Heart failure with preserved ejection fraction: diagnostic value of HFA-PEFF score, H2FPEF score, and the diastolic stress echocardiography.

INTRODUCTION: The aim of our study was to compare 3 diagnostic pathways: diastolic stress echocardiography (DSE) based on the ASE/EACVI 2016 guidelines, the 2018 H2FPEF score, and the 2019 HFA-PEFF algorithm, in patients suspected of heart failure with preserved ejection fraction (HFpEF). MATERIAL AND METHODS: The study group included 80 consecutive patients with a clinical suspicion of HFpEF. The H2FPEF and HFA-PEFF scores and serum NT-proBNP concentrations were assessed in all the patients before they were sent for DSE. RESULTS: The DSE-based pathway confirmed HFpEF in 17 (21%) patients, the HFA-PEFF algorithm in 43 (54%), and H2FPEF scoring in 4 (5%) patients. The ROC analysis showed that HFA-PEFF score > 5 predicts a DSE-positive test with a sensitivity of 70.5% and a specificity of 65%, (AUC = 0.711, p = 0.002) with a negative predictive value of 89.1% and positive predictive value of 35.3%. The H2FPEF score > 3 had a negative predictive value of 90%, a positive predictive value of 29.8%, and predicted positive DSE result with a sensitivity of 82.3% but rather poor specificity of 47.6% (AUC = 0.692, p = 0.004). Both H2FPEF and HFA-PEFF showed similar predictive values (AUC) in the prediction of positive DSE test (p = ns). CONCLUSIONS: The HFA-PEFF score overestimated the rate of HFpEF in comparison to DSE and the H2FPEF score. The H2FPEF and HFA-PEFF scores showed only modest predictive values of the positive DSE and had a diagnostic power to rule out the HFpEF.

Can transesophageal echocardiography be safely omitted in patients scheduled for elective ablation of atrial arrhythmias? Data based on the LATTEE registry.

BACKGROUND: According to the present guidelines, transesophageal echocardiography (TEE) before scheduled catheter ablation (CA) for atrial arrhythmias (atrial fibrillation [AF] or atrial flutter [AFL]) is not deemed obligatory for optimally anticoagulated patients. However, daily clinical practice significantly differs from the recommendations. AIMS: We aimed to identify transthoracic echocardiographic parameters that could be useful in identifying patients without left atrial thrombus (LAT), which makes it possible to avoid unnecessary TEE before scheduled CA. METHODS: This is a sub-analysis of a multicenter, prospective, observational study - the LATTEE registry. A total of 1346 patients referred for TEE before scheduled CA of AF/AFL were included. RESULTS: LAT was present in 44 patients (3.3%) and absent in the remaining 1302, who were younger, more likely to have paroxysmal AF, and displayed sinus rhythm during TEE. Additionally, they exhibited a lower incidence of heart failure, diabetes, systemic connective tissue disease, and chronic obstructive pulmonary disease. Furthermore, they had a lower CHA2DS2-VASc score and a higher prevalence of direct oral anticoagulants. Echocardiographic parameters, including left ventricular ejection fraction (LVEF) >65%, left atrial diameter (LAD) <40 mm, left atrial area (LAA) <20 cm2, left atrial volume (LAV) <113 ml, and left atrial volume index (LAVI) <51 ml/m2, demonstrated 100% sensitivity and 100% negative predictive value for the absence of LAT and were met by 417 patients. Additional echocardiographic indices: LVEF/LAD ≥1.4, LVEF/LAVI ≥1.6, and LVEF/LAA ≥2.7 identified 57 additional patients, bringing the total of predicted LAT-free patients to 474 (35%). CONCLUSIONS: Simple echocardiographic parameters could help identify individuals for whom TEE could be safely omitted before elective CA due to atrial arrhythmias.

Echocardiography and Cardiac Magnetic Resonance in the Assessment of Left-Ventricle Remodeling: Differences Implying Clinical Decision.

Introduction: Transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) are the most important modalities used in clinical practice to assess cardiac chambers. However, different imaging techniques may affect their results and conclusions. The aim of our study was to compare left-ventricle (LV) remodeling assessed using TTE and CMR in the context of various cardiovascular diseases. Methods: A total of 202 consecutive patients sent for an elective cardiovascular diagnosis were scheduled for a 2D TTE and CMR, performed within 2 weeks. The study group was divided and analyzed based on the clinical indications for CMR, including coronary artery disease, heart failure, native aortic valve regurgitation or paravalvular leak after aortic valve replacement, or cardiomyopathies. Results: The mean LV mass index (LVMi) values calculated using TTE were significantly larger (127.1 ± 44.5 g/m²) compared to the LVMi assessed using CMR (77.1 ± 26.2 g/m²; p < 0.001). The LV end-diastolic volumes assessed using TTE were underestimated for all the study patients (78.6 ± 43 mL vs. 100.5 ± 39 mL; p < 0.0001) and subgroups, but a statistical trend was observed in patients with cardiomyopathy. Those differences in single parameters led to differences in LV remodeling and the final treatment decision. CMR and TTE provided similar conclusions on LV systolic dysfunction in 68% of the patients. Conclusions: Our results showed that the greater the degree of LV remodeling and dysfunction, the greater the difference between the modalities. Therefore, CMR should be introduced into routine clinical practice, especially for patients undergoing LV remodeling, which may change clinical decisions in a considerable number of cases.