Diagnosis of heart failure with preserved ejection fraction: a systematic narrative review of the evidence.

Heart failure (HF) with preserved ejection fraction (HFpEF) is a common condition in clinical practice, affecting more than half of patients with HF. HFpEF is associated with morbidity and mortality and with considerable healthcare resource utilization and costs. Therefore, early diagnosis is crucial to facilitate prompt management, particularly initiation of sodium-glucose co-transporter 2 inhibitors. Although European guidelines define HFpEF as the presence of symptoms with or without signs of HF, left ventricular EF ≥ 50%, and objective evidence of cardiac structural and/or functional abnormalities, together with elevated natriuretic peptide levels, the diagnosis of HFpEF remains challenging. First, there is no clear consensus on how HFpEF should be defined. Furthermore, diagnostic tools, such as natriuretic peptide levels and resting echocardiogram findings, are significantly limited in the diagnosis of HFpEF. As a result, some patients are overdiagnosed (i.e., elderly people with comorbidities that mimic HF), although in other cases, HFpEF is overlooked. In this manuscript, we perform a systematic narrative review of the diagnostic approach to patients with HFpEF. We also propose a comprehensible algorithm that can be easily applied in daily clinical practice and could prove useful for confirming or ruling out a diagnosis of HFpEF.

[Erectile dysfunction as a marker of silent cardiovascular disease in type-2 diabetic patients in Spain. The DIVA (DIabetes and VAscular disease) study]. / Disfunción eréctil como marcador de vasculopatía en la diabetes mellitus tipo 2 en España. Estudio DIVA.

BACKGROUND AND OBJECTIVES: Erectile dysfunction (ED) is a sign of vascular disease in type 2 diabetic patients. The present subanalysis of the DIVA Registry, whose main objective was to estimate the prevalence of clinical vascular disorder and silent vascular disorder, as well as risk factors in type 2 diabetic patients treated in Spain, aims to analyze the relationship between those data and the prevalence of ED in these patients. PATIENTS AND METHODS: A total of 2444 type 2 diabetic patients (56% male; mean age 65.2 years) attended by 387 cardiologists and endocrinologists at ambulatory care were included. RESULTS: Coronary heart disease was present in 37% of the patients, cerebrovascular disease in 12%, and peripheral arterial disease in 13%. Forty percent of male patients had ED (according to the IIEF criteria), although in this group, as compared to those patients without ED, the prevalence of cardiovascular disease and signs of subclinical vascular disorder (microalbuminuria and abnormal ankle/brachial index (ABI)) was higher. The only independent predictor of ED was left ventricular hypertrophy (OR 5.2; 95% CI: 1.1-24.1; P=.03), with the ABI <0,9 being of borderline significance (OR 5.9; 95% CI: 0.9-39.9; P=.06). Poor glycemic and lipemic control (P<.05 in both cases) as well as cerebrovascular and peripheral arterial disease (P<.01 in both cases) and renal dysfunction (P<.001) were all more frequent among patients with severe ED. CONCLUSIONS: Forty percent of diabetic patients suffer from ED. The results of this study suggest that ED may be considered as an atherosclerosis marker and could be included in algorithms for risk stratification and subclinical vascular disorder detection.

[Prevalence of undetected chronic kidney disease in dyslipidemic population treated in primary care. LIPICAP study]. / Prevalencia de la enfermedad renal crónica oculta en la población dislipémica asistida en atención primaria. Estudio LIPICAP.

