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Description of the H2FPEF score and point allocations for each clinical characteristic (top), with associated probability of having heart failure with preserved ejection fraction (HFpEF) based on the total score as estimated from the model (bottom).
Source publication
Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have symptoms and signs of HF with normal or near-normal left ventricular ejection fraction (LVEF ≥50%). Roughly half of all patients with HF worldwide have an LVEF ≥50% and nearly half have an LVEF <50%. Thanks to the increased scientific attention...
Context in source publication
Context 1
... are three main steps in this method: 1) identification of patients with suspected HFpEF based upon clinical evaluation, including history, physical examination, and echocardiography; 2) use of the H2FPEF score to estimate the probability of presence of HFpEF versus noncardiac causes of symptoms (42); and 3) if H2FPEF score is intermediate (or low but the diagnosis remains uncertain), further testing (including natriuretic peptide level and/or right heart catheterization) is indicated. This approach is displayed in Figure 1. ...
Citations
... This in turn can cause ventricular remodeling and diastolic dysfunction through various signaling pathways (2)(3)(4).Other mechanisms that may contribute to the pathogenesis of HFpEF include adiponectin deficiency and endothelial dysfunction (5,6). These factors can lead to adverse cardiac and vascular changes, such as left ventricular hypertrophy, concentric remodeling, reduced longitudinal systolic function, right ventricular dysfunction, pulmonary hypertension, vascular stiffness and dysfunction, and cardiac dyssynchrony (7).These alterations can result in elevated left ventricular end-diastolic pressure and clinical signs and symptoms of HFpEF. ...
Background
Heart failure with preserved ejection fraction (HFpEF) is a common and heterogeneous syndrome with high mortality and morbidity. However, few studies have evaluated the relationship between biomarkers and subsequent outcomes in HFpEF patients.
Objective
To assess the association between plasma hepatocyte growth factor (HGF) levels and all-cause mortality in HFpEF patients.
Methods
This was a retrospective cohort study of 412 HFpEF patients who were hospitalized in the Department of Cardiology of the First Affiliated Hospital of Anhui Medical University from November 2020 to November 2021. The patients were divided into two groups according to the 24-month follow-up results: deceased (82 cases) and survivors (330 cases). The primary outcome was all-cause mortality. Multivariate logistic regression analysis was performed to identify the risk factors for all-cause mortality in HFpEF patients. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of relevant indicators for HFpEF mortality risk. Kaplan–Meier analysis was used to assess the risk of all-cause mortality in patients with increased relevant indicators.
Results
Multivariate logistic regression analysis showed that HGF, B-type natriuretic peptide precursor (BNP), total protein (TP), estimated glomerular filtration rate (eGFR), and tetraiodothyronine (T4) were independent risk factors for all-cause mortality in HFpEF patients (P < 0.05). ROC curve analysis showed that the optimal cut-off point of HGF was 1,598 pg/ml [area under the curve (AUC) = 0.645, P = 0.000, hazard ratio (HR) = 3.186, 95% confidence interval (CI): 1.963–5.171], the optimal cut-off point of BNP was 271 pg/ml (AUC = 0.703, P < 0.000, HR = 4.494, 95% CI: 2.914–6.930), and the optimal cut-off point of eGFR was 114.5 ml/min/1.73 m² (AUC = 0.644, P = 0.423). Kaplan–Meier survival curve analysis showed that the survival probability of the patients with low HGF and BNP concentrations was significantly higher (P < 0.0001), while there was no significant difference in the survival rate between the two subgroups with eGFR as the cut-off value (P = 0.423).
Conclusion
HGF and BNP are independent risk factors for all-cause mortality events in HFpEF patients during 24 months of follow-up, and the survival probability of HFpEF patients with low HGF and BNP concentrations is higher.
