Abstract 16070: Prognostic Value of H2FPEF Score Among Symptomatic Patients Referred for Exercise Echocardiography

Abstract

Introduction: The H2FPEF score is a recommended tool for estimating the likelihood of heart failure with preserved ejection fraction (HFpEF) in cases of unexplained dyspnea. Limited data is available regarding its prognostic ability. This restrospective study aimed to assess the prognostic value of the H2FPEF score for adverse cardiovascular outcomes. Methods: 532 patients [age 69±6 years, 57% female, and ejection fraction 61±5% (all >50%)] with suspected symptoms of heart failure (HF) referred for exercise echocardiography were included. H2FPEF score was calculated based on: BMI >30 kg/m2 (2 points), atrial fibrillation (3 points), age >60 years (1 point), use of ≥2 hypertension drugs (1 point), E/e’ ratio >9 (1 point), and pulmonary systolic pressure >35 mmHg (1 point). Comparisons were made for death and HF hospitalization. Results: During a median follow-up of 3.8 years, 13 patients died, 35 had HF hospitalizations, and 48 experienced the composite outcome. The score distribution was as follows: 0-1 in 69 (13%) patients, 2-5 in 430 (81%) patients, and ≥6 in 33 (6%) patients. The H2FPEF score averaged 3.2±1.5 and showed a progressive increase in the risk of adverse outcomes. A score of 0-1 was associated with the lowest risk, ≥6 with the highest risk, and 2-5 with an intermediate risk (Figure 1A-C). Compared to a score of 0-1, increased risk for combined outcomes occurred with a score of 2-5 (HR: 3.4, 95% CI: 1.5-8) and ≥6 (HR: 9.6, 95% CI: 3.6-26). Similar risk patterns were observed for death and HF hospitalization. Importantly, during exercise echocardiography, new wall motion abnormalities occurred in 105 (20%) patients and did not differ significantly among the different H2FPEF score groups (p=0.403). A H2FPEF score >1 was associated with an increased risk regardless of the presence or absence of myocardial ischemia (Figure 1D). Conclusions: H2FPEF score is a useful prognostic tool in suspected HFpEF, regardless of echocardiographic presence or absence of ischemia.