Department of Cardiology, Copenhagen University Hospital Bispebjerg, Copenhagen NV, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Open Heart. 2019 Jun 20;6(1):e000928. doi: 10.1136/openhrt-2018-000928. eCollection 2019.
Heart failure with preserved ejection fraction (HFpEF) involves half of hospitalised patients with heart failure (HF), but estimates vary due to unclear diagnostic criteria. We performed a prospective observational study of hospitalised patients admitted with dyspnoea. The aim was to apply contemporary guidelines to diagnose HF due to valvular disease (HFvhd), HF due to reduced ejection fraction (HFrEF), HF due to midrange EF (HFmrEF) and HFpEF in relation to presumed cardiac or non-cardiac dyspnoea.
We included consecutive hospitalised patients with presumed HF or dyspnoea and excluded patients with acute coronary syndrome, estimated glomerular filtration rate <30 mL/min/1.73 m² or low NT-proBNP (<296 ng/L). Higher age-adjusted NT-proBNP values excluded patients with presumptive non-cardiac dyspnoea. Contemporary criteria for HFpEF and diastolic dysfunction were assessed, and we adjudicated whether acute decompensated HF (ADHF) had been the primary diagnosis.
Of 707 eligible patients, we included 370 patients of whom 75 had non-cardiac dyspnoea. Of these, 10% (38/370) had no cardiac dysfunction. Cardiac dysfunction consisted of 18.4%, HFvhd, 30.1% HFrEF, 10.2% HFmrEF and 41.3% HFpEF. HFpEF was twice as common in presumptive non-cardiac dyspnoea versus cardiac dyspnoea (71% vs 34%, p<0.0001). However, adjudicated ADHF was the primary diagnosis in 80% of HFrEF, 62% of HFmrEF and just 28% of HFpEF.
HF according to contemporary criteria applied to 90% of patients admitted with dyspnoea and elevated NT-proBNP irrespective of the presumptive cause of dyspnoea, of whom 10% had HFmrEF and 41% HFpEF. However, significant non-cardiac diagnoses related to 9 out of 10 with HFpEF with pulmonary disease as the predominant adjudicated problem.
应用当代指南诊断因瓣膜病（HFvhd）、射血分数降低的心力衰竭（HFrEF）、中间射血分数的心力衰竭（HFmrEF）和心力衰竭伴有保留射血分数（HFpEF）导致的呼吸困难住院患者，并评估呼吸困难的假定心脏或非心脏病因。
我们纳入了因疑似心力衰竭或呼吸困难而住院的连续患者，并排除了急性冠状动脉综合征、估计肾小球滤过率 <30 mL/min/1.73 m² 或低 NT-proBNP(<296 ng/L)的患者。较高的年龄调整后 NT-proBNP 值排除了有非心脏性呼吸困难假定的患者。评估了 HFpEF 和舒张功能障碍的当代标准，并判断急性失代偿性心力衰竭 (ADHF) 是否为主要诊断。
在 707 名合格患者中，我们纳入了 370 名患者，其中 75 名有非心脏性呼吸困难。在这些患者中，10%（38/370）没有心脏功能障碍。心脏功能障碍包括 18.4%的 HFvhd、30.1%的 HFrEF、10.2%的 HFmrEF 和 41.3%的 HFpEF。HFpEF 在假定非心脏性呼吸困难患者中是假定心脏性呼吸困难患者的两倍（71%比 34%，p<0.0001）。然而，ADHF 是 HFrEF、HFmrEF 中 62%和 HFpEF 中仅 28%患者的主要诊断。
根据当代标准，90%因呼吸困难和升高的 NT-proBNP 而住院的患者被诊断为心力衰竭，无论呼吸困难的假定病因如何，其中 10%有 HFmrEF 和 41%有 HFpEF。然而，与 10 例 HFpEF 相关的 9 例有重要的非心脏性诊断，以肺病为主要判断问题。
