Current diagnostic algorithms for chronic heart failure with preserved left ventricular ejection fraction

Authors

DOI:

https://doi.org/10.14739/2310-1210.2023.1.270044

Keywords:

chronic heart failure, preserved left ventricular ejection fraction, diagnostics

Abstract

Chronic heart failure remains one of the main causes of mortality and reduced life quality both in Ukraine and around the world. More than 50 % of all patients with chronic heart failure are those with preserved left ventricular ejection fraction.

In current guidelines, the criteria for evaluating heart failure with reduced left ventricular ejection fraction are described properly, but the issue of timely diagnosing chronic heart failure with preserved ejection fraction still remains unsolved.

This review presents four diagnostic algorithms for this condition, which were presented by international scientific societies in recent years: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure; H2FPEF Score for Heart Failure with Preserved Ejection Fraction (Mayo, 2018); HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) (2019); Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging (2021). The main advantages, limitations and disadvantages of each one are analyzed. All steps of diagnostic evaluation are described in detail.

The review is illustrated with patterns of the latest diagnostic approaches.

Author Biographies

M. Yu. Kolesnyk, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor of the Department of Family Medicine, Therapy, Cardiology and Neurology, Faculty of Postgraduate Education

Ya. Yu. Maistrovych, Zaporizhzhia State Medical University, MESC “University Clinic” of Zaporizhzhia State Medical University, Ukraine

MD, PhD student, Department of Family Medicine, Therapy, Cardiology and Neurology, Faculty of Postgraduate Education