BACKGROUND AND OBJECTIVE: Information about the prevalence of chronic kidney disease (CKD) in population treated in primary care (PC) is scarce. The aim of this study was to determine undetected CKD prevalence in dyslipidemic population measuring creatinine clearance according to the Cockcroft-Gault equation corrected for surface area. PATIENTS AND METHOD: Cross-sectional study including patients with diagnosis of dyslipidemia selected by consecutive sampling in PC. CKD was diagnosed when the glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2. We assessed sociodemographic and clinical data, cardiovascular risk factors, coronary disease risk categories, dyslipidemia characteristics, functional CKD stage, and pharmacological treatments. RESULTS: The sample included 5,990 patients (50.2% women). The mean (standard deviation) age was 60.9 (11.1) years. The main reason for iclusion was hypercholesterolemia (65%), followed by mixed hyperlipidemia (26.4%), low high density lipoproteins (HDL)-cholesterol (4.9%) and hypertrigliceridemia (3.7%). According to the Cockcroft-Gault equation, CKD prevalence was 16.2% (95% confidence interval, 15.3-17.1) and it was significantly higher in women (22.7%) than in men (9.8%) (p < 0.0001). Patients with CKD were older compared with patients with normal GFR, and had higher systolic blood pressure, glucose and HDL-cholesterol (p < 0.001), as well as lower levels of total cholesterol, low density lipoproteins-cholesterol, and triglycerides (p < 0.01). The probability of presenting CKD was related to female gender, age, and lower body mass index. CONCLUSIONS: The LIPICAP study results indicate that almost 20% of PC dyslipidemic patients in Spain present undetected CKD when the GFR is measured according to the Cockcroft-Gault equation corrected for surface area.

Prevalence of chronic kidney disease in patients with or at a high risk of cardiovascular disease.

This secondary analysis of data from the MULTIRISC study investigated the prevalence of chronic kidney disease (CKD) in patients who either had or were at a high risk of cardiovascular disease. The original, epidemiological, cross-sectional, multicenter study was carried out in outpatient clinics belonging to cardiology, internal medicine and endocrinology departments. It included patients aged > or = 18 years with a high cardiovascular risk (i.e., a SCORE [Systematic Coronary Risk Evaluation] risk >5% or diabetes mellitus or associated clinical disease). The definition of CKD was an estimated glomerular filtration rate (Modification of Diet in Renal Disease formula) <60 mL/min per 1.73 m2. Established CKD was regarded as present when, in addition, the serum creatinine level was > or = 1.3 mg/dL in men or > or = 1.2 mg/dL in women, and occult CKD as present when the creatinine level was lower. In total, 2608 patients were included. Some 62.7% did not have CKD, 18.9% had established CKD and 18.4% had occult CKD. In summary, CKD was highly prevalent in patients with a high risk of cardiovascular disease.

Respuesta: Importancia de la identificación precoz de la enfermedad renal. Respuesta / Response: Importance of identifying renal disease early

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Prevalencia de insuficiencia renal crónica en pacientes de alto riesgo o con enfermedad cardiovascular / Prevalence of chronic kidney disease in patients with or at a high risk of cardiovascular disease

Este subanálisis del estudio MULTIRISC evaluó la prevalencia de insuficiencia renal crónica (IRC) en pacientes con alto riesgo o enfermedad cardiovascular. Se trata de un estudio epidemiológico, transversal y multicéntrico realizado en consultas externas de cardiología, medicina interna o endocrinología. Se incluyó a pacientes con 18 años o más, con alto riesgo cardiovascular (SCORE > 5% o diabetes o enfermedad clínica concomitante). Se definió IRC si el filtrado glomerular estimado (MDRD) era < 60 ml/min/1,73 m2; IRC establecida si además la creatinina era ≥ 1,3 mg/dl en varones o ≥ 1,2 mg/dl en mujeres, e IRC oculta cuando la creatinina era inferior. Se incluyó a 2.608 pacientes. El 62,7% no presentaba IRC, el 18,9% presentaba IRC establecida y el 18,4%, IRC oculta. La IRC es muy prevalente en pacientes con alto riesgo cardiovascular (AU)

This secondary analysis of data from the MULTIRISC study investigated the prevalence of chronic kidney disease (CKD) in patients who either had or were at a high risk of cardiovascular disease. The original, epidemiological, cross-sectional, multicenter study was carried out in outpatient clinics belonging to cardiology, internal medicine and endocrinology departments. It included patients aged ≥18 years with a high cardiovascular risk (i.e., a SCORE [Systematic Coronary Risk Evaluation] risk >5% or diabetes mellitus or associated clinical disease). The definition of CKD was an estimated glomerular filtration rate (Modification of Diet in Renal Disease formula) <60 ml min per 1 73 m2 established ckd was regarded as present when in addition the serum creatinine level 8805 3 mg dl men or 2 women and occult lower total 2608 patients were included some 62 7 did not have 18 9 had 4 summary highly prevalent with a high risk of cardiovascular disease (AU)

