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Abstract

Background:

The diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) is challenging. Although diagnostic criteria have been proposed, limited information exists concerning its implication on prognosis. We aimed to evaluate the prognostic significance of applying the European Society of Cardiology algorithm for HFpEF diagnosis, namely the tissue Doppler imaging information, in patients with acute heart failure (HF).

Hypothesis:

The application of the European Society of Cardiology algorithm for HFpEF diagnosis, identifies a group of HF patients with high morbidity and mortality.

Methods:

Consecutive patients admitted due to acute HF were recruited. The European Society of Cardiology algorithm was used in the HFpEF diagnosis. Patients were followed for a 6-month period and mortality and rehospitalization due to HF were recorded.

Results:

A total of 491 patients were included in this registry. Mean patient age was 78 years and 63% were women; 177 patients had HFpEF and 314 had HF with reduced ejection fraction (HFrEF). Of the HFpEF patients, 44.8% had an E/E′ ratio >15 and 1.8% had an E/E′ ratio <8. Patients with HFpEF and those with HFrEF had a similarly dismal prognosis when considering all-cause mortality, and morbidity and mortality, but there was a trend for better survival when HF death was the outcome in analysis (hazard ratio 1.63 [95% confidence interval: 0.95–2.80, P = 0.08]).

Conclusions:

The use of objective criteria for diagnosis of HFpEF identifies patients with similar outcomes as patients with HFrEF; this observation increases the robustness of the diagnostic criteria for HFpEF. The use of objective criteria for the diagnosis of HFpEF identifies patients with a similarly ominous prognosis as patients with HFrEF; this observation increases the robustness of the diagnostic criteria for HFpEF. Identifying these patients based on objective criteria, as we did, is an important step for future investigation, namely drugs, warranted to the HFpEF approach.

This work was performed at the departments of internal medicine and cardiology at Centro Hospitalar São João in Porto, Portugal. This work was supported by a grant from Fundação para a Ciência e a Tecnologia (Foundation for Science and Technology), project PIC/IC/82773/2007.

The authors have no other funding, financial relationships, or conflicts of interest to disclose.