References

  1. Serhiyenko, V. A., & Serhiyenko, A. A. (2022). Tsukrovyi diabet i khronichna sertseva nedostatnist [Diabetes mellitus and congestive heart failure]. Mizhnarodnyi endokrynolohichnyi zhurnal, 18(1), 57-69. [in Ukrainian]. https://doi.org/10.22141/2224-0721.18.1.2022.1146
  2. Voronkov, L. H., Amosova, K. M., Dziak, H. V., Zharinov, O. I., Kovalenko, V. M., Korkushko, O. V., Nesukai, O. H., Parkhomenko, O. M., Rudyk, Yu. S., & Sychov, O. S. (2017). Rekomendatsii Asotsiatsii kardiolohiv Ukrainy z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti (2017) [Guidelines of Ukrainian Association of Cardiology on Diagnosis and Treatment of Chronic Heart failure (2017)] Sertseva nedostatnist i komorbidni stany, (1, Suppl 1), 1-66. [in Ukrainian].
  3. Kolesnyk, М. О. (2019). Porivnialna kharakterystyka funktsionalnykh parametriv u patsiientiv z khronichnoiu sertsevoiu nedostatnistiu zi znyzhenoiu fraktsiieiu vykydu livoho shlunochka zalezhno vid variantu zalizodefitsytu [Comparative Characteristics of the Functional Parameters in Patients with Chronic Heart Failure with Reduced Left Ventricular Ejection Fraction Depending on Iron Deficiency Type]. Art of Medicine, (3), 39-46. [in Ukrainian]. https://doi.org/10.21802/artm.2019.3.11.39
  4. Agarwal, M. A., Fonarow, G. C., & Ziaeian, B. (2021). National Trends in Heart Failure Hospitalizations and Readmissions From 2010 to 2017. JAMA cardiology, 6(8), 952-956. https://doi.org/10.1001/jamacardio.2020.7472
  5. Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., Lancellotti, P., Muraru, D., Picard, M. H., Rietzschel, E. R., Rudski, L., Spencer, K. T., Tsang, W., & Voigt, J. U. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), 1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003
  6. McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., Cleland, J. G. F., Coats, A. J. S., Crespo-Leiro, M. G., Farmakis, D., Gilard, M., Heymans, S., Hoes, A. W., Jaarsma, T., Jankowska, E. A., Lainscak, M., … ESC Scientific Document Group (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European heart journal, 42(36), 3599-3726. https://doi.org/10.1093/eurheartj/ehab368
  7. Dunlay, S. M., Roger, V. L., & Redfield, M. M. (2017). Epidemiology of heart failure with preserved ejection fraction. Nature reviews. Cardiology, 14(10), 591-602. https://doi.org/10.1038/nrcardio.2017.65
  8. Pfeffer, M. A., Shah, A. M., & Borlaug, B. A. (2019). Heart Failure With Preserved Ejection Fraction In Perspective. Circulation research, 124(11), 1598-1617. https://doi.org/10.1161/CIRCRESAHA.119.313572
  9. Borlaug, B. A. (2020). Evaluation and management of heart failure with preserved ejection fraction. Nature reviews. Cardiology, 17(9), 559-573. https://doi.org/10.1038/s41569-020-0363-2
  10. Sun, Y., Wang, N., Li, X., Zhang, Y., Yang, J., Tse, G., & Liu, Y. (2021). Predictive value of H2 FPEF score in patients with heart failure with preserved ejection fraction. ESC heart failure, 8(2), 1244-1252. https://doi.org/10.1002/ehf2.13187
  11. Nair, N. (2020). Epidemiology and pathogenesis of heart failure with preserved ejection fraction. Reviews in cardiovascular medicine, 21(4), 531-540. https://doi.org/10.31083/j.rcm.2020.04.154
  12. Kapłon-Cieślicka, A., Kupczyńska, K., Dobrowolski, P., Michalski, B., Jaguszewski, M. J., Banasiak, W., Burchardt, P., Chrzanowski, Ł., Darocha, S., Domienik-Karłowicz, J., Drożdż, J., Fijałkowski, M., Filipiak, K. J., Gruchała, M., Jankowska, E. A., Jankowski, P., Kasprzak, J. D., Kosmala, W., Lipiec, P., Mitkowski, P., … "Club 30" Of The Polish Cardiac Society, O. B. O. (2020). On the search for the right definition of heart failure with preserved ejection fraction. Cardiology journal, 27(5), 449-468. https://doi.org/10.5603/CJ.a2020.0124
  13. Pieske, B., Tschöpe, C., de Boer, R. A., Fraser, A. G., Anker, S. D., Donal, E., Edelmann, F., Fu, M., Guazzi, M., Lam, C. S. P., Lancellotti, P., Melenovsky, V., Morris, D. A., Nagel, E., Pieske-Kraigher, E., Ponikowski, P., Solomon, S. D., Vasan, R. S., Rutten, F. H., Voors, A. A., … Filippatos, G. (2019). How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European heart journal, 40(40), 3297-3317. https://doi.org/10.1093/eurheartj/ehz641
