Early Identification of Patients At-Risk for Incident Heart Failure with Preserved Ejection Fraction (HFpEF): Novel Approach to Echocardiographic Trends.

Abstract Background : Heart failure with preserved ejection fraction (HFpEF) continues to increase in prevalence with a 50% mortality rate within 3 years of diagnosis but lacking effective evidenced-based therapies. Specific echocardiographic markers are not typically used to trigger alarm prior to acute HFpEF decompensation. The goal of this study was to retrospectively track changes in echo markers leading to the time of incident HFpEF hospitalization. Methods : In a single-center, retrospective analysis, HFpEF patients admitted between 2007-2014, were identified using the International Classification of Diseases, 9th Revision (ICD-9) with search refined using the European Society of Cardiology (ESC) HFpEF guidelines. Using linear mixed effects models, changes in echocardiographic markers preceding acute HF decompensation due to incident HFpEF were analyzed. Results : With an incident HFpEF cohort of 242 patients, extending 18 years retrospectively, and including 675 echocardiograms analyzed from the overall sample at 14 distinct time intervals before acute decompensation. The regression models demonstrated three echo markers with statistically significant increases across multiple time intervals including, arterial elastance (Ea, p=0.006), right atrial pressure estimate (RAest, p 8-10yrs before HFpEF diagnosis, b) LV filling pressure (E/e’) 2-6years before HFpEF diagnosis, c) ventricular elastance (Ees) 3-6monthsbefore HFpEF diagnosis and d) Ees/Ea as early as 10-20 years and as late as 3-6 months before HFpEF diagnosis. Furthermore, African-Americans presented with incident HFpEF at an average younger age than White patients (65.6 ± 15.2 vs. 76.7 years ± 11.7, p Conclusions : Non-invasive echocardiographic markers associated with incident HFpEF diagnosis showed long, mid, and acute range, significant changes as far back as 10-20 years and as close as 3-6 months before acute HFpEF decompensation. Including a diverse study cohort is critical to understanding the phenotypic differences of HFpEF. This hypothesis generating study identified a novel approach to identifying trends in echocardiographic markers that may be used as a signal of impending incident HFpEF.