... The main clinical manifestations are dyspnoea, fatigue (limited activity tolerance) and/or fluid retention (peripheral oedema), and elevated plasma natriuretic peptide levels [2]. International guidelines based on left ventricular ejection fraction (LVEF) differences and post-treatment changes, heart failure was divided into three groups: heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%), heart failure with reduced ejection fraction (HFrEF, LVEF <40%), and heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 40-49%) [3][4][5]. ...
Background
The serum C-reactive protein-to-albumin ratio (CAR) has been identified as an adverse prognostic indicator in a variety of diseases. Nevertheless, there have been not been any studies reporting a relationship between CAR and the prognosis of chronic heart failure (CHF). This study was designed to evaluate the association between CAR and all-cause mortality in CHF patients with different ejection fractions.
Methods
A total of 1221 heart failure (HF) patients were enrolled at the First Affiliated Hospital of Kunming Medical University due to acute exacerbation of chronic HF from January 2017 to October 2021. The main outcome was all-cause mortality. After collecting baseline characteristics and laboratory results from all patients, we classified all participants into four groups based on CAR quartile (G1–G4). Kaplan-Meier survival curves and multivariate Cox proportional hazard models were employed to investigate the association between CAR and all-cause mortality in the patients. Furthermore, receiver operating characteristic (ROC) curves were constructed for CARs, and the area under the curve (AUC) was calculated.
Results
After excluding ineligible patients, we ultimately included 1196 patients with CHF. The mean age was 66.38 ± 12.521 years, and 62% were male. According to the Kaplan‒Meier analysis, with different ejection fractions, the risk of all-cause mortality was always highest for G4 (CAR >63.27) and lowest for G1 (CAR ≤7.67). Cox multivariate regression analyses indicated that the CAR was an independent predictor of all-cause mortality in all HF patients and in patients with different HF subtypes. According to the ROC curves, the AUC for the CAR was 0.732 (p < 0.001), with a sensitivity of 66.2% and the specificity of 72.7%. CAR had a greater predictive value for all-cause mortality than did C-reactive protein (CRP).
Conclusions
An elevated serum CAR was independently associated with an increased risk of all-cause death, regardless of heart failure subtype.
... In contrast, a moderate positive correlation was observed between EF% and AIx, suggesting a less pronounced relationship. These results are consistent with previous studies indicating that decreased EF is associated with increased arterial stiffness, reflecting the deteriorating cardiovascular function in patients with HF [33,34]. The contrasting relationships highlight the utility of PWV as a more sensitive marker of arterial stiffness compared to AIx when assessing the HF severity. ...
Background/Objectives: Heart failure (HF) remains a leading cause of hospitalization and morbidity. Arterial stiffness, measured by pulse wave velocity (PWV) and the augmentation index (AIx), has been linked to HF severity and prognosis. This study investigates the relationship between clinical parameters, biochemical indicators, and arterial stiffness in hospitalized patients with HF, aiming to identify predictors of hospitalization and improve patient management. Methods: This cross-sectional study included 98 patients admitted with HF: 53 with acutely decompensated HF (sudden worsening of symptoms) and 45 with chronic HF (stable symptoms of HF). Clinical and biochemical parameters, including ejection fraction (EF), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, and arterial stiffness indicators (PWV and AIx), were measured at admission. During follow-up, 59 patients required re-hospitalization due to acutely decompensated HF, while 39 remained outpatients without further hospitalization. The relationship between these parameters was analyzed using Pearson correlation coefficients, and multiple Cox regression analysis was conducted to identify independent predictors of re-hospitalization. Results: A significant negative correlation between EF and PWV was found (r = −0.853, 95% CI [−0.910, −0.764]), suggesting an association between improved heart function (higher EF) and reduced arterial stiffness (lower PWV). A moderate positive correlation between EF and AIx (r = 0.626, 95% CI [0.473, 0.805]) suggests that, while higher EF is associated with increased AIx, the relationship is weaker compared to EF and PWV. This may reflect differing contributions of vascular and myocardial factors to HF severity. Hospitalized patients exhibited significantly poorer clinical and biochemical profiles, including higher NT-proBNP levels (p < 0.001) and worse blood pressure (BP) measurements (systolic and diastolic, p < 0.01). Multiple Cox regression analysis identified PWV, Aix, and NT-proBNP as independent predictors of re-hospitalization in HF patients, with significant hazard ratios: PWV (HR = 1.15, p = 0.02), AIx (HR = 1.03, p = 0.02), and NT-proBNP (HR = 1.0001, p < 0.01). Conclusions: Arterial stiffness indices (PWV and AIx), EF, and NT-proBNP were identified as significant predictors of re-hospitalization in HF patients. These findings suggest that integrating arterial stiffness measurements into routine clinical assessments may enhance the risk stratification and inform targeted interventions to reduce hospitalizations and improve outcomes.