  14. Kolesnyk, M. Yu. (2021). Vyznachennia miokardialnoi roboty – nova kontseptsiia neinvazyvnoi otsinky systolichnoi funktsii livoho shlunochka [Estimation of myocardial work – a new concept of non-invasive left ventricular systolic function assessment]. Ukrainskyi kardiolohichnyi zhurnal, 28(1), 56-65. [in Ukrainian]. https://doi.org/10.31928/1608-635X-2021.1.5665
  15. Nakagawa, Y., Nishikimi, T., & Kuwahara, K. (2019). Atrial and brain natriuretic peptides: Hormones secreted from the heart. Peptides, 111, 18-25. https://doi.org/10.1016/j.peptides.2018.05.012
  16. Goetze, J. P., Bruneau, B. G., Ramos, H. R., Ogawa, T., de Bold, M. K., & de Bold, A. J. (2020). Cardiac natriuretic peptides. Nature reviews. Cardiology, 17(11), 698-717. https://doi.org/10.1038/s41569-020-0381-0
  17. Mueller, C., McDonald, K., de Boer, R. A., Maisel, A., Cleland, J. G. F., Kozhuharov, N., Coats, A. J. S., Metra, M., Mebazaa, A., Ruschitzka, F., Lainscak, M., Filippatos, G., Seferovic, P. M., Meijers, W. C., Bayes-Genis, A., Mueller, T., Richards, M., Januzzi, J. L., Jr, & Heart Failure Association of the European Society of Cardiology (2019). Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. European journal of heart failure, 21(6), 715-731. https://doi.org/10.1002/ejhf.1494
  18. Çavuşoğlu, Y., Alper, A. T., Altay, H., Çelik, A., Demirkan, B., Güvenç, T. S., Küçükoğlu, M. S., Nalbantgil, S., Özdemir, M., Özin, B., Sayın, T., Yıldırımtürk, Ö., Yılmaz, M. B., & Zorkun, C. (2019). Natriuretic Peptides in Clinical Practice. Anatolian journal of cardiology, 21(Suppl 1), 1-40. https://doi.org/10.14744/AnatolJCardiol.2019.55623
  19. Harada, E., Mizuno, Y., Kugimiya, F., Shono, M., Maeda, H., Yano, N., & Yasue, H. (2018). Sex Differences in Heart Failure With Preserved Ejection Fraction Reflected by B-type Natriuretic Peptide Level. The American journal of the medical sciences, 356(4), 335-343. https://doi.org/10.1016/j.amjms.2018.06.009
  20. Nishikimi, T., & Nakagawa, Y. (2021). Potential pitfalls when interpreting plasma BNP levels in heart failure practice. Journal of cardiology, 78(4), 269-274. https://doi.org/10.1016/j.jjcc.2021.05.003
  21. Reddy, Y. N. V., Carter, R. E., Obokata, M., Redfield, M. M., & Borlaug, B. A. (2018). A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction. Circulation, 138(9), 861-870. https://doi.org/10.1161/CIRCULATIONAHA.118.034646
  22. Suzuki, S., Kaikita, K., Yamamoto, E., Sueta, D., Yamamoto, M., Ishii, M., Ito, M., Fujisue, K., Kanazawa, H., Araki, S., Arima, Y., Takashio, S., Usuku, H., Nakamura, T., Sakamoto, K., Izumiya, Y., Soejima, H., Kawano, H., Jinnouchi, H., Matsui, K., … Tsujita, K. (2020). H2 FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors. ESC heart failure, 7(1), 65-74. https://doi.org/10.1002/ehf2.12570
  23. Sueta, D., Yamamoto, E., Nishihara, T., Tokitsu, T., Fujisue, K., Oike, F., Takae, M., Usuku, H., Takashio, S., Arima, Y., Suzuki, S., Nakamura, T., Ito, M., Kanazawa, H., Sakamoto, K., Kaikita, K., & Tsujita, K. (2019). H2FPEF Score as a Prognostic Value in HFpEF Patients. American journal of hypertension, 32(11), 1082-1090. https://doi.org/10.1093/ajh/hpz108
  24. Tao, Y., Wang, W., Zhu, J., You, T., Li, Y., & Zhou, X. (2021). H2FPEF score predicts 1-year rehospitalisation of patients with heart failure with preserved ejection fraction. Postgraduate medical journal, 97(1145), 164-167. https://doi.org/10.1136/postgradmedj-2019-137434
  25. Melillo, E., Masarone, D., Oh, J. K., Verrengia, M., Valente, F., Vastarella, R., Ammendola, E., Pacileo, R., & Pacileo, G. (2021). Echocardiography in Advanced Heart Failure for Diagnosis, Management, and Prognosis. Heart failure clinics, 17(4), 547-560. https://doi.org/10.1016/j.hfc.2021.05.001
  26. Lüscher T. F. (2021). Classification of heart failure: A farewell to ejection fraction?. Anatolian journal of cardiology, 25(1), 2-6. https://doi.org/10.14744/AnatolJCardiol.2020.70138
  27. Fonarow, G. C. (2017). Refining Classification of Heart Failure Based on Ejection Fraction. JACC. Heart failure, 5(11), 808-809. https://doi.org/10.1016/j.jchf.2017.08.011
