Early Identification of Patients at Risk for Incident Heart Failure With Preserved Ejection Fraction: Novel Approach to Echocardiographic Trends |
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| Institution: | 1. Division of Cardiology, Duke University School of Medicine, Durham, North Carolina;2. Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina;3. Division of Biostatistics, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina;4. Division of Cardiology, Duke University Medical Center, Durham, North Carolina;5. Division of Cardiology, Duke University School of Nursing, Durham, North Carolina;6. Division of Nursing, Virginia Commonwealth University, Richmond, Virginia;7. Division of Cardiology, Duke Molecular Physiology Institute, Durham, North Carolina;1. Division of Cardiology, Columbia University Medical Center–New York Presbyterian Hospital in New York, New York, New York;2. Cardiovascular Institute at Alleghany Health Network in Pittsburgh, Pennsylvania;3. Division of Cardiology, MedStar Georgetown University/Washington Hospital Center in Washington, DC;4. Division of Cardiology, Weill Cornell University-New York Presbyterian Hospital in New York, New York;5. Cardiovascular Research Foundation in New York, New York;1. Department of Pediatric Cardiology, Cleveland Clinic Children''s Hospital, Cleveland, Ohio;2. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio;3. Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio and St. Luke''s Health System, Boise, Idaho;4. Kaufman Center for Heart Failure, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio;1. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, New York, New York;2. The Mindich Child Health and Development Institute, Icahn School of Medicine, New York, New York;3. Division of Genomic Medicine, Department of Medicine, Icahn School of Medicine, New York, New York;4. The Institute for Genomic Health, Icahn School of Medicine, New York, New York;1. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;2. Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;3. Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA;4. Department of Biostatistics, Epidemiology, & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;5. Penn Center for Community Health Workers, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA |
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| Abstract: | BackgroundHeart failure with preserved ejection fraction (HFpEF) continues to increase in prevalence with a 50% mortality rate within 3 years of diagnosis, but lacking effective evidence-based therapies. Specific echocardiographic markers are not typically used to trigger alarm before acute HFpEF decompensation. The goal of this study was to retrospectively track changes in echocardiographic markers leading to the time of incident HFpEF hospitalization.Methods and ResultsIn a single-center, retrospective analysis, patients with HFpEF admitted between 2007 and 2014 were identified using the International Classification of Diseases, 9th Revision with search refined using the European Society of Cardiology HFpEF guidelines. Using linear mixed effects models, changes in echocardiographic markers preceding acute HF decompensation owing to incident HFpEF were analyzed. We report on an incident HFpEF cohort of 242 patients, extending 18 years retrospectively, and including 675 echocardiograms analyzed from the overall sample at 14 distinct time intervals before acute decompensation. The regression models demonstrated 3 echocardiographic markers with statistically significant increases across multiple time intervals including, arterial elastance (P = .006), right atrial pressure estimate (P < .001), and right ventricular systolic pressure (P = .006). Other echocardiographic markers had individual time intervals with significant increases before acute decompensation, including (a) left atrial diameter, 8 to 10 years before HFpEF diagnosis, (b) left ventricular filling pressure 2 to 6 years before HFpEF diagnosis, (c) ventricular elastance 3 to 6 months before HFpEF diagnosis, and (d) ventricular elastance/arterial elastance as early as 10 to 20 years and as late as 3 to 6 months before HFpEF diagnosis. Furthermore, African Americans presented with incident HFpEF at an average younger age than White patients (65.6 ± 15.2 years vs. 76.7 years ± 11.7, P < .001).ConclusionsNoninvasive echocardiographic markers associated with incident HFpEF diagnosis showed long, mid, and acute range, significant changes as far back as 10 to 20 years and as close as 3 to 6 months before acute HFpEF decompensation. Including a diverse study cohort is critical to understanding the phenotypic differences of HFpEF. This hypothesis-generating study identified a novel approach to identifying trends in echocardiographic markers that may be used as a signal of impending incident HFpEF. |
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