Heart Failure With Preserved Ejection Fraction Underdiagnosed

MONDAY, Nov. 25, 2024 (HealthDay News) — Heart failure with preserved ejection fraction (HFpEF) is underdiagnosed in patients with severe secondary tricuspid regurgitation (STR) of undefined etiology (isolated STR), according to a study published online Nov. 6 in JAMA Cardiology.

Jwan A. Naser, M.B.B.S., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined the prevalence of HFpEF and precapillary pulmonary hypertension (PH) in patients with severe isolated STR referred for exercise right heart catheterization (RHC) in a cross-sectional study. Fifty-four consecutive patients with severe isolated STR who underwent rest-and-exercise RHC were included.

The primary indication for RHC was evaluation of tricuspid regurgitation prior to potential intervention, evaluation of PH, and confirmation of HFpEF in 67, 24, and 9 percent of patients, respectively. The researchers identified HFpEF in 74 percent of patients; in only 35 percent of patients was HFpEF recognized prior to RHC. Precapillary PH was diagnosed in 10 of the 14 remaining patients without HFpEF (71 percent). Twenty-four patients (60 percent) who were subsequently diagnosed with HFpEF did not have guideline-defined diastolic dysfunction. Robust discrimination for HFpEF was seen for left atrial emptying fraction and strain (area under the receiver operating characteristic curve, 0.90 and 0.91, respectively).

“HFpEF remains underdiagnosed,” the authors write. “Patients with severe STR in the absence of another apparent etiology should be evaluated for HFpEF and precapillary PH.”

Two authors disclosed ties to the biopharmaceutical and medical device industries.

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