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure), (iii) atrial fibrillation (AF) group, and (iv) ‘grey area’ (no consistent description of MIP despite no report of AF). Of 6365 hospitalized patients, 1848 (29%) had EF ≥ 50%. Natriuretic peptides were assessed in 28%, LV hypertrophy in 92%, LAVI in 13%, and MIP in 67%. The 2016 ESC HFpEF criteria could be assessed in 27% of the 1848 patients and, if assessed, were met in 52%. Of the 1848 patients, 19% had restrictive/pseudonormal MIP, 43% had MIP other than restrictive/pseudonormal, 18% had AF and 20% were grey area. There were no differences in long‐term all‐cause or cardiovascular mortality, or all‐cause hospitalizations or HF rehospitalizations between the four groups. Despite fewer non‐cardiac comorbidities reported at baseline, patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure) had more non‐cardiovascular (14.0 vs. 6.7 per 100 patient‐years, P < 0.001) and cardiovascular non‐HF (13.2 vs. 8.0 per 100 patient‐years, P = 0.016) hospitalizations in long‐term follow‐up than patients with restrictive/pseudonormal MIP. CONCLUSIONS: Acute HFpEF diagnosis could be assessed (based on the 2016 ESC criteria) in only a quarter of patients and confirmed in half of these. When assessed, only one in three patients had restrictive/pseudonormal MIP suggestive of elevated LA pressure. Patients with MIP other than restrictive/pseudonormal (suggestive of normal LA pressure) could have been misdiagnosed with acute HFpEF or had echocardiography performed after normalization of LA pressure. They were more often hospitalized for non‐HF reasons during follow‐up. Symptoms suggestive of acute HFpEF may in some patients represent non‐HF comorbidities.
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spelling pubmed-75242162020-10-02 Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry Kapłon‐Cieślicka, Agnieszka Laroche, Cécile Crespo‐Leiro, Maria G. Coats, Andrew J.S. Anker, Stefan D. Filippatos, Gerasimos Maggioni, Aldo P. Hage, Camilla Lara‐Padrón, Antonio Fucili, Alessandro Drożdż, Jarosław Seferovic, Petar Rosano, Giuseppe M.C. Mebazaa, Alexandre McDonagh, Theresa Lainscak, Mitja Ruschitzka, Frank Lund, Lars H. ESC Heart Fail Original Research Articles AIMS: In hospitalized patients with a clinical diagnosis of acute heart failure (HF) with preserved ejection fraction (HFpEF), the aims of this study were (i) to assess the proportion meeting the 2016 European Society of Cardiology (ESC) HFpEF criteria and (ii) to compare patients with restrictive/pseudonormal mitral inflow pattern (MIP) vs. patients with MIP other than restrictive/pseudonormal. METHODS AND RESULTS: We included hospitalized participants of the ESC‐Heart Failure Association (HFA) EURObservational Research Programme (EORP) HF Long‐Term Registry who had echocardiogram with ejection fraction (EF) ≥ 50% during index hospitalization. As no data on e', E/e' and left ventricular (LV) mass index were gathered in the registry, the 2016 ESC HFpEF definition was modified as follows: elevated B‐type natriuretic peptide (BNP) (≥100 pg/mL for acute HF) and/or N‐terminal pro‐BNP (≥300 pg/mL) and at least one of the echocardiographic criteria: (i) presence of LV hypertrophy (yes/no), (ii) left atrial volume index (LAVI) of >34 mL/m(2)), or (iii) restrictive/pseudonormal MIP. Next, all patients were divided into four groups: (i) patients with restrictive/pseudonormal MIP on echocardiography [i.e. with presumably elevated left atrial (LA) pressure], (ii) patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure), (iii) atrial fibrillation (AF) group, and (iv) ‘grey area’ (no consistent description of MIP despite no report of AF). Of 6365 hospitalized patients, 1848 (29%) had EF ≥ 50%. Natriuretic peptides were assessed in 28%, LV hypertrophy in 92%, LAVI in 13%, and MIP in 67%. The 2016 ESC HFpEF criteria could be assessed in 27% of the 1848 patients and, if assessed, were met in 52%. Of the 1848 patients, 19% had restrictive/pseudonormal MIP, 43% had MIP other than restrictive/pseudonormal, 18% had AF and 20% were grey area. There were no differences in long‐term all‐cause or cardiovascular mortality, or all‐cause hospitalizations or HF rehospitalizations between the four groups. Despite fewer non‐cardiac comorbidities reported at baseline, patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure) had more non‐cardiovascular (14.0 vs. 6.7 per 100 patient‐years, P < 0.001) and cardiovascular non‐HF (13.2 vs. 8.0 per 100 patient‐years, P = 0.016) hospitalizations in long‐term follow‐up than patients with restrictive/pseudonormal MIP. CONCLUSIONS: Acute HFpEF diagnosis could be assessed (based on the 2016 ESC criteria) in only a quarter of patients and confirmed in half of these. When assessed, only one in three patients had restrictive/pseudonormal MIP suggestive of elevated LA pressure. Patients with MIP other than restrictive/pseudonormal (suggestive of normal LA pressure) could have been misdiagnosed with acute HFpEF or had echocardiography performed after normalization of LA pressure. They were more often hospitalized for non‐HF reasons during follow‐up. Symptoms suggestive of acute HFpEF may in some patients represent non‐HF comorbidities. John Wiley and Sons Inc. 2020-07-02 /pmc/articles/PMC7524216/ /pubmed/32618139 http://dx.doi.org/10.1002/ehf2.12817 Text en © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research Articles
Kapłon‐Cieślicka, Agnieszka
Laroche, Cécile
Crespo‐Leiro, Maria G.
Coats, Andrew J.S.
Anker, Stefan D.
Filippatos, Gerasimos
Maggioni, Aldo P.
Hage, Camilla
Lara‐Padrón, Antonio
Fucili, Alessandro
Drożdż, Jarosław
Seferovic, Petar
Rosano, Giuseppe M.C.
Mebazaa, Alexandre
McDonagh, Theresa
Lainscak, Mitja
Ruschitzka, Frank
Lund, Lars H.
Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry
title Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry
title_full Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry
title_fullStr Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry
title_full_unstemmed Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry
title_short Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology ‐ Heart Failure Association EURObservational Research Programme Heart Failure Long‐Term Registry
title_sort is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? from the european society of cardiology ‐ heart failure association eurobservational research programme heart failure long‐term registry
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524216/
https://www.ncbi.nlm.nih.gov/pubmed/32618139
http://dx.doi.org/10.1002/ehf2.12817
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