Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Netherlands Heart Journal
Published in: Netherlands Heart Journal 4/2016

Open Access 01-04-2016 | Review Article

How to diagnose heart failure with preserved ejection fraction: the value of invasive stress testing

Authors: A. E. Huis in ’t Veld, F. S. de Man, A. C. van Rossum, M. L. Handoko

Published in: Netherlands Heart Journal | Issue 4/2016

Login to get access

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden worldwide and its prevalence is increasing. Diagnosing HFpEF is challenging and relies upon the presence of symptoms and/or signs of heart failure, preserved left ventricular systolic function, and evidence of diastolic dysfunction. Current diagnostic algorithms mainly rely on echocardiography (E/e’) and biomarkers (NT-proBNP). However, only a minority of patients with HFpEF are identified, and especially HFpEF patients at an early stage of the disease are easily missed. We propose to incorporate invasive stress testing, by means of right heart catheterisation at rest and during exercise, and accurate assessment of right ventricular function, by means of cardiac magnetic resonance imaging. These additions to the current diagnostic work-up will improve diagnostic sensitivity and accurate staging of HFpEF patients.
Literature
1.
Paulus WJ, Tschöpe C, Sanderson JE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28:2539–50.CrossRefPubMed
2.
McMurray JJV, Carson PE, Komajda M, et al. Heart failure with preserved ejection fraction: clinical characteristics of 4133 patients enrolled in the I-PRESERVE trial. Eur J Heart Fail. 2008;10:149–56.CrossRefPubMed
3.
Steinberg BA, Zhao X, Heidenreich PA, et al. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation. 2012;126:65–75.CrossRefPubMed
4.
Mohammed SF, Hussain S, Mirzoyev SA, Edwards WD, Maleszewski JJ, Redfield MM. Coronary microvascular rarefaction and myocardial fibrosis in heart failure with preserved ejection fraction. Circulation. 2015;131:550–9.CrossRefPubMedPubMedCentral
5.
Wang J, Khoury DS, Yue Y, Torre-Amione G, Nagueh SF. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Eur Heart J. 2008;29:1283–9.CrossRefPubMed
6.
Phan TT, Shivu GN, Abozguia K, et al. Impaired heart rate recovery and chronotropic incompetence in patients with heart failure with preserved ejection fraction. Circ Heart Fail. 2010;3:29–34.CrossRefPubMed
7.
Borlaug BA, Kass DA. Ventricular-vascular interaction in heart failure. Cardiol Clin. 2011;29:447–59.CrossRefPubMed
8.
Lam CSP, Donal E, Kraigher-Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011;13:18–28.CrossRefPubMedPubMedCentral
9.
Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. New Engl. J Med. 2006;355:251–9.
10.
Hancock HC, Close H, Mason JM, et al. High prevalence of undetected heart failure in long-term care residents: findings from the Heart Failure in Care Homes (HFinCH) study. Eur J Heart Fail. 2013;15:158–65.CrossRefPubMedPubMedCentral
11.
Penicka M, Bartunek J, Trakalova H, et al. Heart failure with preserved ejection fraction in outpatients with unexplained dyspnea: a pressure-volume loop analysis. J Am Coll Cardiol. 2010;55:1701–10.CrossRefPubMed
12.
Maeder MT, Thompson BR, Brunner-La Rocca H-P, Kaye DM. Hemodynamic Basis of Exercise Limitation in Patients With Heart Failure and Normal Ejection Fraction. J Am Coll Cardiol. 2010;56:855–63.CrossRefPubMed
13.
Yturralde RF, Gaasch WH. Diagnostic criteria for diastolic heart failure. Prog Cardiovasc Dis. 2005;47:314–9.CrossRefPubMed
14.
Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation. 2000;101:2118–21.CrossRefPubMed
15.
How to diagnose diastolic heart failure. European Study Group on Diastolic Heart Failure. Eur Heart J. 1998;19:990–1003. [See PubMed, PMID: 9717033].
16.
