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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.
ESC Heart Fail. 2020 Jul 02 [Online ahead of print]EH

Abstract

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/m2), 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.

Authors+Show Affiliations

1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France.Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna (CHUAC), INIBIC, UDC, CIBERCV, A Coruña, Spain.IRCCS San Raffaele, Pisana, Rome, Italy.Division of Cardiology and Metabolism; Department of Cardiology (CVK); and Berlin-Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany & Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany.School of Medicine, University of Cyprus & Heart Failure Unit, Department of Cardiology, University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece.EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France. ANMCO Research Centre, Florence, Italy.Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Complejo Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.Department of Medical Sciences, University of Ferrara, Ferrara, Italy.Department of Cardiology, Medical University of Lodz, Lodz, Poland.Faculty of Medicine, University of Belgrade; Serbian Academy of Sciences and Arts, Belgrade, Serbia.IRCCS San Raffaele, Pisana, Rome, Italy.Department of Anaesthesia and Critical Care, University Hospitals Saint Louis-Lariboisière, APHP; University Paris Diderot; UMR 942 Inserm - MASCOT, Paris, France.King's College Hospital, London, UK.Department of Internal Medicine, General Hospital Murska Sobota, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.Clinic of Cardiology, University Hospital, Zürich, Switzerland.Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32618139

Citation

Kapłon-Cieślicka, Agnieszka, et al. "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." ESC Heart Failure, 2020.
Kapłon-Cieślicka A, Laroche C, Crespo-Leiro MG, et al. 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. ESC Heart Fail. 2020.
Kapłon-Cieślicka, A., Laroche, C., Crespo-Leiro, M. G., Coats, A. J. S., Anker, S. D., Filippatos, G., Maggioni, A. P., Hage, C., Lara-Padrón, A., Fucili, A., Drożdż, J., Seferovic, P., Rosano, G. M. C., Mebazaa, A., McDonagh, T., Lainscak, M., Ruschitzka, F., & Lund, L. H. (2020). 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. ESC Heart Failure. https://doi.org/10.1002/ehf2.12817
Kapłon-Cieślicka A, et al. 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. ESC Heart Fail. 2020 Jul 2; PubMed PMID: 32618139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Kapłon-Cieślicka,Agnieszka, AU - Laroche,Cécile, AU - Crespo-Leiro,Maria G, AU - Coats,Andrew J S, AU - Anker,Stefan D, AU - Filippatos,Gerasimos, AU - Maggioni,Aldo P, AU - Hage,Camilla, AU - Lara-Padrón,Antonio, AU - Fucili,Alessandro, AU - Drożdż,Jarosław, AU - Seferovic,Petar, AU - Rosano,Giuseppe M C, AU - Mebazaa,Alexandre, AU - McDonagh,Theresa, AU - Lainscak,Mitja, AU - Ruschitzka,Frank, AU - Lund,Lars H, AU - ,, Y1 - 2020/07/02/ PY - 2019/08/16/received PY - 2020/05/12/revised PY - 2020/05/20/accepted PY - 2020/7/4/entrez KW - Comorbidity KW - Death KW - Diastolic dysfunction KW - Heart failure with preserved ejection fraction KW - Hospitalization KW - Overdiagnosis JF - ESC heart failure JO - ESC Heart Fail N2 - 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/m2), 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. SN - 2055-5822 UR - https://www.unboundmedicine.com/medline/citation/32618139/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 L2 - https://doi.org/10.1002/ehf2.12817 DB - PRIME DP - Unbound Medicine ER -
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