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Usefulness of Simple Clinical Markers for Diagnosing Heart Failure with Preserved Left Ventricular Ejection Fraction in Argentinean Hospical II Registry

2009; Elsevier BV; Volume: 15; Issue: 6 Linguagem: Inglês

10.1016/j.cardfail.2009.06.156

1532-8414

Eduardo Perna, María Lorena Coronel, Juan P. Címbaro Canella, Fabián Diez, Roberto Colque, Lilia Luz Lobo Márquez, Carlos Poy, Gustavo Bargazzi, Pablo M. Alvarenga, Sergio V. Perrone,

Blood Pressure and Hypertension Studies

Usually, the treatment for chronic heart failure (CHF) must start before knowing the status of left ventricular systolic function (LVSF). We sought to determine the role of simple clinic markers to identify the presence of CHF with preserved LVSF (PresHF). Method: Argentinean Hospical II Registry prospectively recruited 2754 outpatients with CHF from 309 physicians and 13 provinces. A cohort of 2316 (84%) subjects with LVSF determined by echocardiogram was selected for this analysis. PresHF was defined by LV ejection fraction ≥ 40%, or qualitatively by a LVSF normal or with mild impairment. Results: PresHF was present in 734 cases (32%). In univariate analysis, in PresHF the following variables were more frequent: female, hypertension, current smoker, renal failure, CHF less than 30 days, previous pulmonary edema and systolic blood pressure (SBP) >140 mmHg; whereas the followings were less common: COPD, diabetes, hospitalizations for CHF, LBBB, coronary heart disease, treating by cardiologist, atrial fibrillation, previous diagnosis of heart failure, history of systemic congestion, cardiomegaly, abnormal ECG, third sound, ortopnea, increased jugular venous pressure, NYHA class III-IV and creatinine. In multiple regression analysis, the variables independently associated with PresHF were the presence of the followings: female (OR=1.4), hypertension (OR=1.5), smoker (OR=1.6), SBD >140 mmHg (OR=1.5); and absence of the followings: COPD (OR=1.8), hospitalizations for CHF (OR=1.5), coronary heart disease (OR=2.1), treating by cardiologist (OR=1.4), history of systemic congestion (OR=1.4), third sound (OR=2.4), class III-IV (OR=1.7), cardiomegaly (OR=1.9) and abnormal ECG (OR=2.2). A score based on the count of the variables above mentioned (0 to 13) showed an area under ROC curve of 0.75 to identifying PresHF. Three tertiles of probability were established: Low (0-5), Intermediate (6-7) and High (8-13), with a prevalence of PresHF of 12, 29 and 54% (p<0,0001). Conclusions: An easy estimation of probability of PresHF might be done during the clinical evaluation of outpatients with CHF through previous history, clinical findings, ECG and chest film.