Outcome assessment using estimation of left ventricular filling pressure in asymptomatic patients at risk for heart failure with preserved ejection fraction

Figures

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  Fig. 1. Flowchart for selection of patients for analysis: At baseline asymptomatic patients with preserved left ventricular ejection fraction (LVEF) were classified according to HFA/ESC criteria for HFpEF. Outcome was assessed over ten years after baseline. FPe = asymptomatic patients that fulfill HFA/ESC criteria (elevated LV filing pressure), E/e’ >15 or 15 > E/e’ >8 and either atrial fibrillation or NT-proBNP > 220 ng/l or BNP > 200 ng/l. From 181 patients who fulfilled the HFA/ESC criteria 82 were hat E/e’ > 15 (45.3%). 75 patients had E/e’ > 8 and NT-proBNP > 220 (41.4%), 16 patients had E/e’ > 8 and atrial fibrillation (8.8%) and 8 patients had E/e’ > 8 and both NT-proBNP > 220 and atrial fibrillation (4.4%). controls = all asymptomatic patients that did not fulfill criteria.

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  Fig. 2. (A) Characteristics associated with FPe classification: Multiple logistic model for elevated left ventricular filling pressures according to HFA/ESC criteria (FPe) in asymptomatic patients at baseline. Odd’s ratio and 95% CI. Anaemia is defined according to WHO: Hb < 13 g/dL (m), <12 g/dL (f). (B) Cumulative incidences for death and cardiovascular hospitalization within a 10-year follow-up: Asymptomatic patients who fulfill HFA/ESC criteria for HFpEF (FPe) significantly more often showed events of death than controls (p < 0.001) but did not differ in the amount of cardiovascular hospitalization within a 10-year follow-up. (C) Outcome status after 10 years (first event): Within a 10-year follow-up, patients with elevated left ventricular filling pressures according to HFA/ESC criteria (FPe, n = 181, grey) showed a significantly higher number of total events (p = 0.005) than controls (n = 670, white). However, this difference is mainly a consequence of 11.3% more patients with signs and symptoms of heart failure (HF) in FPe. Only in 4% death was the first occurring event (e.g prior to occurrence of HF signs/symptoms). In controls 38% of all patients did not show any event within a…