How to diagnose heart failure with preserved ejection fraction the HFA-PEFF diagnostic algorithm a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) - Université de Rennes Accéder directement au contenu
Article Dans Une Revue European Heart Journal Année : 2019

How to diagnose heart failure with preserved ejection fraction the HFA-PEFF diagnostic algorithm a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Alan G Fraser
  • Fonction : Auteur
Michael Fu
  • Fonction : Auteur
Patrizio Lancellotti
Piotr Ponikowski
Gerasimos Filippatos

Résumé

Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for HF symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), left ventricular (LV) filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1 Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2 Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.

Dates et versions

hal-02304376 , version 1 (03-10-2019)

Identifiants

Citer

Burkert Pieske, Carsten Tschöpe, Rudolf A de Boer, Alan G Fraser, Stefan D Anker, et al.. How to diagnose heart failure with preserved ejection fraction the HFA-PEFF diagnostic algorithm a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European Heart Journal, 2019, 40 (40), pp.3297-3317. ⟨10.1093/eurheartj/ehz641⟩. ⟨hal-02304376⟩
195 Consultations
0 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More