Role of Diastolic Stress Testing in the Evaluation for Heart Failure With Preserved Ejection Fraction: A Simultaneous Invasive-Echocardiographic Study
Authors' conclusion
Currently proposed HFpEF diagnostic guidelines on the basis of resting data are poorly sensitive. Adding exercise E/e' data improves sensitivity and negative predictive value but compromises specificity, suggesting that exercise echocardiography may help rule out HFpEF.
Study context
- Population
- Subjects with invasively proven heart failure with preserved ejection fraction (HFpEF) and dyspneic participants without identifiable cardiac pathology
- Comparison
- Resting-data guideline criteria vs addition of exercise echocardiography (E/e' ratio) for diagnosis of HFpEF
- HFpEFn = 50
- Dyspnean = 24reference
- Outcome
- Diagnostic performance for invasively proven HFpEF
Methodological detailsprospective, simultaneous echocardiographic-catheterization at rest and exercise
- Prospective
- Simultaneous echocardiographic-catheterization at rest and exercise
Performance
As reported in the abstract
| Test or model | Sensitivity | Specificity |
|---|---|---|
| Current guidelines | 34% to 60% | Not reported in the abstract |
| Exercise E/e' ratio>14 | 90% | 71% |
Sensitivity
Current guidelines34% to 60%
Exercise E/e' ratio>1490%
Specificity
Current guidelinesNot reported in the abstract
Exercise E/e' ratio>1471%
Further findings
- NT-proBNP ≤125 pg/mL in HFpEF
- 18%
Correlation of E/e' ratio with directly measured pulmonary capillary wedge pressure
- At rest r=0.63
- P < 0.0001
- During exercise r=0.57
- P < 0.0001
Original publication
Role of Diastolic Stress Testing in the Evaluation for Heart Failure With Preserved Ejection Fraction: A Simultaneous Invasive-Echocardiographic Study. Circulation. Published 30 December 2016. doi:10.
Summarised from the published abstract; every number is checked against it