KaRen is a prospective study designed to characterize and follow a cohort of heart failure with preserved ejection fraction (HFpEF) patients. HFpEF remains a challenging syndrome. Patients have clinical signs linked to congestion but left ventricular (LV) EF is > 45%. We sought to test the relevance of echocardiographic parameters as predictors of death or hospitalization for cardiovascular reasons.

Following an acute HF accompanied with NT-proBNP >300pg/ml (BNP >100pg/ml) and LVEF >45%, patients were included (n=349). The patients were reassessed by echo-Doppler after 4-8 weeks. Echocardiographies were standardized and the analysis centralized. LVEF was 62±13%, LV global longitudinal strain: – 15±3%, E/e’:12.9±6.2, Left atrial volume: 49±18ml/m², Tricuspid regurgitation: 2.9±0.9m/s. Two parameters are correlated with the survival without any death or hospitalisation for cardiovascular reason and could be combined in a score: 2 x (E / e’) + RA area. This score has a theoretical range between 0 and 14. Based on tertiles of the score, censoring (frequencies of death or hospitalization for heart failure) were 48 (37.80), 67 (57.76) and 85 (75.22) in the 1st tertile – poor prognosis (N = 127), the 2nd tertile – intermediate (N = 116) and the 3rd tertile – good prognosis (N = 113), respectively.

Combination of simple echocardiographic criteria (right atrial area and E/e’ ratio) was found relevant to predict the long term prognosis in a large cohort of patients diagnosed for heart failure with preserved ejection fraction.