Evaluation of early diagnosis and progression to heart failure with preserved ejection fraction: A retrospective study in patients with arterial hypertension and left ventricular hypertrophy.

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) accounts for 50 % of all heart failure cases. The H₂FPEF score, used to estimate HFpEF probability, incorporates factors such as Heavy, Hypertensive, Atrial Fibrillation, Elder, and Filling Pressure. Left ventricle hypertrophy (LVH) and left atrial (LA) enlargement has been associated to HFpEF, though the role of myocardial thickening and LAE on progression of this condition is not fully understood.

Objectives: To evaluate correlation of cardiac function and structure obtained by echocardiogram, presence of comorbidities, b-type natriuretic peptide and the probability of HFpEF evaluated by H₂FPEF score in patients with arterial hypertension (AH) and LVH without diagnosis of HFpEF.

Methods: Retrospective data obtained from medical records of 118 hypertensive patients with LV ejection fraction ≥55 %, septum wall thickness (SWT) and LV posterior wall >9 mm were evaluated. The patients were divided into 2 groups: SWT ≥ 13 mm (moderate/severe hypertrophy) and SWT <13 mm (mildly abnormal hypertrophy). H₂FPEF score was used to classify the patients: score < 6 (low probability of HFpEF) and score ≥ 6 (high probability of HFpEF). Comorbidities, such as obesity and diabetes were also evaluated.

Results: LA (AUC 0.657; 95 %CI, 0.551-0.763; p = 0.010; cutoff value 37.50), sensitivity 96.7 % and specificity 84.8 % was the best independent predictor of HFpEF. BMI (AUC 0.766; 95 %CI, 0.664-0.868; p = 0.001), cutoff value of 21.655, sensitivity of 96,7 % and specificity of 81,8 % also showed a significant association.

Conclusion: Patients with AH and LVH, LA enlargement was associated with higher probability of HFpEF by H₂FPEF score, which could improve early diagnosis and risk stratification.