  28. Yap, J., Lim, F. Y., Gao, F., Teo, L. L., Lam, C. S., & Yeo, K. K. (2015). Correlation of the New York Heart Association Classification and the 6-Minute Walk Distance: A Systematic Review. Clinical cardiology, 38(10), 621-628. https://doi.org/10.1002/clc.22468
  29. Ganga, H. V., & Jantz, J. (2016). The Limitations of the 6-Minute Walk Test as a Measurement Tool in Chronic Heart Failure Patients. Revista espanola de cardiologia (English ed.), 69(6), 629. https://doi.org/10.1016/j.rec.2016.01.024
  30. Nishi, T., Kobayashi, Y., Christle, J. W., Cauwenberghs, N., Boralkar, K., Moneghetti, K., Amsallem, M., Hedman, K., Contrepois, K., Myers, J., Mahaffey, K. W., Schnittger, I., Kuznetsova, T., Palaniappan, L., & Haddad, F. (2020). Incremental value of diastolic stress test in identifying subclinical heart failure in patients with diabetes mellitus. European heart journal. Cardiovascular Imaging, 21(8), 876-884. https://doi.org/10.1093/ehjci/jeaa070
  31. Obokata, M., Reddy, Y. N. V., & Borlaug, B. A. (2020). Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: Understanding Mechanisms by Using Noninvasive Methods. JACC. Cardiovascular imaging, 13(1 Pt 2), 245-257. https://doi.org/10.1016/j.jcmg.2018.12.034
  32. Smiseth, O. A., Morris, D. A., Cardim, N., Cikes, M., Delgado, V., Donal, E., Flachskampf, F. A., Galderisi, M., Gerber, B. L., Gimelli, A., Klein, A. L., Knuuti, J., Lancellotti, P., Mascherbauer, J., Milicic, D., Seferovic, P., Solomon, S., Edvardsen, T., Popescu, B. A., & Reviewers: This document was reviewed by members of the 2018-2020 EACVI Scientific Documents Committee (2022). Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging. European heart journal. Cardiovascular Imaging, 23(2), e34-e61. https://doi.org/10.1093/ehjci/jeab154
  33. Inoue, K., Khan, F. H., Remme, E. W., Ohte, N., García-Izquierdo, E., Chetrit, M., Moñivas-Palomero, V., Mingo-Santos, S., Andersen, Ø. S., Gude, E., Andreassen, A. K., Wang, T. K. M., Kikuchi, S., Stugaard, M., Ha, J. W., Klein, A. L., Nagueh, S. F., & Smiseth, O. A. (2021). Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. European heart journal. Cardiovascular Imaging, 23(1), 61-70. https://doi.org/10.1093/ehjci/jeaa415
  34. Morris, D. A., Belyavskiy, E., Aravind-Kumar, R., Kropf, M., Frydas, A., Braunauer, K., Marquez, E., Krisper, M., Lindhorst, R., Osmanoglou, E., Boldt, L. H., Blaschke, F., Haverkamp, W., Tschöpe, C., Edelmann, F., Pieske, B., & Pieske-Kraigher, E. (2018). Potential Usefulness and Clinical Relevance of Adding Left Atrial Strain to Left Atrial Volume Index in the Detection of Left Ventricular Diastolic Dysfunction. JACC. Cardiovascular imaging, 11(10), 1405-1415. https://doi.org/10.1016/j.jcmg.2017.07.029
  35. Andersen, O. S., Smiseth, O. A., Dokainish, H., Abudiab, M. M., Schutt, R. C., Kumar, A., Sato, K., Harb, S., Gude, E., Remme, E. W., Andreassen, A. K., Ha, J. W., Xu, J., Klein, A. L., & Nagueh, S. F. (2017). Estimating Left Ventricular Filling Pressure by Echocardiography. Journal of the American College of Cardiology, 69(15), 1937-1948. https://doi.org/10.1016/j.jacc.2017.01.058
  36. Lancellotti, P., Galderisi, M., Edvardsen, T., Donal, E., Goliasch, G., Cardim, N., Magne, J., Laginha, S., Hagendorff, A., Haland, T. F., Aaberge, L., Martinez, C., Rapacciuolo, A., Santoro, C., Ilardi, F., Postolache, A., Dulgheru, R., Mateescu, A. D., Beladan, C. C., Deleanu, D., … Popescu, B. A. (2017). Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. European heart journal. Cardiovascular Imaging, 18(9), 961-968. https://doi.org/10.1093/ehjci/jex067

Downloads

Published

2023-03-06

How to Cite

1.
Kolesnyk MY, Maistrovych YY. Current diagnostic algorithms for chronic heart failure with preserved left ventricular ejection fraction. Zaporozhye Medical Journal [Internet]. 2023Mar.6 [cited 2026May17];25(1):72-80. Available from: https://zmj.zsmu.edu.ua/article/view/270044

Issue

Vol. 25 No. 1 (2023)

Section

Review

License

Authors who publish with this journal agree to the following terms:

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons