Comparative Value of Echocardiography vs. Right Heart Catheterization in Heart Failure With Preserved Ejection Fraction

Background Echocardiography and right heart catheterization (RHC) are useful in the evaluation of heart failure with preserved ejection fraction (HFpEF). We compared the two among decompensated HFpEF patients to determine their relative value in predicting all‐cause mortality and a composite of cardiovascular (CV) death and heart failure (HF) readmission at 1 year. Methods One hundred seventy‐eight decompensated HFpEF patients who underwent both procedures and survived to hospital discharge were retrospectively identified. Hospital records and the National Death Index were queried to determine outcomes. Echocardiographic and invasive parameters were tested for significant associations with each outcome. Additionally, three predictive models were developed: Model‐1: basic demographics and comorbidities, Model‐2: adding echocardiographic parameters, and Model‐3: adding invasive hemodynamic parameters. Results For mortality ( n = 26; 15%), echocardiographic E /average e′ , invasive mean pulmonary artery pressure (mPAP), and pulmonary capillary wedge pressure (PCWP) showed significant associations. Model‐1 yielded a c ‐statistic of 0.65; 95% CI (0.54–0.76). Adding echocardiographic and hemodynamic variables produced a nonsignificant increase to 0.71; 95% CI (0.60–0.82), though mPAP remained an independent predictor (OR 1.05; 95% CI 1.01–1.09, p = 0.025). For the composite outcome ( n = 31; 17%), significant associations were found for echocardiographic right atrial reservoir strain (RAsr), E /average e′ , and invasive right atrial pressure, mPAP, and PCWP. Model‐1 had a c ‐statistic of 0.70; 95% CI (0.60–0.79). Adding echocardiographic parameters significantly increased this to 0.81; 95% CI (0.73–0.88). Adding hemodynamic parameters (model‐3) resulted in a nonsignificant increase to 0.83; 95% CI (0.76–0.90). Conclusions Among decompensated HFpEF patients, the addition of echocardiographic parameters significantly improved model prediction for the composite endpoint of CV death and HF hospitalization. Further addition of invasive hemodynamic variables did not.