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Pulsatile hemodynamics in patients with exertional dyspnea - potentially of value in the diagnostic evaluation of suspected heart failure with preserved ejection fraction.
MedLine Citation:
PMID:  23500307     Owner:  NLM     Status:  Publisher    
OBJECTIVES: To test whether measures of pulsatile arterial function are useful for diagnosing heart failure with preserved ejection fraction (HFPEF), in comparison with and in addition to Tissue Doppler Echocardiography (TDE). BACKGROUND: Increased arterial stiffness and wave reflections are present in most patients with HFPEF. METHODS: Patients with dyspnea as major symptom were categorized as having HFPEF or no HFPEF, based on invasively derived filling pressures and natriuretic peptide levels. Pulse wave velocity was measured invasively (aoPWV). Aortic pulse pressure (aoPP) and its components (incident pressure wave height - P1, forward wave amplitude - Pf; augmented pressure - AP; backward wave amplitude - Pb) were quantified non-invasively. RESULTS: 71 patients were classified as HFPEF, and 65 as no HFPEF (223 patients had intermediate results). Patients with HFPEF were older, more often had hypertension and diabetes, had larger left atria and higher left ventricular mass. Brachial (bPP) and aortic pulse pressures and all measures of arterial stiffness and wave reflections were higher in HFPEF patients. Receiver operating curve analysis derived area under the curve (AUC) values for separating HFPEF from no HFPEF were 0.823 for E/E'med, the best TDE parameter, 0.816 for bPP, and 0.867, 0.851, and 0.825 for aoPWV, aoPP, and Pb, respectively. Adding measures of pulsatile function to TDE resulted in an increase in AUC to 0.875 (bPP; p=0.03) and 0.901 (aoPP; p=0.005). In comparison with a TDE-based algorithm, net reclassification improvement was 32.9 % (p<0.0001). CONCLUSION: Measures of pulsatile arterial hemodynamics may complement TDE for the diagnosis of HFPEF.
Thomas Weber; Siegfried Wassertheurer; Michael F O'Rourke; Anton Haiden; Robert Zweiker; Martin Rammer; Bernhard Hametner; Bernd Eber
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-3-6
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  -     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-3-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Cardiology Department, Klinikum Wels-Grieskirchen, Austria; Paracelsus Medical University, Salzburg, Austria. Electronic address:
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