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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)
B. Pieske, C. Tschöpe, RA. de Boer, AG. Fraser, SD. Anker, E. Donal, F. Edelmann, M. Fu, M. Guazzi, CSP. Lam, P. Lancellotti, V. Melenovsky, DA. Morris, E. Nagel, E. Pieske-Kraigher, P. Ponikowski, SD. Solomon, RS. Vasan, FH. Rutten, AA. Voors,...
Jazyk angličtina Země Velká Británie
Typ dokumentu časopisecké články
NLK
Free Medical Journals
od 1996 do Před 1 rokem
Open Access Digital Library
od 1996-01-01
PubMed
31504452
DOI
10.1093/eurheartj/ehz641
Knihovny.cz E-zdroje
- MeSH
- algoritmy * MeSH
- diastolické srdeční selhání diagnóza etiologie patofyziologie MeSH
- echokardiografie MeSH
- kardiologie organizace a řízení MeSH
- klinické rozhodování * MeSH
- konsensus MeSH
- lidé středního věku MeSH
- lidé MeSH
- natriuretické peptidy krev MeSH
- senioři MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- srdeční komory diagnostické zobrazování patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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.
Cardiology and CIC IT1414 CHU de Rennes LTSI Université Rennes 1 INSERM 1099 Rennes France
Cardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MA USA
Department of Cardiology National and Kapodistrian University of Athens Medical School
Institute for Clinical and Experimental Medicine IKEM Prague Czech Republic
Medical University Clinical Military Hospital Wroclaw Poland
School of Medicine Cardiff University Cardiff UK
Section of Cardiology Department of Medicine Sahlgrenska University Hosptal Ostra Göteborg Sweden
University Heart Centre University Hospital Zurich Switzerland
University Hospital Attikon Athens Greece University of Cyprus School of Medicine Nicosia Cyprus
University of Belgrade School of Medicine Belgrade University Medical Center Serbia
Citace poskytuje Crossref.org
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- $a Pieske, Burkert $u Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum. German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany. Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany. Berlin Institute of Health (BIH), Germany.
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- $a 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.
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