Screening for asymptomatic heart failure with preserved Ejection Fraction in Mongolian population at high risk

Abstract

Purpose: The goals of the present study were to assess the prevalence of asymptomatic heart failure with ejection fraction in subjects at high risk of developing HF and to define the diagnostic accuracy of NT-pro BNP assay compared with echocardiography in this setting. Materials and methods: This cross-sectional study was included subjects aged from 35to 64 years, with high risk for heart failure, who had no clinical symptoms of heart failure. Risk factors for heart failure were detected by clinical examinations. NT-pro BNP determination was performed on a immunoassay analyzer (FIA8000, Getein Bio Medical Inc, China), which uses reagent strip to obtain quantitative NT-pro BNP results in whole blood or plasma. The cut-off point for NT-pro BNP was 125pg/ml. Diagnosis of heart failure with preserved ejection fraction was based on criteria recommended by ESC heart failure guideline. Diastolic dysfunction was assessed according to the algorithm proposed in the joint recommendations of the American Echocardiographic Society and the European Association for Imaging Cardiovascular Research Methods. Results: A total of 602 patients with risk factor of heart failure were included in the study of which, 256 (42.5%) were males and 346 (57.5%) were females. The mean age was 51.71 ± 8.07. Eighty-three patients (13,8 %) showed elevated NT-pro BNP levels of ≥125 pg/ml. Our study has shown that NT-pro BNP concentration was positively correlated with age, both systolic and diastolic blood pressure, left ventricular mass and E/e’ ratio and negatively correlated with waist circumference, body mass index, left ventricular ejection fraction and E/A ratio in an asymptomatic population. The likelihood of positive NT-pro BNP test was independently (p<0.05) associated with age, hypertension and diabetes. The diagnosis of asymptomatic heart failure with preserved ejection fraction was confirmed in 12.3% of studied population. A cutoff value of 125 pg/ml for NT-pro BNP concentration showed the following diagnostic re-abilities in identifying asymptomatic heart failure with preserved ejection fraction: sensitivity 85.0%, specificity 88.6 % and area under curve (AUC) 0.92(95% CI 0.86-0.98). Conclusion: Subjects with a raised NT-pro BNP level (≥125 pg/ml) were more likely to have a confirmed diagnosis of asymptomatic heart failure with preserved ejection fraction after screening. In summary, in an at-risk population, natriuretic peptide-based screening combined with echocardiography identifies high prevalence of asymptomatic heart failure with preserved ejection fraction.