Verwerft Jan, Verbrugge Frederik H, Claessen Guido, Herbots Lieven, Dendale Paul, Gevaert Andreas B
Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
Faculty of Medicine and Life Sciences, Biomedical Research Institute, Hasselt University, Hasselt, Belgium.
Front Cardiovasc Med. 2022 Feb 9;9:814601. doi: 10.3389/fcvm.2022.814601. eCollection 2022.
Diastolic stress testing (DST) is recommended to confirm heart failure with preserved ejection fraction (HFpEF) in patients with exertional dyspnea, but current algorithms do not detect all patients. We aimed to identify additional echocardiographic markers of elevated pulmonary arterial wedge pressure during exercise (exPAWP) in patients referred for DST.
We identified candidate parameters in 22 patients referred for exercise right heart catheterization with simultaneous echocardiography. Elevated exPAWP (≥25 mmHg) was present in 14 patients, and was best identified by peak septal systolic annular velocity <9.5 cm/s [, area under the receiver operating characteristic curve (AUC) 0.97, 95% confidence interval 0.92-1.0] and mean pulmonary artery pressure/cardiac output slope ≥3.2 mmHg/L [mPAP/CO, AUC 0.88 (0.72-1.0)]. We propose a decision tree to identify patients with elevated exPAWP. Applying this decision tree to 326 patients in an independent non-invasive DST cohort showed that patients labeled as "high probability of HFpEF" ( = 85) had reduced peak oxygen uptake [13.0 (10.7-15.1) mL/kg/min, < 0.001 vs. intermediate/low probability], high H2FPEF score [53 (40-72) %, < 0.001 vs. intermediate/low probability], and typical clinical characteristics. The diagnostic yield of DST increased from 11% using exercise E/e', to 62% using the decision tree.
In DST for suspected HFpEF, was the most accurate echocardiographic parameter to identify elevated PAWP. We propose a decision tree including and mPAP/CO for interpretation of DST. Application of this decision tree revealed typical HFpEF characteristics in patients labeled as high probability of HFpEF, and substantially reduced the number of inconclusive results.
对于有劳力性呼吸困难的患者，推荐采用舒张期负荷试验（DST）来确诊射血分数保留的心力衰竭（HFpEF），但目前的算法无法检测出所有此类患者。我们旨在确定接受DST检查的患者运动期间肺动脉楔压升高（exPAWP）的其他超声心动图标志物。
我们在22例接受运动右心导管检查并同步进行超声心动图检查的患者中确定了候选参数。14例患者存在exPAWP升高（≥25 mmHg），最佳识别指标为室间隔收缩期峰值环向速度<9.5 cm/s [，受试者工作特征曲线下面积（AUC）0.97，95%置信区间0.92 - 1.0]以及平均肺动脉压/心输出量斜率≥3.2 mmHg/L [mPAP/CO，AUC 0.88（0.72 - 1.0）]。我们提出了一个决策树来识别exPAWP升高的患者。将此决策树应用于一个独立的非侵入性DST队列中的326例患者，结果显示被标记为“HFpEF高概率”（ = 85）的患者峰值摄氧量降低[13.0（10.7 - 15.1）mL/kg/min，与中/低概率组相比，< 0.001]，H2FPEF评分较高[53（40 - 72）%，与中/低概率组相比，< 0.001]，且具有典型的临床特征。DST的诊断率从使用运动E/e'时的11%提高到使用决策树时的62%。
在疑似HFpEF的DST中，是识别PAWP升高最准确的超声心动图参数。我们提出了一个包含和mPAP/CO的决策树用于解释DST。应用此决策树揭示了被标记为HFpEF高概率的患者具有典型的HFpEF特征，并显著减少了不确定结果的数量。
