A non-invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigue
Background: While Reddy proposed the H2FPEF diagnostic algorithm to aid in diagnosing heart failure with preserved ejection fraction (HFpEF), certain parameters like age and obesity are not suitable for Asian population, especially given the increasing incidence of HFpEF in younger individuals. Ther...
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Elsevier
2024-12-01
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| Series: | Journal of the Formosan Medical Association |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664624001086 |
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| author | Yi-Wei Chung Jen-Fang Cheng Yen-Liang Lin Hung-Jui Chuang Chia-Chuan Chuang Cheng-Wei Chen Wei-Ming Huang Cho-Kai Wu Lian-Yu Lin |
| author_facet | Yi-Wei Chung Jen-Fang Cheng Yen-Liang Lin Hung-Jui Chuang Chia-Chuan Chuang Cheng-Wei Chen Wei-Ming Huang Cho-Kai Wu Lian-Yu Lin |
| author_sort | Yi-Wei Chung |
| collection | DOAJ |
| description | Background: While Reddy proposed the H2FPEF diagnostic algorithm to aid in diagnosing heart failure with preserved ejection fraction (HFpEF), certain parameters like age and obesity are not suitable for Asian population, especially given the increasing incidence of HFpEF in younger individuals. Therefore, this study aimed to develop an easy-to-use nomogram with non-invasive indices that can be used in outpatient clinics in Taiwan to quickly estimate the probability of HFpEF and help decide whether further invasive cardiopulmonary exercise test (CPET) is needed. Methods: Outpatients with unexplained dyspnea and fatigue were recruited divided into HFpEF (n = 64) and non-HFpEF (n = 34) groups based on invasive CPET and echocardiography. Multivariate logistic regression analyses identified independent noninvasive variables for developing an HFpEF nomogram. The nomogram's performance was assessed and validated using the concordance index (C-index), area under the curve (AUC), calibration curves, and decision curve analysis. Results: Multivariate logistic regression analyses identified five independent noninvasive variables for developing an HFpEF nomogram, including dyslipidemia (OR = 5.264, p = 0.010), diabetes (OR = 3.929, p = 0.050), left atrial area (OR = 1.130, p = 0.046), hemoglobin <13 g/dL (OR = 5.372, p = 0.010), and NT-proBNP ≥245 pg/mL (OR = 5.108, p = 0.027). The nomogram showed good discriminatory ability (C-index = 0.842) and calibration performance (p = 0.873) and high net benefit (0.1−0.95). Notably, the HFpEF nomogram showed better diagnostic accuracy than the H2FPEF score model in predicting Taiwanese HFpEF patients (AUC: 0.873 vs. 0.608, p = 0.0006). Conclusion: The noninvasive HFpEF nomogram provides a preliminary estimation of the probability of HFpEF in Taiwanese outpatients with unexplained dyspnea and fatigue, which may help the decision-making on further invasive CPET. |
| format | Article |
| id | doaj-art-3b8e032255bc4044a70300bf9c6965e1 |
| institution | OA Journals |
| issn | 0929-6646 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj-art-3b8e032255bc4044a70300bf9c6965e12025-08-20T01:52:45ZengElsevierJournal of the Formosan Medical Association0929-66462024-12-01123121260126610.1016/j.jfma.2024.02.008A non-invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigueYi-Wei Chung0Jen-Fang Cheng1Yen-Liang Lin2Hung-Jui Chuang3Chia-Chuan Chuang4Cheng-Wei Chen5Wei-Ming Huang6Cho-Kai Wu7Lian-Yu Lin8Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsinchu, Taiwan; Graduate institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Division of Hospitalist, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu branch, Hsinchu, TaiwanDepartment of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, TaiwanDivision of Cardiology, Department of internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, TaiwanDivision of Cardiology, Department of internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, TaiwanDepartment of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health, National Yang-Ming University, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Corresponding author.Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Corresponding author. Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, TaiwanBackground: While Reddy proposed the H2FPEF diagnostic algorithm to aid in diagnosing heart failure with preserved ejection fraction (HFpEF), certain parameters like age and obesity are not suitable for Asian population, especially given the increasing incidence of HFpEF in younger individuals. Therefore, this study aimed to develop an easy-to-use nomogram with non-invasive indices that can be used in outpatient clinics in Taiwan to quickly estimate the probability of HFpEF and help decide whether further invasive cardiopulmonary exercise test (CPET) is needed. Methods: Outpatients with unexplained dyspnea and fatigue were recruited divided into HFpEF (n = 64) and non-HFpEF (n = 34) groups based on invasive CPET and echocardiography. Multivariate logistic regression analyses identified independent noninvasive variables for developing an HFpEF nomogram. The nomogram's performance was assessed and validated using the concordance index (C-index), area under the curve (AUC), calibration curves, and decision curve analysis. Results: Multivariate logistic regression analyses identified five independent noninvasive variables for developing an HFpEF nomogram, including dyslipidemia (OR = 5.264, p = 0.010), diabetes (OR = 3.929, p = 0.050), left atrial area (OR = 1.130, p = 0.046), hemoglobin <13 g/dL (OR = 5.372, p = 0.010), and NT-proBNP ≥245 pg/mL (OR = 5.108, p = 0.027). The nomogram showed good discriminatory ability (C-index = 0.842) and calibration performance (p = 0.873) and high net benefit (0.1−0.95). Notably, the HFpEF nomogram showed better diagnostic accuracy than the H2FPEF score model in predicting Taiwanese HFpEF patients (AUC: 0.873 vs. 0.608, p = 0.0006). Conclusion: The noninvasive HFpEF nomogram provides a preliminary estimation of the probability of HFpEF in Taiwanese outpatients with unexplained dyspnea and fatigue, which may help the decision-making on further invasive CPET.http://www.sciencedirect.com/science/article/pii/S0929664624001086Heart failure with preserved ejection fractionDyslipidemiaDiabetes mellitusLeft atrial areaHemoglobinN-terminal pro-B-Type natriuretic peptide |
| spellingShingle | Yi-Wei Chung Jen-Fang Cheng Yen-Liang Lin Hung-Jui Chuang Chia-Chuan Chuang Cheng-Wei Chen Wei-Ming Huang Cho-Kai Wu Lian-Yu Lin A non-invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigue Journal of the Formosan Medical Association Heart failure with preserved ejection fraction Dyslipidemia Diabetes mellitus Left atrial area Hemoglobin N-terminal pro-B-Type natriuretic peptide |
| title | A non-invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigue |
| title_full | A non-invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigue |
| title_fullStr | A non-invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigue |
| title_full_unstemmed | A non-invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigue |
| title_short | A non-invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigue |
| title_sort | non invasive nomogram for predicting heart failure with preserved ejection fraction in taiwanese outpatients with unexplained dyspnea and fatigue |
| topic | Heart failure with preserved ejection fraction Dyslipidemia Diabetes mellitus Left atrial area Hemoglobin N-terminal pro-B-Type natriuretic peptide |
| url | http://www.sciencedirect.com/science/article/pii/S0929664624001086 |
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