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T. Weber, S. Wassertheurer, R. Zweiker, B. Hametner, A. Haiden, B. Eber:
"Diagnostic value of pulsatile hemodynamics for heart failure with normal ejection fraction";
European Heart Journal, 33 (2012), 933 - 934.

Purpose: Increased arterialstiffness and wave reflections are present in most patients with heart
failurewith normal ejection fraction (HFNEF). We tested whether measures of pulsatilearterial
function are useful for diagnosing HFNEF, in comparison with and in addition to Tissue Doppler
Echocardiography (TDE).
Methods: Patients with dyspnea as leading symptom were categorized as having HFNEF or no
HFNEF, based on invasively derived filling pressures and natriuretic peptide levels. Pulse wave
velocity was measured invasively (aoPWV), aortic pulse pressure (aoPP) and its components (incident
pressure wave height - P1, forward wave amplitude - Pf;augmented pressure - AP; backward wave
amplitude - Pb) were quantified non-invasively from radial tonometry, using pulse waveform analysis
and wave separation analysis.
Results: 71 patients were classified as having HFNEF, and 65 as no HFNEF (in 223 patients,
intermediate results were present). Patients with HFNEF were older, more often had hypertension
and diabetes, and had more advanced coronary artery disease, larger left atria and higher left
ventricular mass. Blood pressures and all measures of arterial stiffness and wave reflections were
higher in HFNEF group. Receiver operating curve analysis derived area under the curve values were
0.823 for E/E' (medial annulus), the best TDE parameter, and 0.867, 0.851, 0.812, 0,813, 0.804,
and 0.825 for aoPWV, aoPP, P1, Pf, AP, and Pb, respectively (Figure). Multivariable logistic regression
models proved that measures of pulsatile arterial function provided independent and additive
diagnostic information.
Conclusion: Measures of arterial stiffness, central pressures and wave reflections complement TDE
for the diagnosis of DHF.