151 The pre-HFpEF entity: a window of opportunity to prevent and halt the progression to HF with preserved ejection fraction (HFpEF)

Background Before the emergence of HFpEF, there is an insidious phase of progressive myocardial fibrosis, arterial stiffness, and rising left ventricular end-diastolic pressures (LVEDP) driven by amassing cardio-metabolic comorbidities. This phase is characterized by incipient structural cardiac abnormalities but without the manifestation of HF. We hence propose the term ‘pre-HFpEF’. (Figure 1) We hypothesize that pre-HFpEF is associated with high morbidity (e.g. hospitalization rate) similar to HFpEF but without the increased mortality, presuming the ventricle is ‘fatigued’ but remains compensated. Expanding on preventive cardiology, we believe that early identification of this cohort with aggressive comorbidity control may potentially halt its progression to HFpEF which has a dismal prognosis and disappointing therapies. Our study therefore aims to demonstrate that this seemingly subclinical entity is clinically diagnosable and depending on the degree of LVEDP, is associated with adverse clinical outcomes. Methods 1294 consecutive patients with NYHA II-IV breathlessness referred to the community HF clinic were screened and included if LVEF >45% and LV diastolic dysfunction (LVDD) were present but without clinical and radiological evidence of HF. Echocardiographic assessment of diastology was based on 2016 EACVI guidelines. 175 patients were included and divided into two groups: rising LVEDP (E/e’ Results 55 patients had E/e’ ≥14 and 120 had E/e’ Conclusion A high E/e ≥14 cut-off with raised NT-proBNP may be used as a screening tool to identify high-risk pre-HFpEF group which is associated with adverse clinical outcomes. Without increased mortality so far, it is crucial to promptly identify this population that may be more amenable to risk factor modification than HFpEF. Close monitoring in a dedicated HFpEF clinic with vigorous management of comorbidities is therefore recommended. Conflict of Interest None