Pulse waveform characteristics for diagnosis and longitudinal monitoring in heart failure with reduced ejection...

Arterial waveforms are altered in left ventricular systolic dysfunction. We aimed to investigate the diagnostic implications of automatically analyzed pressure waveforms and their changes over time in patients with reduced ejection fraction (EF). Arterial waveforms were recorded noninvasively using applanation tonometry in patients with heart failure with reduced ejection fraction (HFrEF) and in matched controls. Waveform parameters were analyzed with respect to the left ventricular ejection time index (LVETI), the characteristics of antegrade and reflected waves, their interaction as quantified by the augmentation index, and wave intensity, expressed as the ratio of the S and D peak intensities (SDR). Overall, 78 HFrEF patients [ejection fraction (EF) 28 ± 9%] and 78 controls (EF 66 ± 8%), matched for sex, age, presence of hypertension and diabetes, systolic and diastolic blood pressure, and heart rate, were included. All waveform parameters were statistically different between patients and controls. In receiver-operator characteristic (ROC) analysis, HFrEF patients and controls could be separated best using LVETI [area under the ROC curve (AUC) 0.897; P < 0.0001] and SDR (AUC 0.911; P < 0.0001). In newly diagnosed and treated HFrEF patients, the AUC for discrimination between HFrEF patients and controls was almost ideal (0.978; P < 0.0001), when a combination of LVETI and SDR was used. Finally, in 46 HFrEF patients with available follow-up (FU) data, concordance analysis showed a high agreement of up to 0.8 between changes in the cardiac function (e.g., using EF) and changes in several waveform parameters. Pulse waveform parameters may be useful for screening and follow-up of patients with HFrEF.NEW & NOTEWORTHY Arterial pulse waveforms carry distinct signatures of heart failure with reduced ejection fraction (HFrEF). In this study, tonometry revealed differences in waveform timing, wave reflection, and wave intensity between HFrEF patients and matched controls. Combining left ventricular ejection time index and wave intensity ratios enabled near-perfect discrimination in newly diagnosed patients and closely tracked longitudinal changes in cardiac function. These findings highlight pulse waveform analysis as a promising tool for HFrEF screening and follow-up.