Diagnostic value of different strategies in heart failure with preserved ejection fraction

XIE Chun-lin; CONG Tao; WANG Ke; SUN Ying-hui; SHANG Zhi-juan; SU De-chun

doi:10.19538/j.nk2017070115

Abstract：Objective To explore whether the simplified strategy from the 2010 Chinese consensus statements and other three diagnostic criteria are useful for diagnosing heart failure with preserved ejection fraction in patients admitted for acute dyspnoea.Methods Echocardiographic data and B-type natriuretic peptide levels were assessed in 111 consecutive patients admitted for acute dyspnoea.The patients were divided into the heart failure with preserved ejection fraction group (n=71) and the control group(n=40).Various parameters and the value of four diagnostic criteria,including the 2012 ESC heart failure guideline,the 2009 EAE/ ASE recommendations,simplified and modified diagnostic criteria,were compared.Results The ratio of the early mitral inflow velocity to the tissue Doppler velocity at the lateral mitral annulus (AUC=0.77),B-type natriuretic peptide (AUC=0.78),the left atrial volume index (AUC=0.73),the left ventricular mass index (AUC=0.67),and the difference between duration of reversed pulmonary vein atrial systolic flow and duration of mitral A wave flow (AUC=0.69) had the greatest diagnostic values among all single parameters.The comparison between the four diagnostic criteria and the clinical golden criterion showed that the Chinese simplified criterion was worst in the consistency test (Kappa=0.13,P=0.063),with a low diagonistic accuracy (50.5％).The best diagnostic accuracy (82％) was shownin the 2012 ESC guideline,with a good consistency (Kappa=0.62,P＜0.001).After the introduction of the left atrial volume index and B-type natriuretic peptide into the simplified criterion,an acceptable diagnostic accuracy (73.9％) and consistency (Kappa=0.47,P＜0.001) were achieved.Conclusion The simplified criterion from the 2010 Chinese consensus statements is not applicable to the screening of patients admitted to the basic level hospitals for acute dyspnoea.The modified diagnostic criterion is recommended for promotion in primary care.