الفهرس 
ABSTRACTOnly 14 pages are availabe for public view
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Abstract
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have clinical features of heart failure in the presence of normal or near-normal left ventricular ejection fraction, usually defined as ejection fraction at 50% or above. HFpEF is not a single condition but a result of much different pathology, adding challenges to management. HFpEF is a rapidly growing problem due to an aging population as well as increased incidence of risk factors such as hypertension, diabetes and obesity. It can potentially become a major burden to healthcare systems worldwide, which are already overstretched.
Unlike impaired ejection fraction, which reliably defines heart failure with reduced ejection fraction (HFrEF), the diagnosis of HFpEF can be challenging as there is no single abnormal echocardiographic parameter that defines its presence. A diagnosis relies on thorough interpretation of the entire echocardiogram, including left ventricular mass, left atrial volume and assessment of diastolic function.
The incidence of heart failure with preserved ejection fraction (HFpEF) is increasing and it’s challenging diagnosis and management combines clinical, imagistic and biological data. The incidence of heart failure (HF) is increasing. If for HF with reduced ejection fraction (HFrEF) there are well-established methods of diagnosis and treatment, this is far from true in HF with preserved ejection fraction (HFpEF) patients.
This increasing incidence justifies the need for proper diagnostic, therapeutic and prognostic tools. In the era of cardiac biomarkers, natriuretic peptides (NPs) have a well-established role in HF pathophysiology and patient management. However, both the lack of consensus regarding NPs in HFpEF and the heterogeneous population makes diagnosis and management difficult and unstandardized, leading to a decrease in quality of life and increase in mortality and hospitalization.
The main aim of this study was to compare BNP levels in HFpEF patients presented with symptoms of decompensated heart failure with Atrial fibrillation versus those in normal sinus rhythm, and to propose a cut-off level of BNP for diagnosis of HFpEF in patients with atrial fibrillation.
This cross-sectional observational control study was conducted Beni-Suef University and Aswan heart centre in the period between March 2021 to March 2022 . This study includes 120 patients; half of them were proved to have heart failure with preserved ejection fraction based on symptoms, echocardiography findings and BNP levels. Also of the 120 patients, 60 patients were proven to have either paroxysmal or permanent Atrial fibrillation. The studied patients allocated into four groups group (A): 30 HFpEF patients in normal sinus rhythm. group (B): 30 HFpEF patients with atrial fibrillation. group (C): A control group (n=30) without HFpEF and in sinus rhythm. group D: A control group (n=30) without HFpEF and in Atrial fibrillation.
The main findings of the study revealed that:
• As regard the relation between sinus rhythm or AF and demographic data, the current study showed that there was no statistically significant correlation between age, sex and BMI with both sinus rhythm and AF.
• The Relation between sinus rhythm or AF and severity of heart failure symptoms according to NYHA functional classification , our results showed that there was statistically significant correlation between NYHA class with both sinus rhythm and AF groups of HFpEF patients being more severe among the AF group.
• As regarding the Relation between sinus rhythm or AF and comorbidities, the current study showed that the most common comorbidities were Hypertension (56.7%) followed by diabetes (25%), and we found that there was no statistically significant correlation between diabetes or hypertension with both sinus rhythm or AF.
• The current study showed that there was statistically significant difference between Atrial Fibrillation without heart failure group Vs. (Control, Sinus rhythm and AF groups) as regard the BNP level being significantly higher among HFpEF patients with atrial fibrillation in comparison to the sinus rhythm group of patients. Moreover, BNP values were found to be higher among AF control group of patients compared to the control group in sinus rhythm.
Using the Roc curve analysis for BNP to predict AF cases, showed that the area under the curve was 0.813 and the best cutoff point to discriminate HFpEF cases with AF was BNP> 459 with Sensitivity, Specificity, NPV and PPV were 76.67%, 83.33%, 78% and 82% respectively and a cutoff level of 89 pg/ ml for HFpEF diagnosis in SR.
• . Based on our findings, we recommend for further studies on larger sample size and on large geographical scale to emphasize our conclusion.