Risk stratification with echocardiographic biomarkers in heart failure with preserved ejection fraction: the media
Olivier Huttin1,2, Alan G Fraser3, Lars H Lund4,5
1Inserm, Centre d'Investigations Cliniques-Plurithématique 1433, Inserm U1116, CHRU Nancy, Université de Lorraine, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
Insights
Four echocardiographic measures predict cardiovascular events in heart failure with preserved ejection fraction (HFpEF). These findings improve risk stratification beyond clinical factors and NT-proBNP, validated in an independent cohort.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Predicting outcomes in heart failure with preserved ejection fraction (HFpEF) remains challenging.
- Echocardiographic predictors require systematic validation in large, independent cohorts.
Purpose of the Study:
- To identify and validate echocardiographic predictors of cardiovascular events in HFpEF patients.
- To assess the added value of these predictors for risk stratification.
Main Methods:
- A multicentre study (MEDIA) of 515 HFpEF patients.
- Validation in an independent cohort (KaRen) of 286 HFpEF patients.
- Analysis of echocardiographic parameters, clinical variables, and NT-proBNP for prediction of death or hospitalization.
Main Results:
- Pulmonary arterial systolic pressure > 40 mmHg, respiratory variation in inferior vena cava diameter > 0.5, E/e' > 9, and lateral mitral annular s' < 7 cm/s were significant predictors.
- The combination of these four parameters significantly improved 1-year risk prediction.
- These echocardiographic variables enhanced risk stratification beyond clinical factors and NT-proBNP in both cohorts.
Conclusions:
- Four echocardiographic parameters (pulmonary hypertension, elevated central venous pressure, diastolic dysfunction, long-axis systolic dysfunction) independently predict prognosis in HFpEF.
- The MEDIA echo score improves risk stratification in HFpEF.
- Findings were validated in an independent cohort, confirming their clinical utility.
Aims:
Echocardiographic predictors of outcomes in heart failure with preserved ejection fraction (HFpEF) have not been systematically or independently validated. We aimed at identifying echocardiographic predictors of cardiovascular events in a large cohort of patients with HFpEF and to validate these in an independent large cohort.
Methods And Results:
We assessed the association between echocardiographic parameters and cardiovascular outcomes in 515 patients with heart failure with preserved left ventricular (LV) ejection fraction (>50%) in the MEtabolic Road to DIAstolic Heart Failure (MEDIA) multicentre study. We validated out findings in 286 patients from the Karolinska-Rennes Prospective Study of HFpEF (KaRen). After multiple adjustments including N-terminal pro-brain natriuretic peptide (NT-proBNP), the significant predictors of death or cardiovascular hospitalization were pulmonary arterial systolic pressure > 40 mmHg, respiratory variation in inferior vena cava diameter > 0.5, E/e' > 9, and lateral mitral annular s' < 7 cm/s. The combination of these four variables differentiated patients with <10% vs. >35% 1 year risk. Adding these four echocardiographic variables on top of clinical variables and NT-proBNP yielded significant net reclassification improvement (33.8%, P < 0.0001) and increase in C-index (5.3%, a change from 72.2% to 77.5%, P = 0.015) of similar magnitude as the addition of NT-proBNP on top of clinical variables alone. In the KaRen cohort, these four variables yielded a similar improvement in net reclassification improvement (22.3%, P = 0.014) and C-index (4.0%, P = 0.029).
Conclusions:
Use of four simple echocardiographic parameters (within the MEDIA echo score), indicative of pulmonary hypertension, elevated central venous pressure, LV diastolic dysfunction, and LV long-axis systolic dysfunction, independently predicted prognosis and improved risk stratification additionally to clinical variables and NT-proBNP in HFpEF. This finding was validated in an independent cohort.
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