... Patients with heart failure and preserved ejection fraction may experience increased systemic vascular resistance, left ventricular afterload, and decreased left ventricular ejection fraction if their hemoglobin levels are elevated. 3 Heart failure can arise from any structural or functional heart issue, 4 potentially explaining the inverse relationship between hemoglobin levels and left ventricular ejection fraction observed in some studies. 1 Atrial fibrillation is one of the most common clinically significant arrhythmias 5 and is linked to higher ventricular rates and stress, increasing the risk of developing heart failure, known as tachyarrhythmia-induced cardiomyopathy. Atrial fibrillation commonly develops in patients with heart failure. ...
... Heart failure symptoms are often caused by multiple impairments in reserve capacity that are present in patients with HFpEF. However, the pathophysiology of HFpEF varies greatly among patients (35), making it difficult to diagnose and treat HFpEF clinically. ...
Background and Objective
About half of all heart failures are heart failures with preserved ejection fraction (HFpEFs). As the population ages and metabolic disorders become more common, the prevalence of HFpEF continues to increase annually. Patients with HFpEF typically show a decline in various reserve capacities after exercise. According to recent research, patients with HFpEF may have significant clinical symptoms due to left atrial (LA) dysfunction. Patients with HFpEF may benefit greatly from the early detection of LA myocardial damage using echocardiographic measurements, particularly LA strain. This article examined state-of-the-art echocardiography as it relates to the assessment of LA function in patients with HFpEF.
Methods
Databases such as PubMed, Google Scholar, and Baidu Scholar were searched to retrieve the latest articles on research advances in the field from 1998 to 2024. The article searches were not limited by rigid language or publication date constraints.
Key Content and Findings
This article outlines LA strain measurements using echocardiography, and provides the current normal reference range for LA strain values. Further, the features of differences in LA strain during exercise and rest are outlined for HFpEF patients in varying stages of heart failure. Finally, the clinical significance of LA strain in HFpEF is highlighted, including its substantial advantages in diagnosing diastolic dysfunction and left ventricular filling pressures, as well as its diagnostic and prognostic utility and potential as a therapeutic target.
Conclusions
When evaluating the structure and function of the left atrium in patients with HFpEF, echocardiography shows a great deal of clinical promise. Specifically, LA strain may provide additional useful information for the early identification of LA dysfunction in HFpEF patients. The measurement of LA size is currently the only clinical test available for evaluating the left atrium in individuals with HFpEF. This review will enable ultrasonographers and physicians to better understand the clinical utility of LA strain in patients with HFpEF, and also provides important resources for future LA strain-related scientific research and clinical practice.
... Heart failure (HF) is a progressive, multifactorial, and heterogeneous clinical syndrome characterized by symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood. It is categorized based on ejection fraction (EF) into HF with reduced EF (HFrEF, left ventricular ejection fraction [LVEF] ≤ 40%), HF with mildly reduced EF (HFmrEF, LVEF 41%-49%), HF with improved EF (previous LVEF ≤ 40% and a follow-up measurement of LVEF > 40%), and HF with preserved EF (HFpEF, LVEF ≥ 50%) [1][2][3][4], HFpEF can be further classified into HF with normal EF (HFnEF, 50% ≤ LVEF ≤ 65%) and HF with supra-normal EF (HFsnEF, LVEF > 65%) [5,6]. Among them, HFpEF constitutes 50% of HF cases [7], which is correlative with ageing, hypertension, obesity, and characterized by an elevated left ventricular filling pressure [8], with comparable rates of readmission and mortality to HFrEF [9]. ...