Disfunción eréctil como marcador de vasculopatía en la diabetes mellitus tipo 2 en España. Estudio DIVA / Erectile dysfunction as a marker of silent cardiovascular disease in type-2 diabetic patients in Spain. The DIVA (Diabetes and Vascular disease) study

Fundamento y objetivo: la disfunción eréctil (DE) es un signo de enfermedad vascular en los sujetos con diabetes mellitus tipo 2 (DM2). El objetivo principal del estudio DIVA (por las letras iniciales de diabetes y vasculopatía) fue estimar la prevalencia de vasculopatía clínica y asintomática, así como la prevalencia de factores de riesgo en los sujetos diabéticos atendidos por especialistas en España; en él se analizó la relación de los datos citados con la prevalencia de DE. Pacientes y método: registro transversal compuesto por 2.444 sujetos consecutivos (56% varones con una edad media de 65,2 años) diagnosticados de DM2, atendidos en consulta por 387 cardiólogos y endocrinólogos. Resultados: el 37% de los sujetos presentaba cardiopatía isquémica, el 12% presentaba enfermedad cerebrovascular (ECRV) y el 13% presentaba arteriopatía periférica. El 40% de los varones tenía DE (según criterios del Índice internacional de la función eréctil), aunque en comparación con los grupos que no presentaban DE, en este grupo la enfermedad cardiovascular era significativamente más prevalente, así como los signos de vasculopatía subclínica (albuminuria e índice tobillo-brazo [ITB] anormal). El único factor predictor de DE independiente de otras variables de confusión fue la hipertrofia ventricular izquierda (riesgo relativo [RR] de 5,2; intervalo de confianza [IC] del 95%: 1,1¿24,1; p=0,03); el ITB fue menor que 0,9 de significación limítrofe (RR de 5,9; IC de 95%: 0,9¿39,9; p=0,06). El mal control glucémico y lipídico (p<0,05 en ambos casos) así como la presencia de ECRV, de enfermedad arterial periférica (p<0,01 en ambos casos) y de disfunción renal (p<0,001) eran más prevalentes en sujetos con DE grave. Conclusiones: el 40% de los varones diabéticos presenta DE. Los resultados de este estudio demuestran que la DE puede considerarse como marcador de aterosclerosis e incluirse en los algoritmos de estratificación de riesgo y detección de vasculopatía asintomática (AU)

Background and objectives: Erectile dysfunction(ED) is a sign of vascular disease in type 2 diabetic patients. The presents ubanalys is of the DIVA Registry, whos emain objective wast o estimate the prevalence of clinical vascular disorder and silent vascular disorder, as well as risk factors in type2diabetic patients treated in Spain, aims to analyze the relationship between those data and the prevalence of ED in these patients. Patients and Methods: A total of 2444 type 2 diabetic patients (56%male; meanage 65.2 years) attended by 387 cardiologists and endocrinologists at ambulatory care were included. Results: Coronary heart disease was present in 37%of the patients, cerebrovascular disease in12%,and peripheral arterial disease in 13%. Forty percent of male patients had ED (according to the IIEF criteria),although in this group, as compared to those patients without ED, the prevalence of cardiovascular disease and signs of subclinical vascular disorder (microalbuminuria and abnormalankle/brachialindex (ABI)) was higher. The only independent predictor of ED was left ventricular hypertrophy (OR5.2;95%CI: 1.1–24.1; P ¼ .03), with the ABI o0,9 being of border line significance (OR5.9;95%CI:0.9–39.9;P ¼ .06).Poor glycemic and lipemic control (Po.05 in both cases)as well as cerebrovascular and peripheral arterial disease (Po.01inbothcases) and renaldys function (Po.001)were all more frequent among patients with severe ED. Conclusions: Forty percent of diabetic patients suffer from ED. The results of this study suggest that EDmay be considered as an at hero sclerosis marker and could be included in algorithms for risk stratification and subclinical vascular disorder detection (AU)

