Karolinska Institutet, Department of Medicine, Cardiology unit, Stockholm, Sweden; Karolinska University Hospital, Heart and Vascular Theme, Stockholm, Sweden.
Karolinska Institutet, Department of Medicine, Cardiology unit, Stockholm, Sweden; St Görans Hospital, Department of Cardiology, Stockholm, Sweden.
J Card Fail. 2020 Aug;26(8):673-684. doi: 10.1016/j.cardfail.2019.04.013. Epub 2019 Apr 26.
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.
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.
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).
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.
射血分数保留的心力衰竭（HFpEF）可能会被误诊。我们评估了急性与随后稳定的 HFpEF 中弗明汉标准的体征和症状的患病率和一致性。
根据弗明汉标准，399 例急性 HFpEF 患者在稳定状态下重新评估。在随访中，HFpEF 有 4 种定义：（1）仅弗明汉标准，（2）弗明汉标准加利钠肽（NPs），（3）弗明汉标准、NPs 和欧洲心脏病学会心力衰竭指南超声心动图标准，（4）弗明汉标准、NPs 和 LCZ696 与缬沙坦在射血分数保留的心力衰竭患者中的疗效和安全性比较（PARAGON）试验超声心动图标准。
随访时，HFpEF 分别仍存在于 27%、22%、21%和 22%的患者中。在急性 HFpEF 中最常见的是活动时呼吸困难（90%）、肺部啰音（71%），在随访中分别有 70%和 13%持续存在。在急性 HF 中具有更高或更低稳定 HFpEF 可能性的特征；（1）颈静脉扩张（比值比 [OR] 1.80，95%置信区间 [CI] 1.13-2.87；P=0.013）和胸腔积液（OR 0.45，95%CI 0.24-0.85；P=0.014）和（4）年龄较大（1.04，95%CI 1.01-1.08；P=0.014）和心动过速（>100 bpm）0.52，95%CI 0.27-1.00；P=0.048）。
在急性 HFpEF 患者中，有四分之一的患者根据弗明汉标准在门诊随访时符合心力衰竭的定义。出院后 HFpEF 患者的比例在很大程度上不受附加超声心动图或 NP 标准的影响。急性发作时的年龄较大和颈静脉扩张预测了随访时持续的 HFpEF，而胸腔积液和心动过速可能导致假 HFpEF 诊断。这一发现对 HFpEF 试验设计具有重要意义。
