Tani Yuta, Reddy Yogesh N V, Verbrugge Frederik H, Yang Jeong Hoon, Negishi Kazuaki, Harada Tomonari, Kagami Kazuki, Saito Yuki, Yuasa Naoki, Sorimachi Hidemi, Murakami Fumitaka, Kato Toshimitsu, Wada Naoki, Ishii Hideki, Obokata Masaru
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Eur Heart J Imaging Methods Pract. 2024 Jun 12;2(1):qyae059. doi: 10.1093/ehjimp/qyae059. eCollection 2024 Jan.
The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging based on resting assessments. Exercise echocardiography is often used to unmask abnormalities that develop during exercise, but the diagnostic criteria have not been standardized. This study aimed to elucidate how cardiologists utilize exercise echocardiography to diagnose HFpEF in real-world practice.
An international web-based survey involving 87 cardiologists was performed. We also performed a retrospective cross-sectional study to investigate the impact of different exercise echocardiographic diagnostic criteria in 652 dyspnoeic patients who underwent exercise echocardiography. The HFA-PEFF algorithm was the most commonly used exercise echocardiography criterion for HFpEF diagnoses (48%), followed by the ASE/EACVI criteria (24%) and other combinations of multiple parameters (22%). Among 652 patients, the proportion of HFpEF diagnosis varied substantially according to the criteria used ranging from 20.1% (ASE/EACVI criteria) to 44.3% (HFA-PEFF algorithm). Many cases (49.4-70.5%) remained indeterminate after exercise echocardiography, but only 41% of surveyed cardiologists would utilize exercise right heart catheterization to resolve an indeterminate result. Despite these diagnostic uncertainties, 54% of surveyed cardiologists would utilize exercise echocardiography results to initiate sodium-glucose co-transporter 2 inhibitors.
In real-world practice, exercise echocardiographic criteria utilized across cardiologists vary, which meaningfully impacts the frequency of HFpEF diagnoses, with indeterminate results being common. Despite these diagnostic uncertainties, many cardiologists initiate pharmacotherapy based on exercise echocardiography. The lack of consensus on universal diagnostic criteria for exercise echocardiography and approaches to indeterminate results may limit the delivery of evidence-based treatment for HFpEF.
基于静息评估，射血分数保留的心力衰竭（HFpEF）的诊断仍然具有挑战性。运动超声心动图常用于揭示运动期间出现的异常情况，但诊断标准尚未标准化。本研究旨在阐明心脏病专家如何在实际临床实践中利用运动超声心动图诊断HFpEF。
开展了一项涉及87名心脏病专家的基于网络的国际调查。我们还进行了一项回顾性横断面研究，以调查不同运动超声心动图诊断标准对652例接受运动超声心动图检查的呼吸困难患者的影响。HFA-PEFF算法是HFpEF诊断中最常用的运动超声心动图标准（48%），其次是ASE/EACVI标准（24%）和其他多个参数的组合（22%）。在652例患者中，根据所使用的标准，HFpEF诊断的比例差异很大，从20.1%（ASE/EACVI标准）到44.3%（HFA-PEFF算法）。运动超声心动图检查后，许多病例（49.4-70.5%）仍不确定，但只有41%的受访心脏病专家会使用运动右心导管检查来解决不确定的结果。尽管存在这些诊断上的不确定性，但54%的受访心脏病专家会利用运动超声心动图的结果来启动钠-葡萄糖协同转运蛋白2抑制剂治疗。
在实际临床实践中，心脏病专家使用的运动超声心动图标准各不相同，这对HFpEF诊断的频率有显著影响，不确定结果很常见。尽管存在这些诊断上的不确定性，但许多心脏病专家仍根据运动超声心动图启动药物治疗。运动超声心动图通用诊断标准和不确定结果处理方法缺乏共识，可能会限制HFpEF循证治疗的实施。