Background
Heart failure with preserved ejection fraction (HFpEF) is associated with high hospitalization and mortality rates, representing a significant healthcare burden. This study aims to utilize various information including echocardiogram and phonocardiogram to construct and validate a nomogram, assisting in clinical decision‐making.
Methods
This study analyzed 204 patients (68 HFpEF and 136 non‐HFpEF) from the First Affiliated Hospital of Chongqing Medical University. A total of 49 features were integrated and used, including phonocardiogram, echocardiogram features, and clinical parameters. The least absolute shrinkage and selection operator (LASSO) regression was used to select the optimal matching factors, and a stepwise logistic regression was employed to determine independent risk factors and develop a nomogram. Model performance was evaluated by the area under receiver operating characteristic (ROC) curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC).
Results
The nomogram was constructed using five significant indicators, including NT‐proBNP (OR = 4.689, p = 0.015), E/e′ (OR = 1.219, p = 0.032), LAVI (OR = 1.088, p < 0.01), D/S (OR = 0.014, p < 0.01), and QM1 (OR = 1.058, p < 0.01), and showed a better AUC of 0.945 (95% CI = 0.908–0.982) in the training set and 0.933 (95% CI = 0.873–0.992) in the testing set compared to conventional nomogram without phonocardiogram features. The calibration curve and Hosmer–Lemeshow test demonstrated no statistical significance in the training and testing sets (p = 0.814 and p = 0.736), indicating the nomogram was well‐calibrated. The DCA and CIC results confirmed favorable clinical usefulness.
Conclusion
The nomogram, integrating phonocardiogram and echocardiogram features, enhances HFpEF diagnostic efficiency, offering a valuable tool for clinical decision‐making.
... HFrEF is characterized by impaired pumping capability of the heart, which exacerbates blood stasis, and increases the risk of thrombus formation [9]. HFpEF is defined as HF despite preserved LVEF(≥ 50%), with elevated natriuretic peptides, and impaired blood flow dynamics [10]. Given the increasing prevalence of AF and HF and their intricate relationship, it becomes imperative to understand nuanced aspects of their association with the risk of stroke and TE [11]. ...
Background
Stroke and thromboembolism (TE) are significant complications in patients with atrial fibrillation (AF) and heart failure (HF). The impact of ejection fraction status on these risks remains unclear. This study aims to compare the risk of stroke and TE in patients with AF and HF with preserved (HFpEF) or reduced (HFrEF) ejection fraction.
Methods
Literature search of PubMed, Embase, and Scopus databases was done for studies in adult (20 years or more) population of AF patients. Included studies had reported on the incidences of stroke and/or TE in patients with AF and associated HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Cohort (prospective and retrospective), case-control studies, and studies that were based on secondary analysis of data from a trial were eligible for inclusion. Methodological quality was assessed using the Newcastle Ottawa Scale (NOS). Pooled hazard ratio (HR) with 95% confidence intervals (CI) were reported. Exploratory analysis was conducted based on the different cut-offs used to define HFrEF and HFpEF.
Results
Twenty studies were analyzed. In the overall analysis, HFrEF in AF patients was associated with a significantly reduced risk of stroke and systemic TE (HR 0.88, 95% CI: 0.81, 0.96; n = 20, I2 = 86.6%), compared to HFpEF. However, most studies showed comparable risk of stroke among the two groups of patients except for two studies that had documented significantly reduced risk. Upon doing the sensitivity analysis by excluding these two studies, we found similar risk among the two group of subjects and with no heterogeneity (HR 1.01, 95% CI: 0.99, 1.03; n = 18, I2 = 0.0%). Exploratory analysis also showed that the risk of stroke and systemic thromboembolism was similar between those with HFpEF and HFrEF.
