Author + information
- C. Hage,
- U. Löfström,
- E. Donal,
- E. Oger,
- J.C. Daubert,
- C. Linde and
- L.H. Lund
In the multi-center Karolinska-Rennes HFpEF study, patients with acute HF according to Framingham criteria, EF ≥45% and elevated brain natriuretic peptides (NPs; NT-proBNP >300 ng/L; BNP >100 ng/L) were assessed again in stable condition 4-8 weeks after hospitalization. Logistic regression was used to assess association between baseline characteristics and types and number of Framingham criteria in acute HFpEF, and the presence of HF at follow-up defined according to four models based on Framingham, the ESC and the PARAGON trial echo criteria (TABLE).
In 398 patients, all met Framingham criteria for HF in acute HFpEF and the number of Framingham “points” (2 for major criterion; 1 for minor) were in median 8 (Interquartile range 6-10) in acute HFpEF and 2 (1-4) at stable follow-up (p<0.01). The most common criteria in acute HFpEF were dyspnoea at exertion (90%) and pulmonary rales (71%), which were present in 70% and 13% respectively at follow-up. At follow-up HF was present according to the four models in 27%, 22%, 22% and 22% respectively. Associations between acute characteristics and presence of HF at follow-up are shown in TABLE.
|Variable at baseline||Framingham criteria only||Framingham criteria + NP criteria||Framingham criteria + NP criteria + ESC ECHO HFpEF criteria||Framingham criteria + NP + Paragon ECHO structural heart disease criteria|
|n=107 (27%)||n=82 (22%)||n=61(22%)||n=69 (22%)|
|Age per year||1.02||1.04*||1.05*||1.04*|
|NYHA I+II vs. III+IV||0.76||0.80||1.10||1.03|
|NT-proBNP per log||1.30||1.23||1.29||1.29|
|BNP per log||1.09||1.40||1.34||1.37|
|Framingham per point||1.06||1.09||1.09||1.10*|
|Jugular venous distension||1.80*||2.56||2.89*||2.58*|
|Tachycardia (>100 bpm)||0.87||0.61||0.51||0.52*|
Among patients with acute HFpEF, only a quarter meet the HF definition at stable follow-up according to different contemporary criteria. Characteristics of acute HFpEF that predict persistent HF at stable follow-up were higher age and JVD but not severity of HF. Pleural effusion and tachycardia may yield “false positive” HFpEF diagnoses. This has implications for HFpEF trial design and patient screening.