title: Assessing strategies for heart failure with preserved ejection fraction at the outpatient clinic.
abstract: BACKGROUND
  Heart failure with preserved ejection fraction (HFPEF) is the most common form of heart failure (HF), its diagnosis being a challenge to the outpatient clinic practice.
  
  
  OBJECTIVE
  To describe and compare two strategies derived from algorithms of the European Society of Cardiology Diastology Guidelines for the diagnosis of HFPEF.
  
  
  METHODS
  Cross-sectional study with 166 consecutive ambulatory patients (67.9±11.7 years; 72% of women). The strategies to confirm HFPEF were established according to the European Society of Cardiology Diastology Guidelines criteria. In strategy 1 (S1), tissue Doppler echocardiography (TDE) and electrocardiography (ECG) were used; in strategy 2 (S2), B-type natriuretic peptide (BNP) measurement was included.
  
  
  RESULTS
  In S1, patients were divided into groups based on the E/E'ratio as follows: GI, E/E'> 15 (n = 16; 9%); GII, E/E'8 to 15 (n = 79; 48%); and GIII, E/E'< 8 (n = 71; 43%). HFPEF was confirmed in GI and excluded in GIII. In GII, TDE [left atrial volume index (LAVI) ≥ 40 mL/m2; left ventricular mass index LVMI) > 122 for women and > 149 g/m2 for men] and ECG (atrial fibrillation) parameters were assessed, confirming HFPEF in 33 more patients, adding up to 49 (29%). In S2, patients were divided into three groups based on BNP levels. GI (BNP > 200 pg/mL) consisted of 12 patients, HFPEF being confirmed in all of them. GII (BNP ranging from 100 to 200 pg/mL) consisted of 20 patients with LAVI > 29 mL/m2, or LVMI ≥ 96 g/m2 for women or ≥ 116 g/m2 for men, or E/E'≥ 8 or atrial fibrillation on ECG, and the diagnosis of HFPEF was confirmed in 15. GIII (BNP < 100 pg/mL) consisted of 134 patients, 26 of whom had the diagnosis of HFPEF confirmed when GII parameters were used. Measuring BNP levels in S2 identified 4 more patients (8%) with HFPEF as compared with those identified in S1.
  
  
  CONCLUSIONS
  The association of BNP measurement and TDE data is better than the isolated use of those parameters. BNP can be useful in identifying patients whose diagnosis of HF had been previously excluded based only on TDE findings.
authors.forename: Antonio José Lagoeiro
authors.initials: AJ
authors.lastname: Jorge
authors.forename: Maria Luiza Garcia
authors.initials: ML
authors.lastname: Rosa
authors.forename: Mario Luiz
authors.initials: ML
authors.lastname: Ribeiro
authors.forename: Luiz Claudio Maluhy
authors.initials: LC
authors.lastname: Fernandes
authors.forename: Monica Di Calafiori
authors.initials: MD
authors.lastname: Freire
authors.forename: Dayse Silva
authors.initials: DS
authors.lastname: Correia
authors.forename: Patrick Duarte
authors.initials: PD
authors.lastname: Teixeira
authors.forename: Evandro Tinoco
authors.initials: ET
authors.lastname: Mesquita
mesh_terms: D000368:Aged; D000465:Algorithms; D000554:Ambulatory Care Facilities; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D017408:Guidelines as Topic; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology*
chemical_list: D020097:Natriuretic Peptide, Brain