Cahill JM, Horan M, Quigley P, Maurer B, McDonald K. Doppler-echocardiographic indices of diastolic function in heart failure admissions with preserved left ventricular systolic function. Eur J Heart Fail. 2002;4:473–8.CrossRefPubMed
17.
Petrie MC, Hogg K, Caruana L, McMurray JJV. Poor concordance of commonly used echocardiographic measures of left ventricular diastolic function in patients with suspected heart failure but preserved systolic function: is there a reliable echocardiographic measure of diastolic dysfunction? Heart Br Card Soc. 2004;90:511–7.CrossRef
18.
Bhella PS, Pacini EL, Prasad A, et al. Echocardiographic indices do not reliably track changes in left-sided filling pressure in healthy subjects or patients with heart failure with preserved ejection fraction. Circ Cardiovasc Imaging. 2011;4:482–9.CrossRefPubMedPubMedCentral
19.
Lim TK, Ashrafian H, Dwivedi G, Collinson PO, Senior R. Increased left atrial volume index is an independent predictor of raised serum natriuretic peptide in patients with suspected heart failure but normal left ventricular ejection fraction: implication for diagnosis of diastolic heart failure. Eur J Heart Fail. 2006;8:38–45.CrossRefPubMed
20.
Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000;102:1788–94.CrossRefPubMed
21.
Dokainish H, Zoghbi WA, Lakkis NM, et al. Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. Circulation. 2004;109:2432–9.CrossRefPubMed
22.
Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527–33.CrossRefPubMed
23.
Kasner M, Westermann D, Steendijk P, et al. Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation. 2007;116:637–47.CrossRefPubMed
24.
Mullens W, Borowski AG, Curtin RJ, Thomas JD, Tang WH. Tissue Doppler imaging in the estimation of intracardiac filling pressure in decompensated patients with advanced systolic heart failure. Circulation. 2009;119:62–70.CrossRefPubMedPubMedCentral
25.
Geske JB, Sorajja P, Nishimura RA, Ommen SR. Evaluation of left ventricular filling pressures by Doppler echocardiography in patients with hypertrophic cardiomyopathy: correlation with direct left atrial pressure measurement at cardiac catheterization. Circulation. 2007;116:2702–8.CrossRefPubMed
26.
Santos M, Rivero J, McCullough SD, et al. E/e’ ratio in patients with unexplained dyspnea: lack of accuracy in estimating left ventricular filling pressure. Circ Heart Fail. 2015;8(4):749–56CrossRefPubMed
27.
Tschöpe C, Kasner M, Westermann D, Gaub R, Poller WC, Schultheiss H-P. The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements. Eur Heart J. 2005;26:2277–84.CrossRefPubMed
28.
Veldhuisen DJ van, Linssen GCM, Jaarsma T, et al. B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol. 2013;61:1498–506.CrossRefPubMed
29.
Rogers RK, Stoddard GJ, Greene T, et al. Usefulness of Adjusting for Clinical Covariates to Improve the Ability of B-Type Natriuretic Peptide to Distinguish Cardiac from Noncardiac Dyspnea. Am J Cardiol. 2009;104:689–94.CrossRefPubMed
30.
Mottram PM, Leano R, Marwick TH. Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function. Am J Cardiol. 2003;92:1434–8.CrossRefPubMed
31.
Borlaug BA, Nishimura RA, Sorajja P, Lam CSP, Redfield MM. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail. 2010;3:588–95.CrossRefPubMedPubMedCentral
32.
Westermann D, Kasner M, Steendijk P, et al. Role of left ventricular stiffness in heart failure with normal ejection fraction. Circulation. 2008;117:2051–60.CrossRefPubMed
33.
Borlaug BA, Olson TP, Lam CSP, et al. Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2010;56:845–54.CrossRefPubMedPubMedCentral
34.
Donal E, Lund LH, Oger E, et al. Value of exercise echocardiography in heart failure with preserved ejection fraction: a substudy from the KaRen study. Eur Heart J Cardiovasc Imaging. 2016;17:106–13.CrossRefPubMed
35.
Burgess MI, Jenkins C, Sharman JE, Marwick TH. Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise. J Am Coll Cardiol. 2006;47:1891–900.CrossRefPubMed
36.
