Prevalence of heart failure with preserved ejection fraction in type 2 diabetes: assessment with the HFA-PEFF and H2FPEF algorithms
N Khutsishvili, I S Nazarov, A F Safarova, V V Tolkacheva, T M Timofeeva, S A Galochkin, Z H D KobalavaAbstract
Background
The prevalence of heart failure with preserved ejection fraction (HFpEF) shows an increasing trend. The diagnostic gold standard remains invasive hemodynamic assessment at rest and during stress via right heart catheterization. However, due to its complexity and invasive nature, this method is rarely applicable in routine clinical practice. To reduce the need for invasive testing, non-invasive diagnostic algorithms such as H2FPEF and HFA-PEFF have been developed.
Objective
To assess the prevalence of HFpEF in patients with type 2 diabetes mellitus (T2DM) using the HFA-PEFF and H2FPEF algorithms.
Materials and Methods
A prospective single-center observational study included 164 patients with T2DM (mean age 61 ± 8 years) presenting with dyspnea and a left ventricular ejection fraction ≥50%. The most common comorbidity was arterial hypertension, present in 99% of patients, while the prevalence of coronary artery disease and atrial fibrillation was 22% and 7%, respectively. At the first stage, all participants underwent comprehensive screening, including echocardiography with detailed assessment of cardiac structural and functional parameters and measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. At the second stage, HFpEF probability was stratified using the HFA-PEFF and H2FPEF scores. Low or high scores on either scale, respectively, ruled out or confirmed the diagnosis. Patients with intermediate scores underwent a diastolic stress test (DST) using supine bicycle ergometry. A positive DST was defined as an increase in the E/e′ ratio to ≥15 during exercise, or an increase in E/e′ to ≥15 accompanied by a rise in tricuspid regurgitation velocity >3.4 m/s.
Results
The mean score for both the HFA-PEFF and H2FPEF scales was 4. The distribution of HFpEF probability differed: high probability according to the HFA-PEFF and H2FPEF scales was identified in 36% (n=59) and 30% (n=48) of patients, respectively, while HFpEF was considered unlikely in 19% (n=31; HFA-PEFF) and 16% (n=27; H2FPEF). Intermediate probability was noted in 45% (n=74; HFA-PEFF) and 54% (n=89; H2FPEF). DST was performed in 58 patients with intermediate HFpEF probability and confirmed the diagnosis in 29.3% (n=17) of cases.
Conclusions
Among patients with T2DM and dyspnea, the prevalence of HFpEF varied according to the diagnostic algorithm, amounting to 30% by the H2FPEF score and 36% by the HFA-PEFF score. In patients with intermediate probability, the diagnosis was confirmed by DST in approximately one-third of cases.Reclassification HFA-PEFF-->H2FPEFFor image description, please refer to the figure legend and surrounding text.Reclassification H2FPEF-->HFA-PEFFFor image description, please refer to the figure legend and surrounding text.