The Analysis And Comparison Of Different Diagnosis Standards Of The Heart Failure Patients With Preserved Left Ventricular Ejection Fraction

Objective: The heart failure with preserved left ventricular ejectionfraction(HFpEF) constitutes nearly50%of all the patients with heart failure,and it hassimilar one-year and five-year-survival rate to the heart failure with reduced leftventricular ejection fraction(HFrEF). It is more difficult to diagnosis HFpEF thanHFrEF because of the lack of clear and unified diagnostic standard.,especially in theprimary hospitals.The cost and technical requirement for evaluating left ventriculardiastolic function is higher,therefore it becomes more difficult to get access to rapid andaccurate diagnosis of HFpEF and to optimize the therapeutic management.we supposeda brief strategy in2010that was used for diagnosing HFpEF,which is considered simpleand practical,and suited for primary hospitals to take as a preliminary judgment.According to this strategy,HFpEF can be diagnosed on these basic conditions:typicalheart failure symptoms;LVEF≥50%and LVd∕S＜3.7cm∕m2substituted forLVEDVI≤97ml∕m2,then to fulfill any one of these five factors:E∕A＜0.5and EDT＞280ms；Ard－Ad＞30ms；LAd＞4.7cm；LVMI≥149g∕m2,（male）or≥122g∕m2（female）；atrial fibrillation. This article is to evaluate its diagnostic accuracy refer tothe consistent statement on how to diagnose HFpEF from2007European Society ofCardiology(ESC) and the recommendation for the evaluation of left ventricular diastolicfunction from2009the American Society of Echocardiography(ASE) and the EuropeanAssociation of Echocardiography(EAE).Methods All patients were selected due to dyspnoea on exertion or any kinds ofdyspnoea hospitalized from June2012to December2012.Echocardiograph was finishedon all patients and all patients showed LVEF≥50%within24h in hospital and NYHAII-IV. Some cardiovascular disease were excluded from this study such as confirmedcoronary diseases according coronary artery CTA;moderate to severe valvular heart disease;congenital heart disease;primary or secondary cardiac myopathy;constrictivepericarditis;high output heart disease cardiopathy.Patients failed to get echocardiographicparameters due to poor imagine were also excluded.61patients (37women,24man,44-90years, mean age68±11years) were in validation for analysis.Echocardiographic dateand BNP levels were assessed in all these patients,together with history(hypertension)and signs,patients can be diagnosed HFpEF or non-HFpEF,then leftventricular diastolic function is to evaluated by2007ESC consensus statement,or byrecommendation from2009ASE/ESE or the brief strategy on each person.Patients whocan reach the standards of diastolic dysfunction were diagnosed HFpEF correspondingto each HFpEF diagnostic standards.Finally each diagnostic standard’ssensitivity,specificity,positive predictive value and negative predictive value can becalculated refer to the clinical confirmed HFpEF,and receiver operatingcharacteristic(ROC) curves were plotted to assess the clinical value in each diagnosticstandard.Results1.There is statistical difference in the age,sex,body mass index and hypertensionproportion between patients with HFpEF and patients with non-HFpEF, and nodifference in the proportion of type2diabetes mellitus and atrial fibrillation.2.Compared with patients with non-HFpEF, LAd、LAMI、LVMI and PWST increasein patients with HFpEF(P＜0.05),and no statistical difference exists in A、E、E/Abetween the two groups,LnNT-proBNP and LnE/E’(septal,lateral,average) increase inpatients with HFpEF(P＜0.05).3.The most valuable single diagnostic parameters is NT-proBNP,which has thelargest area under ROC curve,and NT-proBNP≥220pg∕ml to diagnose HFpEF has asensitivity of56%and specificity of98%.Another diagnostic parameter which hashigher value is E/E’,and E/E’(septal)≥12has a sensitivity of72%and specificity of65%.4.22patients are clinical diagnosed HFpEF.2007ESC consensus statement candiagnosed30patients HFpEF,and its sensitivity,specificity,positive predictive value andnegative predictive value are72%,64%,53%,and80%correspondingly,the area underROC curve(AUC) is0.68,P＜0.05;2009ASE guideline can diagnose24patientsHFpEF,its diagnostic parameters are63%,74%,58%,78%correspondingly,and its AUC is0.71,P＜0.05;the brief strategies can diagnose32patients,its diagnostic parametersare68%,56%,46%,75%correspondingly,and AUC is0.61,P=0.15.Conclusion1.The most valuable single diagnostic parameters is NT-proBNP which has thelargest area under ROC curve,and NT-proBNP≥220pg∕ml has low sensitivity andhigh specificity.Another diagnostic parameter which has higher value is E/E’,andE/E’(septal)≥12has a desired clinical valuable.2.The most valuable diagnostic standards of the three strategies to diagnose HFpEFis2009ASE guideline, the lest is the brief standard.3.The domestic brief diagnostic standard does not reach the statistical meaning,andcan’t to be used as the definite diagnosis standard. With its high negative predictivevalue it only suits for primary hospitals to exclude HFpEF.4.According to analysis and comparison of these three diagnostic standards,we findthat NT-proBNP and E/E’ can improve the clinical diagnosis value,and should put theminto practice as possible.