Meluzín J, Sitar J, Krístek J, et al. The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction. Eur J Echocardiogr. 2011;12:591–602.CrossRefPubMed
37.
Holland DJ, Prasad SB, Marwick TH. Contribution of exercise echocardiography to the diagnosis of heart failure with preserved ejection fraction (HFpEF). Heart. 2010;96:1024–8.CrossRefPubMed
38.
Andersen MJ, Olson TP, Melenovsky V, Kane GC, Borlaug BA. Differential hemodynamic effects of exercise and volume expansion in people with and without heart failure. Circ Heart Fail. 2015;8:41–8.CrossRefPubMed
39.
Dorfs S, Zeh W, Hochholzer W, et al. Pulmonary capillary wedge pressure during exercise and long-term mortality in patients with suspected heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3103–12.CrossRefPubMed
40.
Hoeper MM, Lee SH, Voswinckel R, et al. Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol. 2006;48:2546–52.CrossRefPubMed
41.
Su M-YM, Lin L-Y, Tseng Y-HE, et al. CMR-verified diffuse myocardial fibrosis is associated with diastolic dysfunction in HFpEF. JACC Cardiovasc Imaging. 2014;7:991–7.CrossRefPubMed
42.
Germans T, Götte MJW, Nijveldt R, et al. Effects of aging on left atrioventricular coupling and left ventricular filling assessed using cardiac magnetic resonance imaging in healthy subjects. Am J Cardiol. 2007;100:122–7.CrossRefPubMed
43.
Leong DP, De Pasquale CG, Selvanayagam JB. Heart failure with normal ejection fraction: the complementary roles of echocardiography and CMR imaging. JACC Cardiovasc Imaging. 2010;3:409–20.CrossRefPubMed
44.
Rathi VK, Doyle M, Yamrozik J, et al. Routine evaluation of left ventricular diastolic function by cardiovascular magnetic resonance: a practical approach. J Cardiovasc Magn Reson. 2008;10:36.CrossRefPubMedPubMedCentral
45.
Champion HC, Michelakis ED, Hassoun PM. Comprehensive Invasive and Noninvasive Approach to the Right Ventricle–Pulmonary Circulation Unit State of the Art and Clinical and Research Implications. Circulation. 2009;120:992–1007.CrossRefPubMed
46.
Melenovsky V, Hwang S-J, Lin G, Redfield MM, Borlaug BA. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3452–62.CrossRefPubMedPubMedCentral
47.
Shah SJ, Katz DH, Selvaraj S, et al. Phenomapping for novel classification of heart failure with preserved ejection fraction. Circulation. 2015;131:269–79.CrossRefPubMedPubMedCentral
48.
Redfield MM, Chen HH, Borlaug BA, et al. Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2013;309:1268–77.CrossRefPubMed
49.
Guazzi M, Vicenzi M, Arena R, Guazzi MD. Pulmonary hypertension in heart failure with preserved ejection fraction: a target of phosphodiesterase-5 inhibition in a 1-year study. Circulation. 2011;124:164–74.CrossRefPubMed
Metadata
Title
How to diagnose heart failure with preserved ejection fraction: the value of invasive stress testing
Authors
A. E. Huis in ’t Veld
F. S. de Man
A. C. van Rossum
M. L. Handoko
Publication date
01-04-2016
Publisher
Bohn Stafleu van Loghum
Published in
Netherlands Heart Journal / Issue 4/2016
Print ISSN: 1568-5888
Electronic ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-016-0811-0

Other articles of this Issue 4/2016

Netherlands Heart Journal 4/2016 Go to the issue

Review Article

Is enhancing cGMP-PKG signalling a promising therapeutic target for heart failure with preserved ejection fraction?

Review Article

The role of titin and extracellular matrix remodelling in heart failure with preserved ejection fraction

Rhythm Puzzle Answer

A stumbling block or a stepping stone?

Rhythm Puzzle Question

A stumbling block or a stepping stone?

Review Article

Understanding heart failure with preserved ejection fraction: where are we today?

Review Article

Uncovering heart failure with preserved ejection fraction in patients with type 2 diabetes in primary care: time for a change

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits