Purpose: No consensus exists for the diagnosis of heart failure with preserved ejection fraction (HFPEF). Current studies recommend stress echocardiography protocols, but single standard peak or timing measurements are limited towards the complexity of the disease. We show the contribution of a combined analysis of multiple myocardial velocity patterns and investigate their relative relevance for the characterization of HFPEF.
Methods: Velocity traces from 55 subjects were examined (69±6 years, 22 healthy, 19 HFPEF and 14 breathless subjects). Data came from tissue Doppler acquisitions at rest and exercise at the basal septum and lateral wall, and were temporally aligned to a common reference for comparison. Each phase of the cycle at each stage of the protocol was identified for analysis (figure). Unsupervised machine learning (multiple kernel learning) was used to characterize this population and automatically determine the relevance of each velocity pattern.
Results: The learning found a discrimination algorithm that performed well in agreement with diagnosis based on current guidelines (sens=78.9%, spec=86.3%, K=0.65). The importance given to early diastole at exercise was substantially higher, while the isovolumic contraction was the lowest contributor. The breathless subjects were associated to their closest subgroup.
Conclusion: The characterization of HFPEF is improved by a combined analysis of multiple velocity traces from stress echo studies using machine learning. The method additionally suggests features of interest to be used in clinical diagnosis.
Atherosclerotic cardiovascular disease is a global health burden. However, there are heterogeneities among countries or regions in the risk factors and clinical manifestations of atherosclerotic diseases as well as management patterns.We collected data from 25 centres in Thailand. Patients with documented coronary artery disease, cerebrovascular disease or peripheral arterial disease, or with at least three atherosclerosis risk factors were enrolled between April 2011 and March 2014. Data on demographics, atherosclerosis risk factors and the management pattern of risk factors, including laboratory findings, were recorded.In total, 9,390 patients, including 4,861 patients with established atherosclerotic disease and 4,529 patients with multiple risk factors, were enrolled. The modifiable risk factors, other than current smoking habit (5.3%), were common: hypertension (83.8%), dyslipidaemia (85.9%) and diabetes mellitus (57.4%). A majority of patients with hypertension (96.3%), dyslipidaemia (93.8%) and diabetes mellitus (78.5%) received medications for their conditions. Antiplatelet agents were given to 73.9% of patients. The undertreatment rate of cardiovascular risk factors, such as blood pressure, low-density lipoprotein cholesterol, haemoglobin A1c and smoking status, was 35.8%, 59.0%, 45.3% and 5.3%, respectively.Conventional atherosclerosis risk factors were common among Thai patients with established atherosclerotic disease. Even though most of the patients received recommended treatments according to established guidelines, a significant proportion of them were undertreated for atherosclerosis risk factors.
RESULTSA total of 1,451 patients were included.The mean age of the patients was 63.7 ± 14.4 years, and 49.7% were male.One-year, five-year and ten-year mortality rates in Thai patients admitted for acute decompensated heart failure were 28.0%, 58.2% and 73.3%, respectively.Independent predictors of increased mortality were identified.There were more cardiovascular-related deaths than non-cardiovascular-related deaths (54.6% vs. 45.4%,respectively). CONCLUSIONSThe ten-year mortality rate in Thai patients admitted for acute decompensated heart failure was 73.3%.Many factors were found to be independently associated with increased mortality, including left ventricular ejection fraction.