Use of the HFA-PEFF algorithm for diagnosis of heart failure with preserved left ventricular ejection fraction

Aim

To evaluate a modified algorithm HFA-PEFF with the use of passive leg elevation and non-invasive assessment of pulmonary capillary wedge pressure (PCWP) for diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) in high risk hypertensive patients with symptoms of heart failure (HF).

Material and methods

We enrolled 90 hypertensive patients with at least one symptom or sign of HF, left ventricular ejection fraction (LV EF) ≥50% (70% females, average age 69.3±10.56 years), and risk factors, including obesity (43%), diabetes mellitus (44%), atrial fibrillation (32%), and/or chronic kidney disease (46%). Median estimated glomerular filtration rate (eGFR) was 58,6 (48,6;72,8) ml/min/1.73 m 2 , and median NT-proBNP level was 142 (50;220) pg/ml. We used HFA-PEFF algorithm to diagnose HFpEF. Stress-echo with passive leg elevation was used to detect impaired LV diastolic function reserve and elevated LV filling pressure. PCWP was evaluated by echocardiography using the Nagueh equation (1997) PCWP = 1.91×(1.24+E/e’).

Results

According to HFA-PEFF algorithm, patients were distributed into three groups, that is, with low probability or no HF in 9% of cases (<2 points), confirmed HF in 40% (≥5 points), and with intermediate probaility HF in 51% (2-4 points). Stress echocardiography allowed to detect HFpEF additionally in 19% of 90 patients.

Conclusion

Using a modified HFA-PEFF algorithm, we established HFpEF in 59% of hypertensive patients with at least one symptom or sign of HF and preserved LV EF. Additional studies are needed to validate HFA-PEFF algorithm in clinical practice.

Key words

Arterial hypertension, heart failure with preserved ejection fraction, stress-echocardiography, non-invasive PCWP, HFA-PEFF.