Conclusion
The findings suggest that there is no significantly different risk of stroke and systemic thromboembolism in cases of AF with associated HFpEF or HFrEF. The finding does not support integration of left ventricular ejection fraction into stroke risk assessments.
... A ICFEP é Brazilian Journal of Health Review, Curitiba, v. 7, n. 5, p. 01-14, sep/oct., 2024 definida por uma FE preservada, superior a 50%, e representa uma forma de insuficiência cardíaca que não é bem compreendida e tem sido menos estudada do que a ICFER. A importância da ICFEP reside na sua prevalência crescente e nos desafios associados ao seu manejo, especialmente considerando que muitas vezes não responde bem às terapias convencionais utilizadas para a ICFER (MA et al., 2020;BORLAUG et al., 2023). ...
... Dados epidemiológicos mostram que a ICFEP está associada a um alto risco de hospitalização e mortalidade, refletindo um impacto significativo na saúde pública e na qualidade de vida dos pacientes. Essa condição tem se tornado uma preocupação crescente, com evidências sugerindo que a sua prevalência pode aumentar ainda mais com o envelhecimento da população e o aumento das taxas de doenças metabólicas (MA et al., 2020;GIJS VAN WOERDEN et al., 2022;KAZUNORI OMOTE;VERBRUGGE;BORLAUG, 2022). ...
... É fundamental realizar uma avaliação completa para excluir outras causas de sintomas semelhantes, como doenças pulmonares crônicas ou disfunções renais. Estudos indicam que a combinação de sintomas clínicos e exames laboratoriais é essencial para um diagnóstico preciso, mas a presença de sintomas isolados não é suficiente para confirmar a ICFEP sem a confirmação de outros critérios diagnósticos (MA et al., 2020;BORLAUG et al., 2023). integrada para o manejo dos pacientes, garantindo que todos os aspectos da condição sejam considerados (COHEN et al., 2020;PEIKERT et al., 2022). ...
A insuficiência cardíaca com fração de ejeção preservada (ICFEP) representa uma condição complexa e desafiadora para o tratamento, envolvendo mecanismos fisiopatológicos intrincados. A principal característica da ICFEP é a disfunção diastólica, resultante da incapacidade do ventrículo esquerdo de relaxar adequadamente durante a diástole. Esse fenômeno é agravado por condições como hipertensão, obesidade e diabetes mellitus, que contribuem para a rigidez miocárdica e o acúmulo de colágeno no miocárdio, prejudicando a função diastólica. A hipertrofia ventricular e a fibrose miocárdica, associadas à inflamação sistêmica e ao estresse oxidativo, desempenham papeis cruciais na progressão da doença. O diagnóstico da ICFEP é desafiador e requer uma abordagem abrangente que inclui avaliação clínica, exames laboratoriais e técnicas de imagem avançadas. O ecocardiograma e a ressonância magnética cardíaca são ferramentas essenciais para a avaliação da função diastólica e para a identificação de alterações estruturais no coração. Biomarcadores como BNP e troponina são úteis para monitorar a gravidade da insuficiência cardíaca e diferenciar a ICFEP de outras condições cardíacas. Diretrizes clínicas fornecem critérios claros para o diagnóstico e destacam a importância de avaliar comorbidades que podem complicar o tratamento. As opções terapêuticas para a ICFEP incluem tanto tratamentos farmacológicos quanto não farmacológicos. Diuréticos, inibidores da enzima conversora de angiotensina (IECA) e beta-bloqueadores são utilizados para aliviar os sintomas. Novas terapias, como os inibidores de SGLT2, mostraram benefícios na redução de hospitalizações e na melhoria do prognóstico, mesmo em pacientes sem diabetes. Além disso, mudanças no estilo de vida, como controle de peso e exercícios regulares, desempenham um papel importante no manejo da condição. A gestão eficaz das comorbidades, como hipertensão e diabetes mellitus, e o cuidado integrado envolvendo uma equipe multidisciplinar são essenciais para otimizar o tratamento e melhorar a qualidade de vida dos pacientes.
