Pieske et al reported a diagnostic algorithm for heart failure with preserved ejection fraction (HFpEF). The authors are from multiple institutions in Europe, the United States, and Singapore.
Parameters:
(1) functional features based on echocardiography
(2) morphological features based on echocardiography
(3) serum biomarkers (serum BNP or NT-proBNP) in sinus rhythm or atrial fibrillation
Functional feature - major criteria - one or more of the following:
(1) age < 75 years AND septal e' < 7 cm/s
(2) age < 75 years or lateral e' < 10 cm/s
(3) age >= 75 years AND septal e' < 5 cm/s
(4) age >= 75 years or lateral e' < 3 cm/s
(5) average E/e' >= 15
(6) TR peak velocity > 2.8 m/s
(7) pulmonary arterial systolic pressure (PASP) > 35 mm Hg
Functional feature - minor criteria - one or both of the following:
(1) average E/e' 9-14
(2) global longitudinal systolic strain (GLS) <16%
Morphological feature - major criteria - one of the following:
(1) sinus rhythm AND left atrial volume index (LAVI) > 34 mL per square meter
(2) atrial fibrillation AND left atrial volume index (LAVI) > 40 mL per square meter
(3) male AND left ventricular mass index (LVMI) >= 149 g per sq m AND relative wall thickness (RWT) > 0.42
(4) female AND left ventricular mass index (LVMI) >= 122 g per sq ml AND RWT > 0.42
Morphological feature - minor criteria - one of the following:
(1) sinus rhythm AND LAVI 29-34 mL per square meter
(2) atrial fibrillation AND LAVI 34-40 mL per sq m
(3) male AND LVMI >= 115 g per sq m
(4) female AND LVMI >= 95 g per sq m
(5) RWT > 0.42
(6) LV wall thickness >= 12 mm
Serum biomarkers - major criteria - one of the following:
(1) sinus rhythm AND NT-proBNP > 220 pg/mL
(2) sinus rhythm AND BNP > 80 pg/mL
(3) atrial fibrillation AND NT-proBNP > 660 pg/mL
(4) atrial fibrillation AND BNP > 240 pg/mL
Serum biomarkers - minor criteria - one of the following:
(1) sinus rhythm AND NT-proBNP 125-220 pg/mL
(2) sinus rhythm AND BNP 35-80 pg/mL
(3) atrial fibrillation AND NT-proBNP 365-660 pg/mL
(4) atrial fibrillation AND BNP 105-240 pg/mL
If a parameter has a major criteria then it is assigned 2 points, else if a minor criteria is present then it is assigned 1 point, else 0.
total score =
= SUM(points for the 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
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Total Score
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Significance
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5 or 6
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HFpEF present
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2 to 4
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perform diastolic stress test or invasive hemodynamic measurements
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0 or 1
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HFpEF unlikely
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