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- Box 1. Recommended echocardiographic indices for diagnosing HFpEF and diastolic dysfunction
European Society of Cardiology clinical practice guidelines on acute and chronic heart failure 20163 Relevant structural heart disease
Left ventricular hypertrophy (left ventricular mass index >115 g/m2 for males and >95 g/m2 for females)
Left atrial enlargement (left atrial volume index >34 mL/m2)
Early diastolic tissue velocity (e’ mean septal-lateral <9 cm/sec)
Ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’>13)
Deceleration time (DecT) of mitral valve early diastolic inflow (MV-E) m/sec
E/A ratio <1 or >2
Isovolumetric relaxation time (IVRT)
American Society of Echocardiography and the European Association of Cardiovascular Imaging 2016 9 Annular e’ velocity
Septal e’ <7 cm/sec
Lateral e’ <10 cm/sec
Left atrium maximum volume index (>34 mL/m2)
Peak tricuspid regurgitation velocity >2.8 m/sec
Note: LV diastolic function is normal if more than half of the variables do not meet the cut-off for identifying abnormal function.cm/sec = centimetres per second. E = early mitral diastolic inflow. e’ = early diastolic tissue velocity. E/A = ratio between peak early (E) and late (A) diastolic filling velocities. E/e’ = ratio between early mitral inflow velocity and mitral annular early diastolic velocity. g/m2 = grams per metre squared. LV = left ventricle. m/sec = metres per second. mL/m2 = millilitres per metre squared. MV = mitral valve.
Patients on heart failure registers (n = 148) Age, years 76.9 + 12 Duration of heart failure diagnosis, years 5.3 + 4 Female sex, % 39 Hypertension, % 84 Chronic kidney disease, % 44 Atrial fibrillation, % 41 BMI 25–29.9 kg/m2,% 31 BMI >30 kg/m2, % 39 Ischaemic heart disease, % 32 Diabetes, % 25 Valvular heart disease, % 22 COPD, % 16 Stroke, % 15 Asthma, % 10 Current smoker, % 10 Ex-smoker, % 30 Echocardiogram information available, % 79 COPD = chronic obstructive pulmonary disease, HF = heart failure; kg/m2 = kilograms per metre squared
Characteristics EF <40%
(n = 43)EF 40–49%
(n = 21)EF >50%
(n = 53)Unclear or missing
(n = 31)P value Mean age (SD) 76 (13) 76 (13) 79.8 (11) 74.2 (11) 0.161 Female sex, % 30 29 45 46 0.293 Hypertension, % 80 81 83 93 0.442 IHD, % 39 29 30 29 0.743 CKD, % 39 38 51 42 0.615 Diabetes, % 24 10 32 26 0.254 AF, % 49 43 47 19 0.048 COPD, % 12 10 19 19 0.638 Stroke, % 15 14 17 13 0.964 Valvular heart disease, % 24 24 28 7 0.123 BMI 25–29.9 kg/m2, % 33 18 34 30 0.630 BMI >30 kg/m2, % 33 29 47 40 0.503 >3 comorbidities, % 51 41 65 63 0.270 Mean duration of HF, years (SD) 4.3 (4.5) 5.9 (4.4) 5.0 (4.0) 6.9 (5.0) 0.08 AF = atrial fibrillation. BMI = body mass index. CKD = chronic kidney disease. COPD = chronic obstructive pulmonary disease. EF = ejection fraction. HF = heart failure. IHD = ischaemic heart disease. Kg/m2 = kilograms per metre squared. SD = standard deviation.
EF >50%a Mean EF (SD) 57 +5% At least one recommended measure of structural heart disease documented, n/N (%) 35/39 (90) LVH present, n/N (%) 16/35 (46) Concentric LVH, n/N (%) 6/16 (38) LA dilated, n/N (%) 28/33 (85) Both LV and LA normal n/N (%) 7/39 (18) At least one recommended index of diastolic function measured, n/N (%) 24/39 (62) E/A ratio, n/N (%) 13/24 (54) e' lateral, n/N (%) 5/24 (21) e' septal, n/N (%) 5/24 (21) E/e' mean, n/N (%) 19/24 (79) TRV, n/N (%) 14/24 (58) At least one recommended index of diastolic function is abnormal, N/n (%) 17/24 (71) Number of diastolic function indices that are abnormal One 8 Two 5 Three 3 Four 1 Diastolic dysfunction labelled on report or in letter where diastolic function mentioned, n/N (%) 11/20 (55) RV dysfunction present, n/N (%) 7/31 (23) RV dilation, n/N (%) 9/27 (33) PH documented, n/N (%) 7/26 (27) aincludes patients labelled as having a ‘normal’, ‘near-normal’ or ‘preserved’ EF
E/A = ratio between peak early (E) and late (A) diastolic filling velocities. EF = ejection fraction. e’ = early diastolic tissue velocity. E/e’ = ratio between early mitral inflow velocity and mitral annular early diastolic velocity. LA = left atrium. LV = left ventricle. LVH = left ventricular hypertrophy. PH = pulmonary hypertension. RV = right ventricle. TRV = peak tricuspid regurgitation velocity.