Key result
Higher E/e' ratio linked to ~18% higher odds of NYHA III-IV symptoms in HFpEF.
Why the study?
HFpEF is a heterogeneous syndrome with substantial symptoms despite preserved LVEF, and the association between symptom severity, echocardiographic parameters, and comorbidities requires evaluation.
Cross-Sectional (n=216)
No
In patients with HFpEF, symptom severity is independently driven by abnormal left ventricular filling pressures (E/e′), left atrial remodeling (LAVI), and pulmonary hemodynamics (PASP) rather than the degree of preserved systolic function.
Answers are grounded in this paper and cite their sources.
E/e' may correlate with severe symptoms in HFpEF; leaves open prospective validation for risk stratification.
Introduction: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome in which substantial symptoms may occur despite preserved left ventricular ejection fraction (LVEF).Echocardiographic abnormalities involving ventricular filling, left atrial remodeling, diastolic function, and pulmonary pressures may contribute to symptom burden.This study evaluated the association between clinical symptom severity, echocardiographic parameters, and comorbidities in patients with HFpEF.Study: This retrospective observational cross-sectional study was conducted at the Government Peripheral Hospital, Periyar Nagar, Chennai, Tamil Nadu, from March 2025 to March 2026.A total of 216 patients aged ≥18 years with HFpEF and LVEF ≥50% were included.Clinical symptom burden was assessed using New York Heart Association (NYHA) functional class and categorized as I-II or III-IV.Demographic characteristics, comorbidities, and echocardiographic parameters, including LVEF, left ventricular mass, left atrial volume index (LAVI), E/e′ ratio, diastolic dysfunction grade, and estimated pulmonary artery systolic pressure (PASP), were evaluated.Multivariable logistic regression identified factors independently associated with NYHA III-IV symptoms.Results: The mean age was 67.8 ± 10.4 years, and 53.7% were female.Hypertension was the most prevalent comorbidity (80.6%), while 76.9% had ≥2 major comorbidities.Fifty-five patients (25.5%) had NYHA III-IV symptoms.Compared with NYHA I-II, the severe symptom group had higher E/e′ (17.4 ± 5.0 vs. 12.6 ± 4.0), LAVI (44.5 ± 12.1 vs. 34.2± 9.1 mL/m²), LV mass, and PASP (43.9 ± 12.4 vs. 36.8± 8.7 mmHg), with significantly more advanced diastolic dysfunction.On multivariable analysis, E/e′ (adjusted OR 1.18), LAVI (adjusted OR 1.05), and PASP (adjusted OR 1.04) were independently associated with severe symptoms.Conclusion: Symptom severity in HFpEF was associated more strongly with abnormal filling pressures, left atrial remodeling, and pulmonary hemodynamics than with preserved systolic function alone.E/e′, LAVI, and PASP may provide useful complementary markers of symptomatic burden and support a multidimensional echocardiographic assessment of HFpEF.
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Athisivam et al. (2026) conducted a cross-sectional in Heart failure with preserved ejection fraction (HFpEF) (n=216). E/e' ratio was evaluated on Severe symptom burden defined as NYHA functional class III-IV (adjusted OR 1.18, 95% CI 1.09-1.27, p=<0.001). An increased E/e' ratio was independently associated with severe NYHA III-IV symptoms in patients with HFpEF (adjusted OR 1.18), alongside greater left atrial volume index and elevated pulmonary artery systolic pressure.
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