ALGORITHM FOR RISK STRATIFICATION OF ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION DURING ONE-YEAR FOLLOW-UP
Abstract
Highlights
Based on one-year prospective follow-up data, a risk stratification algorithm was developed for patients with heart failure with preserved ejection fraction (HFpEF), incorporating clinical and anamnestic characteristics as well as laboratory and instrumental parameters. The proposed algorithm enables the stratification of patients with HFpEF and coronary artery disease with non-obstructive coronary lesions into high-, intermediate-, and low-risk groups for adverse cardiovascular events over a one-year follow-up period. The implementation of this algorithm may help optimize clinical decision-making in patients with HFpEF and non-obstructive coronary atherosclerosis.
Aim. The aim of this study was to develop an algorithm to stratify patients with heart failure with preserved ejection fraction (HFpEF) into risk groups based on a one-year prospective observation. This algorithm will consider clinical, anamnestic, laboratory, and instrumental parameters.
Methods. The study included 55 patients diagnosed with HFpEF and coronary artery disease, who had with non-obstructive atherosclerotic lesions of the coronary arteries. Patients underwent assessment of left ventricular diastolic function, and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured according to current clinical guidelines. The level of growth differentiation factor 15 (GDF-15) was studied. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, and patient’s adherence to treatment was assessed using the Morisky Medication Adherence Scale.
Results. The incidence of unfavorable clinical course of HFpEF during one-year follow-up was 41.8% (n = 37). According to the algorithm, if a patient has carbohydrate metabolism disorders, treatment adherence should be assessed. Low treatment adherence indicates a high risk of cardiovascular events (CVS). With high treatment adherence, the duration of arterial hypertension (AH) should be assessed. Values of ≥ 15 years indicate a high risk of CVS, while values < 15 years indicate an intermediate risk. In the absence of carbohydrate metabolism disorders, the GDF-15 concentration should be measured. If the GDF-15 concentration is ˂ 1753.5 pg/mL, the patient’s treatment adherence should be assessed. Low adherence indicates an intermediate risk, while high adherence indicates a low risk of CVS. If the GDF-15 concentration is ≥ 1753.5 pg/mL, the duration of AH should be assessed. Duration of AH ≥ 15 years indicates a high risk of developing CVS, while duration < 15 years indicates an intermediate risk.
Conclusion: The algorithm developed in this study allows stratifying patients with HFpEF and non-obstructive coronary artery disease into groups with high (> 40%), intermediate (20–40%) and low (< 20%) risk of adverse CVS events during one-year prospective observation.
Keywords
Heart failure with preserved ejection fraction,
Phenotyping,
Non-obstructive coronary artery disease,
Stratification algorithm
Supporting agencies: Source of funding BSR № 122020300045-5.
About the Authors
Elena A. Kuzheleva
Research Institute of Cardiology - branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”
Russian Federation
Russian Federation
Senior Researcher, Department of Myocardial Pathology, Research Institute of Cardiology – branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”, Tomsk, Russian Federation
Alla A. Garganeeva
Research Institute of Cardiology - branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”
Russian Federation
Russian Federation
Professor, Scientific Director of the Department of Myocardial Pathology, Research Institute of Cardiology – branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”, Tomsk, Russian Federation
Karina N. Vitt
Research Institute of Cardiology - branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”
Russian Federation
Russian Federation
Researcher, Department of Myocardial Pathology, Research Institute of Cardiology – branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”, Tomsk, Russian Federation
Olga V. Tukish
Research Institute of Cardiology - branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”
Russian Federation
Russian Federation
PhD, Researcher, Department of Myocardial Pathology, Research Institute of Cardiology – branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”, Tomsk, Russian Federation
Mikhail Yu. Kondratiev
Research Institute of Cardiology - branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”
Russian Federation
Russian Federation
Researcher, Department of Myocardial Pathology, Research Institute of Cardiology – branch of the Federal State Budgetary Scientific Institution “Tomsk National Research Medical Center of the Russian Academy of Sciences”, Tomsk, Russian Federation
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Review
For citations:
Kuzheleva E.A., Garganeeva A.A., Vitt K.N., Tukish O.V., Kondratiev M.Yu. ALGORITHM FOR RISK STRATIFICATION OF ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION DURING ONE-YEAR FOLLOW-UP. Complex Issues of Cardiovascular Diseases. 2026;15(3):6-17. (In Russ.)
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