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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Alternative Echocardiographic Algorithm for Left Ventricular Filling Pressure in Patients With Heart Failure With
Yutaka Matsuhiro1, Masami Nishino1, Kohei Ukita1
1Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Insights
A new echocardiographic algorithm improves prediction of clinical outcomes for patients with heart failure with preserved ejection fraction (HFpEF) by better assessing left ventricular (LV) filling pressures.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Conventional algorithms for estimating left ventricular (LV) filling pressure in heart failure have limitations.
- A significant number of patients are classified as "indeterminate" using current methods, hindering accurate risk stratification.
- Heart failure with preserved ejection fraction (HFpEF) presents unique diagnostic challenges regarding filling pressures.
Purpose of the Study:
- To evaluate a novel echocardiographic algorithm for assessing LV filling pressure in HFpEF patients.
- To determine if the new algorithm can predict clinical outcomes, including hospital readmissions and cardiovascular death.
- To assess the algorithm's ability to reclassify patients previously categorized as "indeterminate" by conventional methods.
Main Methods:
- Utilized data from 754 consecutive patients in the PURSUIT-HFpEF registry.
- Employed a new echocardiographic algorithm to categorize patients into normal (N group) and high (H group) LV filling pressure groups.
- Conducted a multivariable Cox analysis and Kaplan-Meier survival analysis to assess clinical outcomes over a mean follow-up of 342 days.
Main Results:
- The high LV filling pressure (H) group (342 patients) showed a significantly increased rate of cardiac events compared to the normal group (HR: 1.71; p = 0.006).
- The new algorithm successfully reclassified 56 "indeterminate" patients, with the reclassified high-pressure group demonstrating a significantly higher incidence of cardiac events (p < 0.01).
- The primary composite endpoint occurred in 185 patients, including 157 heart failure readmissions and 43 cardiovascular deaths.
Conclusions:
- The novel echocardiographic algorithm effectively predicts clinical outcomes in patients with HFpEF.
- This algorithm offers improved risk stratification by more accurately assessing LV filling pressures, particularly in previously indeterminate cases.
- The findings support the clinical utility of this new algorithm for managing HFpEF patients.
Abstract:
The American Society of Echocardiography and/or the European Association of Cardiovascular Imaging recommend a conventional algorithm for estimating left ventricular (LV) filling pressure in heart failure. However, several patients are classed as "indeterminate" due to their LV filling pressures being impossible to calculate. We investigated whether our new echocardiographic algorithm can predict clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF). We enrolled 754 consecutive patients from the PURSUIT-HFpEF registry. We used the new algorithm to divide them into 2 groups; a normal LV filling pressure group (N group) and a high LV filling pressure group (H group). The H group consisted of 342 patients. Over a mean follow-up of 342 days, 185 patients reached the primary composite end point (157 readmissions for worsening heart failure and 43 cardiovascular deaths). In a multivariable Cox analysis, being in the H group was significantly associated with an increased rate of cardiac events compared with the N group (hazard ratio: 1.71; 95% confidence interval: 1.17 to 2.50, p = 0.006). There were 56 patients (7%) who were assigned to "indeterminate" with the conventional algorithm. Using the new algorithm, we reclassified 16 patients (29%) into the H group and 40 patients (71%) into the N group. The Kaplan-Meier curves showed the reclassified H group had a significantly higher incidence of cardiac events than those assigned to the N group (p < 0.01). In conclusion, the present study demonstrated LV filling pressure assessed by our algorithm can predict clinical outcomes in patients with HFpEF.
