Značaj parametara dijastolnog stres-ehokardiografskog testa kod bolesnika sa srčanom insuficijencijom i očuvanom ejekcionom frakcijom

Abstract

Objective: to determine the parameters of LV and LA VVI echocardiography, B-lines score, BNP levels, HFA PEFF algorithm score, in the group of patients with HFpEF and compare them with values in healthy subjects; to analyze their changes during diastolic SET, then in relation to CV death and to establish which of the examined variables stand out as independent predictors of future adverse CV events (cardiovascular death). Methodology: 110 subjects constituted the clinical (HFpEF) group, and 40 subjects the control group. All subjects underwent diastolic SET. Echocardiographic examination and pulmonary ultrasound were performed: 1) at the beginning of diastolic SET; 2) at SF >100-110 beats/min 3) at rest. All subjects were contacted by telephone at 3, 6, 9, and 12 months, and CV events (HF rehospitalizations, CV death) were recorded. Results: adding the change in BNP/LAVi during diastolic SET, HFA PEFF score significantly contributes to the diagnosis of HFpEF (sensitivity 60.9% and specificity 95%) and the exclusion of HFpEF diagnosis (sensitivity 95.5% and specificity 72.5%). Below the cut-off values for peak GLS LK (-17.22%) and change in GLS LK during diastolic SET (0.35%), there is a high diagnostic ability to predict CV death. Below the cut-off value for LASr at rest (25.5%), peak LASr (28.1%) and change in LASr during diastolic SET (3.7%) there is a high diagnostic ability to predict CV death. Below the cut-off value for peak LASct (13.4%) and change in LASct during diastolic SET (0.3%) there is significant diagnostic ability to predict CV death. Higher peak B-line score values, changes in B-line score during diastolic SET, and peak B-line score ≥10 significantly predicted CV death. Higher values of initial HFA PEFF score, after diastolic SET, as well as after adding variables (BNP/LAVi) significantly predict CV death. Conclusion: the addition of BNP/LAVi changes during diastolic SET increased the sensitivity of the HFA PEFF score for the diagnosis of HFpEF. The peak values of GLS LK, LASr and LASct were singled out as independent predictors of mortality.