Prevalencia de la enfermedad renal crónica oculta en la población dislipémica asistida en atención primaria. Estudio LIPICAP / Prevalence of undetected chronic kidney disease in dyslipidemic population treated in primary care. LIPICAP study

Fundamento y objetivo: Se dispone de poca información sobre la prevalencia de la enfermedad renal crónica (ERC) en atención primaria (AP). El objetivo del estudio LIPICAP ha sido determinar la prevalencia de ERC oculta en población dislipémica mediante el cálculo del aclaramiento de creatinina con la fórmula de Cockcroft-Gault corregida por superficie corporal. Pacientes y método: Se ha realizado un estudio transversal en pacientes dislipémicos seleccionados consecutivamente en AP. Se diagnosticó ERC cuando la tasa de filtrado glomerular (TFG) era inferior a 60 ml/min/1,73 m2. Se evaluaron datos sociodemográficos, clínicos, factores de riesgo cardiovascular, características de la dislipemia, estadio funcional de ERC y tratamientos farmacológicos. Resultados: Se incluyó a 5.990 pacientes (un 50,2% mujeres) con una edad media (desviación estándar) de 60,9 (11,1) años. El principal motivo de inclusión fue la hipercolesterolemia (65%), seguida de la hiperlipemia mixta (26,4%), cifras bajas de colesterol unido a lipoproteínas de alta densidad (cHDL) (4,9%) e hipertrigliceridemia (3,7%). El 16,2% (intervalo de confianza del 95%, 15,3-17,1) presentó ERC según la fórmula de Cockcroft-Gault, siendo la prevalencia mayor en las mujeres (22,7%) que en los varones (9,8%) (p < 0,0001). En comparación con los pacientes con una TFG normal, los pacientes con ERC tenían más edad, cifras mayores de presión arterial sistólica, glucosa y cHDL (p < 0,001) y valores inferiores de colesterol total, colesterol unido a lipoproteínas de baja densidad y triglicéridos (p < 0,01). La probabilidad de presentar ERC se relacionó con el sexo femenino, la edad y un índice de masa corporal inferior. Conclusiones: Los resultados del estudio LIPICAP indican que casi 2 de cada 10 pacientes diagnosticados de dislipemia y atendidos en AP presentan ERC oculta cuando se estima la TFG con la fórmula de Cockcroft-Gault corregida por superficie corporal

Background and objective: Information about the prevalence of chronic kidney disease (CKD) in population treated in primary care (PC) is scarce. The aim of this study was to determine undetected CKD prevalence in dyslipidemic population measuring creatinine clearance according to the Cockcroft-Gault equation corrected for surface area. Patients and method: Cross-sectional study including patients with diagnosis of dyslipidemia selected by consecutive sampling in PC. CKD was diagnosed when the glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2. We assessed sociodemographic and clinical data, cardiovascular risk factors, coronary disease risk categories, dyslipidemia characteristics, functional CKD stage, and pharmacological treatments. Results: The sample included 5,990 patients (50.2% women). The mean (standard deviation) age was 60.9 (11.1) years. The main reason for iclusion was hypercholesterolemia (65%), followed by mixed hyperlipidemia (26.4%), low high density lipoproteins (HDL)-cholesterol (4.9%) and hypertrigliceridemia (3.7%). According to the Cockcroft-Gault equation, CKD prevalence was 16.2% (95% confidence interval, 15.3-17.1) and it was significantly higher in women (22.7%) than in men (9.8%) (p < 0.0001). Patients with CKD were older compared with patients with normal GFR, and had higher systolic blood pressure, glucose and HDL-cholesterol (p < 0.001), as well as lower levels of total cholesterol, low density lipoproteins-cholesterol, and triglycerides (p < 0.01). The probability of presenting CKD was related to female gender, age, and lower body mass index. Conclusions: The LIPICAP study results indicate that almost 20% of PC dyslipidemic patients in Spain present undetected CKD when the GFR is measured according to the Cockcroft-Gault equation corrected for surface area