... These findings align with those reported in a prior small cohort study. 21 The underlying mechanism involves the modulation of LAP via right atrial pacing, which alters LV diastolic filling time without changing LV distensibility, 22 and the effects of isoproterenol, a β-agonist that enhances LV diastolic distensibility. 23 The LAP response to isoproterenol infusion mirrors the effects of β-agonist, thus resembling physiological tachycardia, whereas the response to right atrial pacing reflects changes induced by tachycardia or tachyarrhythmia. ...
Background
Increased left atrial pressure (LAP) contributes to dyspnea and heart failure with preserved ejection fraction in patients with atrial fibrillation (AF). The purpose of this study was to investigate the differences in baseline LAP and LAP response to rapid pacing between paroxysmal and persistent AF.
Methods and Results
This observational study prospectively enrolled 1369 participants who underwent AF catheter ablation, excluding those with reduced left ventricular ejection fraction. H 2 FPEF score was calculated by echocardiography and baseline characteristics. Patients underwent LAP measurements during AF, sinus rhythm, and heart rates of 90, 100, 110, and 120 beats per minute (bpm), induced by right atrial pacing and isoproterenol. The baseline LAP‐peak in the persistent AF group consistently exceeded that in the paroxysmal AF (PAF) group across each H 2 FPEF score subgroup (all P <0.05). LAP‐peak increased with pacing (19.5 to 22.5 mm Hg) but decreased with isoproterenol (20.4 to 18.4 mm Hg). Under pacing, patients with PAF exhibited a significantly lower LAP‐peak (90 bpm) than those with persistent AF (17.7±8.2 versus 21.1±9.3 mm Hg, P <0.001). However, there was no difference in LAP‐peak (120 bpm) between the 2 groups (22.1±8.1 versus 22.9±8.4 mm Hg, P =0.056) because the LAP‐peak significantly increased with heart rate in the group with PAF.
Conclusions
Patients with PAF exhibited lower baseline LAP with greater increases during rapid pacing compared with individuals with persistent AF, indicating a need to revise the H 2 FPEF score for distinguishing PAF from persistent AF and emphasizing the importance of rate and rhythm control in PAF for symptom control.
Registration
URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02138695.
... ATTR cardiac amyloidosis is a progressive and fatal condition without early diagnosis, leading to cardiomyopathy and end-stage cardiac failure. The main problems in the disease's diagnosis are the increased number of misdiagnosed [14] and underdiagnosed cases [15], as well as the lack of awareness of this disease among healthcare professionals and the community in the United Kingdom and the United States [16,17], countries of South America [18], countries in the Middle East and Gulf Region [19], as well as European countries [20,21]. ...
Cardiac amyloidosis is a progressive disease characterized by the buildup of amyloid fibrils in the extracellular space of the heart. It is divided in 2 main types, immunoglobulin light chain amyloidosis and transthyretin amyloidosis (ATTR), and ATTR amyloidosis is further divided in 2 subtypes, non-hereditary wild type ATTR and hereditary mutant variant amyloidosis. Incidence and prevalence of ATTR cardiac amyloidosis is increasing over the last years due to the improvements in diagnostic methods. Survival rates are improving due to the development of novel therapeutic strategies. Tafamidis is the only disease-modifying approved therapy in ATTR amyloidosis so far. However, the most recent advances in medical therapies have added more options with the potential to become part of the therapeutic armamentarium of the disease. Agents including acoramidis, eplontersen, vutrisiran, patisiran and anti-monoclonal antibody NI006 are being investigated on cardiac function in large, multicenter controlled trials which are expected to be completed within the next 2-3 years, providing promising results in patients with ATTR cardiac amyloidosis. However, further and ongoing research is required in order to improve diagnostic methods that could provide an early diagnosis, as well as survival and quality of life of these patients.
