Yang Zi-Xuan, Kang Yu, Zhong Xue-Ke, Chen Qiao-Wei, She Yi, Guo Yun, Chen Xiao-Jing, Wang Hua, Zhang Qing
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Tianfu New Area Zheng Xing Community Health Service Center, Chengdu, Sichuan, China.
Glob Heart. 2025 Jun 19;20(1):55. doi: 10.5334/gh.1439. eCollection 2025.
This study aimed to assess the feasibility and cost-effectiveness of hand-held echocardiography-based screening for Stage B or C heart failure among individuals with hypertension and/or diabetes at the High-tech Area Fangcao Community Health Service Center and the Tianfu New Area Huayang Community Health Service Center in Chengdu, China, with the objective of promoting early diagnosis and intensified care.
Patients with hypertension and/or diabetes registered and cared for at two community health service centers (CHSCs; Chengdu, China) with no history of clinical heart failure were recruited between October 2021 and December 2021. By combining symptom assessment (dyspnea and/or edema) and N-terminal-probrain natriuretic peptide (NT-proBNP ≥ 125 pg/ml as the cut-off) levels with HHE for any indexed abnormality in the dedicated semi-quantitative protocol, patients were categorized into heart failure (HF) Stages A, B, and C. The diagnostic accuracy and cost-effectiveness of several pre-specified screening strategies were compared.
Of the 423 patients (70 ± 9 years; males, 46.6%) enrolled, 166 (39.2%) were symptomatic and 106 (25.1%) exhibited elevated NT-proBNP levels. Hand-held echocardiography (HHE) abnormalities were detected in 286 (67.0%) patients, with interventricular septum thickening (47.0%) being the most common finding, followed by left atrial enlargement (30.0%). Left ventricular systolic dysfunction was identified in 18 (4.3%) patients. A total of 240 (56.7%) patients were reclassified as HF Stage B and 59 (13.9%) as Stage C. The stepwise strategy of using symptoms for initial stratification, followed by the selection of HHE or NT-proBNP in different circumstances, resulted in 100% accuracy and a 31.3% reduction in costs.
HHE-based focused HF screening allows for the early identification of numerous cases of Stage B and mild Stage C HF in high-risk populations. A stepwise screening strategy incorporating symptoms, NT-proBNP, and HHE is feasible and cost-effective and should be adopted in community-based primary care settings.
本研究旨在评估在中国成都高新区芳草社区卫生服务中心和天府新区华阳社区卫生服务中心，对高血压和/或糖尿病患者采用基于手持式超声心动图的筛查方法来诊断B期或C期心力衰竭的可行性和成本效益，以促进早期诊断和强化治疗。
在2021年10月至2021年12月期间，招募在两家社区卫生服务中心（中国成都）登记并接受治疗且无临床心力衰竭病史的高血压和/或糖尿病患者。通过将症状评估（呼吸困难和/或水肿）和N末端脑钠肽前体（NT-proBNP≥125 pg/ml作为临界值）水平与手持式超声心动图（HHE）相结合，采用专门的半定量方案对任何指标异常进行评估，将患者分为心力衰竭（HF）A、B和C期。比较了几种预先指定的筛查策略的诊断准确性和成本效益。
在纳入的423例患者（70±9岁；男性占46.6%）中，166例（39.2%）有症状，106例（25.1%）NT-proBNP水平升高。286例（67.0%）患者检测出手持式超声心动图（HHE）异常，其中室间隔增厚（47.0%）最为常见，其次是左心房扩大（30.0%）。18例（4.3%）患者被诊断为左心室收缩功能障碍。共有240例（56.7%）患者被重新分类为HF B期，59例（13.9%）为C期。采用症状进行初始分层，然后在不同情况下选择HHE或NT-proBNP的逐步策略，诊断准确率达100%且成本降低了31.3%。
基于手持式超声心动图的心力衰竭重点筛查能够在高危人群中早期识别出大量B期和轻度C期心力衰竭病例。将症状、NT-proBNP和HHE纳入其中的逐步筛查策略是可行且具有成本效益的，应在社区基层医疗环境中采用。
