Camilla Hage1, Ulrika LÖfstrÖm2, Erwan Donal3, Emmanuel Oger4, Agnieszka KapŁon-CieŚlicka5, Jean-Claude Daubert3, Cecilia Linde6, Lars H Lund7. 1. Karolinska Institutet, Department of Medicine, Cardiology unit, Stockholm, Sweden; Karolinska University Hospital, Heart and Vascular Theme, Stockholm, Sweden. Electronic address: camilla.hage@sll.se. 2. Karolinska Institutet, Department of Medicine, Cardiology unit, Stockholm, Sweden; St Görans Hospital, Department of Cardiology, Stockholm, Sweden. 3. Département de Cardiologie & CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Rennes, France. 4. Clinical Investigation Center INSERM CIC-1414, Rennes, France. 5. First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 6. Karolinska Institutet, Department of Medicine, Cardiology unit, Stockholm, Sweden. 7. Karolinska Institutet, Department of Medicine, Cardiology unit, Stockholm, Sweden; Karolinska University Hospital, Heart and Vascular Theme, Stockholm, Sweden.
Abstract
BACKGROUND: Heart failure (HF) with preserved ejection fraction (HFpEF) may be misdiagnosed. We assessed prevalence and consistency of Framingham criteria signs and symptoms in acute vs subsequent stable HFpEF. METHODS: Three hundred ninety-nine patients with acute HFpEF according to Framingham criteria were re-assessed in stable condition. Four definitions of HFpEF at follow-up: (1) Framingham criteria alone, (2) Framingham criteria and natriuretic peptides (NPs), (3) Framingham criteria, NPs, and European Society of Cardiology HF guidelines echocardiographic criteria, (4) Framingham criteria, NPs, and the Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction (PARAGON) trial echocardiographic criteria. RESULTS: At follow-up, HFpEF was still present in 27%, 22%, 21%, and 22%, respectively. Most prevalent in acute HFpEF were dyspnea at exertion (90%), pulmonary rales (71%), persisting at follow-up in 70% and 13%, respectively. Characteristics at acute HF with greater or lesser odds of stable HFpEF; (1) jugular venous distention (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.13-2.87; P = .013) and pleural effusion (OR 0.45, 95% CI 0.24-0.85; P = .014) and (4), older age (1.04, 95% CI 1.01-1.08; P = .014) and tachycardia (>100 bpm) 0.52, 95% CI 0.27-1.00; P = .048). CONCLUSIONS: In patients with acute HFpEF, one-quarter met the HF definition according to Framingham criteria at ambulatory follow-up. The proportion of patients with postdischarge HFpEF was largely unaffected by additional echocardiographic or NP criteria Older age and jugular venous distention at acute presentation predicted persistent HFpEF at follow-up, whereas pleural effusion and tachycardia may yield false HFpEF diagnoses. This finding has implications for HFpEF trial design.
BACKGROUND: Heart failure (HF) with preserved ejection fraction (HFpEF) may be misdiagnosed. We assessed prevalence and consistency of Framingham criteria signs and symptoms in acute vs subsequent stable HFpEF. METHODS: Three hundred ninety-nine patients with acute HFpEF according to Framingham criteria were re-assessed in stable condition. Four definitions of HFpEF at follow-up: (1) Framingham criteria alone, (2) Framingham criteria and natriuretic peptides (NPs), (3) Framingham criteria, NPs, and European Society of Cardiology HF guidelines echocardiographic criteria, (4) Framingham criteria, NPs, and the Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction (PARAGON) trial echocardiographic criteria. RESULTS: At follow-up, HFpEF was still present in 27%, 22%, 21%, and 22%, respectively. Most prevalent in acute HFpEF were dyspnea at exertion (90%), pulmonary rales (71%), persisting at follow-up in 70% and 13%, respectively. Characteristics at acute HF with greater or lesser odds of stable HFpEF; (1) jugular venous distention (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.13-2.87; P = .013) and pleural effusion (OR 0.45, 95% CI 0.24-0.85; P = .014) and (4), older age (1.04, 95% CI 1.01-1.08; P = .014) and tachycardia (>100 bpm) 0.52, 95% CI 0.27-1.00; P = .048). CONCLUSIONS: In patients with acute HFpEF, one-quarter met the HF definition according to Framingham criteria at ambulatory follow-up. The proportion of patients with postdischarge HFpEF was largely unaffected by additional echocardiographic or NP criteria Older age and jugular venous distention at acute presentation predicted persistent HFpEF at follow-up, whereas pleural effusion and tachycardia may yield false HFpEF diagnoses. This finding has implications for HFpEF trial design.
Authors: Agnieszka Kapłon-Cieślicka; Karolina Kupczyńska; Piotr Dobrowolski; Błażej Michalski; Miłosz J Jaguszewski; Waldemar Banasiak; Paweł Burchardt; Łukasz Chrzanowski; Szymon Darocha; Justyna Domienik-Karłowicz; Jarosław Drożdż; Marcin Fijałkowski; Krzysztof J Filipiak; Marcin Gruchała; Ewa A Jankowska; Piotr Jankowski; Jarosław D Kasprzak; Wojciech Kosmala; Piotr Lipiec; Przemysław Mitkowski; Katarzyna Mizia-Stec; Piotr Szymański; Agnieszka Tycińska; Wojciech Wańha; Maciej Wybraniec; Adam Witkowski; Piotr Ponikowski; On Behalf Of "Club 30" Of The Polish Cardiac Society Journal: Cardiol J Date: 2020-09-28 Impact factor: 2.737