Diagnosis of Heart Failure With Preserved Ejection Fraction Among Patients With Unexplained Dyspnea

医学 内科学 心脏病学 射血分数 射血分数保留的心力衰竭 心力衰竭 肺楔压 回顾性队列研究
作者
Yogesh N.V. Reddy,David M. Kaye,M. Louis Handoko,Arno A. van de Bovenkamp,Ryan J. Tedford,Carson Keck,Mads J. Andersen,Kavita Sharma,Rishi Trivedi,Rickey E. Carter,Masaru Obokata,Frederik H. Verbrugge,Margaret M. Redfield,Barry A. Borlaug
出处
期刊:JAMA Cardiology [American Medical Association]
卷期号:7 (9): 891-891 被引量:84
标识
DOI:10.1001/jamacardio.2022.1916
摘要

Diagnosis of heart failure with preserved ejection fraction (HFpEF) among dyspneic patients without overt congestion is challenging. Multiple diagnostic approaches have been proposed but are not well validated against the independent gold standard for HFpEF diagnosis of an elevated pulmonary capillary wedge pressure (PCWP) during exercise.To evaluate H2FPEF and HFA-PEFF scores and a PCWP/cardiac output (CO) slope of more than 2 mm Hg/L/min to diagnose HFpEF.This retrospective case-control study included patients with unexplained dyspnea from 6 centers in the US, the Netherlands, Denmark, and Australia from March 2016 to October 2020. Diagnosis of HFpEF (cases) was definitively ascertained by the presence of elevated PCWP during exertion; control individuals were those with normal rest and exercise hemodynamics.Logistic regression was used to evaluate the accuracy of HFA-PEFF and H2FPEF scores to discriminate patients with HFpEF from controls.Among 736 patients, 563 (76%) were diagnosed with HFpEF (mean [SD] age, 69 [11] years; 334 [59%] female) and 173 (24%) represented controls (mean [SD] age, 60 [15] years; 109 [63%] female). H2FPEF and HFA-PEFF scores discriminated patients with HFpEF from controls, but the H2FPEF score had greater area under the curve (0.845; 95% CI, 0.810-0.875) compared with the HFA-PEFF score (0.710; 95% CI, 0.659-0.756) (difference, -0.134; 95% CI, -0.177 to -0.094; P < .001). Specificity was robust for both scores, but sensitivity was poorer for HFA-PEFF, with a false-negative rate of 55% for low-probability scores compared with 25% using the H2FPEF score. Use of the PCWP/CO slope to redefine HFpEF rather than exercise PCWP reclassified 20% (117 of 583) of patients, but patients reclassified from HFpEF to control by this metric had clinical, echocardiographic, and hemodynamic features typical of HFpEF, including elevated resting PCWP in 66% (46 of 70) of reclassified patients.In this case-control study, despite requiring fewer data, the H2FPEF score had superior diagnostic performance compared with the HFA-PEFF score and PCWP/CO slope in the evaluation of unexplained dyspnea and HFpEF in the outpatient setting.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
好运来应助科研通管家采纳,获得10
刚刚
CC2026应助科研通管家采纳,获得10
刚刚
852应助科研通管家采纳,获得10
刚刚
在水一方应助gao采纳,获得10
刚刚
机灵秋柳发布了新的文献求助30
刚刚
Owen应助科研通管家采纳,获得10
刚刚
iNk应助科研通管家采纳,获得10
刚刚
怎么说应助科研通管家采纳,获得10
刚刚
SciGPT应助科研通管家采纳,获得10
刚刚
iNk应助科研通管家采纳,获得10
刚刚
1秒前
1sunpf完成签到,获得积分10
1秒前
斯文败类应助科研通管家采纳,获得10
1秒前
1秒前
1秒前
共享精神应助科研通管家采纳,获得10
1秒前
1秒前
1秒前
1秒前
怎么说应助科研通管家采纳,获得10
1秒前
spf完成签到,获得积分10
1秒前
酷姣完成签到,获得积分20
1秒前
1秒前
别摆烂了完成签到,获得积分10
1秒前
1秒前
1秒前
1秒前
1秒前
游大侠完成签到,获得积分10
1秒前
1秒前
luxkex完成签到,获得积分10
1秒前
fengpu完成签到,获得积分10
1秒前
2718725836发布了新的文献求助10
2秒前
eul完成签到,获得积分10
2秒前
QWJ完成签到,获得积分10
3秒前
陈若凡发布了新的文献求助10
3秒前
3秒前
度容完成签到,获得积分10
3秒前
我是老大应助ws采纳,获得10
3秒前
震动的晓凡完成签到,获得积分20
4秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
Cognitive Neuroscience: The Biology of the Mind 1000
Technical Brochure TB 814: LPIT applications in HV gas insulated switchgear 1000
Immigrant Incorporation in East Asian Democracies 600
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
A Preliminary Study on Correlation Between Independent Components of Facial Thermal Images and Subjective Assessment of Chronic Stress 500
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3968771
求助须知:如何正确求助?哪些是违规求助? 3513729
关于积分的说明 11169450
捐赠科研通 3249084
什么是DOI,文献DOI怎么找? 1794592
邀请新用户注册赠送积分活动 875258
科研通“疑难数据库(出版商)”最低求助积分说明 804740