Article (Scientific journals)
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)
Pieske, B.; Tschöpe, C.; de Boer, R. A. et al.
2019In European Heart Journal, 40 (40), p. 3297-3317
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Keywords :
Heart failure; HFpEF
Abstract :
[en] 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. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Pieske, B.;  Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, German Center for Cardiovascular Research (DZHK), Partner SiteBerlin, Germany, Department of Internal Medicine and Cardiology, German Heart InstituteBerlin, Germany, Berlin Institute of Health (BIH), Germany
Tschöpe, C.;  Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, German Center for Cardiovascular Research (DZHK), Partner SiteBerlin, Germany, Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), ChariteBerlin, Germany
de Boer, R. A.;  University Medical Centre Groningen, University of Groningen, Department of CardiologyGroningen, Netherlands
Fraser, A. G.;  School of Medicine, Cardiff University, Cardiff, United Kingdom
Anker, S. D.;  Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, German Center for Cardiovascular Research (DZHK), Partner SiteBerlin, Germany, Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), ChariteBerlin, Germany, Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany
Donal, E.;  Cardiology and CIC, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France
Edelmann, F.;  Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, German Center for Cardiovascular Research (DZHK), Partner SiteBerlin, Germany
Fu, M.;  Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden
Guazzi, M.;  Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy, Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy
Lam, C. S. P.;  National Heart Centre, Singapore & Duke-National University of Singapore, University Medical Centre Groningen, Netherlands
Lancellotti, Patrizio  ;  Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Melenovsky, V.;  Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
Morris, D. A.;  Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
Nagel, E.;  Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany
Pieske-Kraigher, E.;  Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
Ponikowski, P.;  Medical University, Clinical Military Hospital, Wroclaw, Poland
Solomon, S. D.;  Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, MA, Boston, United States
Vasan, R. S.;  Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, MA, Boston, United States
Rutten, F. H.;  Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityUtrecht, Netherlands
Voors, A. A.;  University Medical Centre Groningen, University of Groningen, Department of CardiologyGroningen, Netherlands
Ruschitzka, F.;  University Heart Centre, University Hospital Zurich, Switzerland
Paulus, W. J.;  Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Netherlands
Seferovic, P.;  University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
Filippatos, G.;  Department of Cardiology, National and Kapodistrian University of Athens Medical School
University Hospital "Attikon", Athens;  Greece, University of Cyprus, School of MedicineNicosia, Cyprus
More authors (15 more) Less
Language :
English
Title :
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)
Publication date :
2019
Journal title :
European Heart Journal
ISSN :
0195-668X
eISSN :
1522-9645
Publisher :
NLM (Medline)
Volume :
40
Issue :
40
Pages :
3297-3317
Peer reviewed :
Peer Reviewed verified by ORBi
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