Discriminative Role of Invasive Left Heart Catheterization in Patients Suspected of Heart Failure With Preserved Ejection Fraction

被引：8

作者：

Choi, Ki Hong ^{[1
]}

Yang, Jeong Hoon ^{[1
,2
,5
]}

Seo, Jeong Hun ^{[3
]}

Hong, David ^{[1
]}

Youn, Taeho ^{[1
]}

Joh, Hyun Sung ^{[1
]}

Lee, Seung Hun ^{[4
]}

Kim, Darae ^{[1
]}

Park, Taek Kyu ^{[1
]}

Lee, Joo Myung ^{[1
]}

Song, Young Bin ^{[1
]}

Choi, Jin-Oh ^{[1
]}

Hahn, Joo-Yong ^{[1
]}

Choi, Seung-Hyuk ^{[1
]}

Gwon, Hyeon-Cheol ^{[1
]}

Jeon, Eun-Seok ^{[1
]}

机构：

[1] Sungkyunkwan Univ, Samsung Med Ctr, Dept Med, Div Cardiol,Sch Med, Seoul, South Korea

[2] Sungkyunkwan Univ, Samsung Med Ctr, Dept Crit Care Med, Sch Med, Seoul, South Korea

[3] Kangwon Natl Univ Hosp, Dept Med, Div Cardiol, Chunchon, Gangwon Do, South Korea

[4] Chonnam Natl Univ Hosp, Cardiovasc Ctr, Dept Internal Med, Gwangju, South Korea

[5] Sungkyunkwan Univ, Samsung Med Ctr, Dept Crit Care Med & Med, Div Cardiol,Sch Med, 81 Irwon Ro, Seoul 06351, South Korea

来源：

JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2023年 / 12卷 / 06期

关键词：

heart failure with preserved ejection fraction; HFA-PEFF score; left ventricular end-diastolic pressure; let heart catheterization; prognosis; EUROPEAN ASSOCIATION; AMERICAN SOCIETY; ECHOCARDIOGRAPHY; RECOMMENDATIONS; DIAGNOSIS; UPDATE; SCORES;

D O I：

10.1161/JAHA.122.027581

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Recently, diastolic stress testing and invasive hemodynamic measurements have been emphasized for diagnosis of heart failure with preserved ejection fraction (HFpEF) because when determined using noninvasive parameters it can fall into a nondiagnostic intermediate range. The current study evaluated the discriminative and prognostic roles of invasive measured left ventricular end-diastolic pressure in the population with suspected HFpEF, particularly for patients with intermediate Heart Failure Association Pre-test Assessment, Echocardiography & Natriuretic Peptide, Functional Testing, Final Etiology (HFA-PEFF) score. METHODS AND RESULTS: A total of 404 patients with symptoms or signs of HF and preserved left ventricular systolic function were enrolled. All subjects underwent left heart catheterization with left ventricular end-diastolic pressure measurement for confirmation of HFpEF (>= 16 mm Hg). The primary outcome was all-cause death or readmission due to HF within 10 years. Among the study population, 324 patients (80.2%) were diagnosed as invasively confirmed HFpEF, and 80 patients (19.8%) were as noncardiac dyspnea. The patients with HFpEF showed a significantly higher HFA-PEFF score than the patients with noncardiac dyspnea (3.8 +/- 1.8 versus 2.6 +/- 1.5, P<0.001). The discriminative ability of the HFA-PEFF score for diagnosing HFpEF was modest (area under the curve, 0.70 [95% CI, 0.64-0.75], P<0.001). The HFA-PEFF score was associated with a significantly higher 10-year risk of death or HF readmission (per-1 increase, hazard ratio [HR], 1.603 [95% CI, 1.376-1.868], P<0.001). Among the 226 patients with an intermediate HFA-PEFF score (2-4), those with invasively confirmed HFpEF had a significantly higher risk of death or HF readmission within 10 years than the patients with noncardiac dyspnea (24.0% versus 6.9%, HR, 3.327 [95% CI, 1.109-16.280], P=0.030). CONCLUSIONS: The HFA-PEFF score is a moderately useful tool for predicting future adverse events in suspected HFpEF, and invasively measured left ventricular end-diastolic pressure can provide additional information to discriminate patient prognosis, particularly in those with intermediate HFA-PEFF scores. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04505449.

引用

页数：19