COMPARISON OF DIAGNOSTIC CRITERIA FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION

Background Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent clinical syndrome. There is no gold-standard method for diagnosis. H2FPEF score, HFA-PEFF score, and diastolic dysfunction algorithm have been developed to assist diagnosis. The aim of our study is to compare various diagnostic criteria in an in-patient cohort of clinical HFpEF patients. Methods This was a single-center, retrospective review of in-patients with primary diagnosis of HFpEF from Jan. 2018 to May 2020. Patient demographics, medical comorbidities and test results were reviewed. Clinical characteristics and echocardiographic parameters including left ventricular mass, left atrial volume index, tricuspid regurgitation jet velocity, and parameters of diastology were evaluated for H2FPEF, HFA-PEFF score, and American Society of Echocardiography diastolic dysfunction (ASE-DD) grading. Sensitivities were compared among diagnostic criteria. A subgroup analysis was performed for different E/e’ septal velocity cut-offs. Student's T test was used for continuous data and statistical significance was defined as p<0.05. Results We randomly sampled 151 in-patients with a clinical diagnosis of HFpEF. Average patient age was 80.1±10.6 years and of this sample 86 (55.8%) were female. BNP >100 pg/ml alone had the highest sensitivity of 94%. ASE-DD grade 2&3, indicative of elevated filling pressure, had a sensitivity of 65%. HFA-PEFF score ≥5 had sensitivity of 58%. H2FPEF probability of >90%, >85% and >80% yielded sensitivity of 61%, 72% and 81%, respectively. E/e’ septal ratio ≥ 10 had 92% sensitivity versus 61% for higher cut-off of ≥ 15. Subgroup analysis with E/e’ septal ratio ≥ 12 compared to those with <12 was found to have higher H2FPEF probability (84.2 vs 90.1%, p<0.033), HFA-PEFF score (4.97 vs 4.17, p<0.001) and higher length of stay (6.3 vs 4.3 days, p<0.039) Conclusion Our study highlights the shortcomings of current scoring criteria and echocardiographic criteria for patients with HFpEF. A proper E/e’ cutoff may not only improve the diagnostic sensitivity, but may be of predictive value in length of stay. An optimized and well validated HFpEF diagnostic algorithm is desirable.