Diagnosis of heart failure with preserved ejection fraction: which parameters and diagnostic strategies are more valuable?

Aims There are no unified criteria for diagnosing heart failure with preserved ejection fraction (HFpEF). The aim of this study was to evaluate the present main diagnostic criteria and to discover which parameters and strategies are more valuable. Methods and results Echocardiographic data and plasma N-terminal pro-brain natriuretic peptide levels were assessed in a derivation cohort (n = 236) and a validation cohort (n = 98). Both cohorts included normal controls, patients with hypertensive heart disease without heart failure and patients with HFpEF. In the derivation cohort, the ratio of early mitral inflow velocity to tissue Doppler velocity at lateral mitral annulus (lateral E/e' >= 12), left atrial volume index (LAVI >= 34 mL/m(2)), and the difference between duration of reversed pulmonary vein atrial systole flow and duration of mitral A wave flow (Ard-Ad > 30 ms) had the greatest diagnostic value among all the single parameters. A brief strategy that consisted of either: (i) lateral E/e' >= 12; or (ii) 12 > lateral E/e' >= 8, with either LAVI >= 34 mL/m(2) or Ard-Ad > 30 ms, provided good diagnostic accuracy for identifying diastolic dysfunction in HFpEF, with a sensitivity of 77% and specificity of 81%. These observations were confirmed in the validation cohort. Conclusion Echocardiographic parameters including lateral E/e', LAVI, and Ard-Ad have the greatest value in diagnosing HFpEF. A brief strategy that included these three parameters had great diagnostic value and would be simple to use in clinic practice.