Alternative Echocardiographic Algorithm for Left Ventricular Filling Pressure in Patients With Heart Failure With Preserved Ejection Fraction - 23/02/21
, Kohei Ukita, MD a, Akito Kawamura, MD a, Hitoshi Nakamura, MD a, Koji Yasumoto, MD a, Masaki Tsuda, MD a, Naotaka Okamoto, MD a, Akihiro Tanaka, MD a, Yasuharu Matsunaga-Lee, MD a, Masamichi Yano, MD, PhD a, Yasuyuki Egami, MD a, Ryu Shutta, MD a, Jun Tanouchi, MD, PhD a, Takahisa Yamada, MD, PhD b, Yoshio Yasumura, MD, PhD c, Shunsuke Tamaki, MD, PhD b, Takaharu Hayashi, MD, PhD d, Akito Nakagawa, MD, PhD c, g, Yusuke Nakagawa, MD, PhD e, Daisaku Nakatani, MD, PhD f, Yohei Sotomi, MD, PhD f, Shungo Hikoso, MD, PhD f, Yasushi Sakata, MD, PhD fon behalf of
Osaka CardioVascular Conference (OCVC)-Heart Failure Investigators
HIGHLIGHTS |
• | When we use a conventional algorithm for estimating left ventricular filling pressures recommended by the American Society of Echocardiography and the European Association of Cardiovascular Imaging, 2% to 10% patients are classed as “indeterminate,” and the algorithm cannot be used in patients with atrial fibrillation. |
• | High left ventricular filling pressure assessed by echocardiography using our proposed algorithm was an independent predictor of poor clinical outcomes in patients with heart failure with preserved ejection fraction . |
• | The same results were seen in patients with atrial fibrillation and patients originally assigned to the “indeterminate” group using the conventional algorithm. |
Résumé |
The American Society of Echocardiography and/or the European Association of Cardiovascular Imaging recommend a conventional algorithm for estimating left ventricular (LV) filling pressure in heart failure. However, several patients are classed as “indeterminate” due to their LV filling pressures being impossible to calculate. We investigated whether our new echocardiographic algorithm can predict clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF). We enrolled 754 consecutive patients from the PURSUIT-HFpEF registry. We used the new algorithm to divide them into 2 groups; a normal LV filling pressure group (N group) and a high LV filling pressure group (H group). The H group consisted of 342 patients. Over a mean follow-up of 342 days, 185 patients reached the primary composite end point (157 readmissions for worsening heart failure and 43 cardiovascular deaths). In a multivariable Cox analysis, being in the H group was significantly associated with an increased rate of cardiac events compared with the N group (hazard ratio: 1.71; 95% confidence interval: 1.17 to 2.50, p = 0.006). There were 56 patients (7%) who were assigned to “indeterminate” with the conventional algorithm. Using the new algorithm, we reclassified 16 patients (29%) into the H group and 40 patients (71%) into the N group. The Kaplan-Meier curves showed the reclassified H group had a significantly higher incidence of cardiac events than those assigned to the N group (p < 0.01). In conclusion, the present study demonstrated LV filling pressure assessed by our algorithm can predict clinical outcomes in patients with HFpEF.
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| This work was funded by Roche Diagnostics K.K. and Fuji Film Toyama Chemical Co. Ltd. |
Vol 143
P. 80-88 - mars 2021 Retour au numéro
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