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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,...
Language English Country Great Britain
Document type Journal Article, Research Support, Non-U.S. Gov't
Grant support
Heart Failure Association - International
NLK
Medline Complete (EBSCOhost)
from 2000-03-01 to 1 year ago
Wiley Free Content
from 1999 to 1 year ago
PubMed
32133741
DOI
10.1002/ejhf.1741
Knihovny.cz E-resources
- MeSH
- Algorithms MeSH
- Cardiology * MeSH
- Consensus MeSH
- Humans MeSH
- Aged MeSH
- Heart Failure * diagnosis MeSH
- Stroke Volume MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't 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 heart failure 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 (LV) 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'), 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.
Berlin Institute of Health Charite Berlin Germany
Berlin Institute of Health Germany
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 Biomedical Sciences for Health University of Milan IRCCS Milan Italy
Department of Cardiology and Pneumology University Medicine Göttingen Germany
Department of Cardiology IRCCS Policlinico San Donato Milanese Milan Italy
Department of Cardiology National and Kapodistrian University of Athens Medical School
Department of Internal Medicine and Cardiology German Heart Institute Berlin Germany
German Center for Cardiovascular Research Berlin Partner Site Germany
German Centre for Cardiovascular Research Partner Site Frankfurt Germany
Institute for Clinical and Experimental Medicine IKEM Prague Czech Republic
Institute for Experimental and Translational Cardiovascular Imaging University Hospital Frankfurt
Medical University Clinical Military Hospital Wroclaw Poland
National Heart Centre Singapore and Duke National University of Singapore
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 Medical Centre Groningen The Netherlands
University of Belgrade School of Medicine Belgrade University Medical Center Serbia
References provided by Crossref.org
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