H2FPEF and HFA-PEFF scores performance and the additional value of cardiac structure and function in patients with atrial fibrillation

Abstract

BackgroundThe H2FPEF and the HFA-PEFF scores have become useful tools to diagnose heart failure with preserved ejection fraction (HFpEF). Their accuracy in patients with a history of atrial fibrillation (AF) is less known. This study evaluates the association of these scores with invasive left atrial pressure (LAP) and the additional value of cardiac measures. MethodsThis is a multicenter observational prospective study involving patients undergoing ablation of AF. Patients with left ventricular ejection fraction (LVEF) < 40%, congenital cardiopathy, any severe cardiac valve disease and prosthetic valves were excluded. Elevated filling pressure was defined as a mean LAP ≥15 mmHg. ResultsA total of 135 patients were enrolled in the study (mean age 65.2 ± 9.1 years, 32% female, mean LVEF 56.9 ± 7.9%). Patients with H2FPEF ≥ 6 or HFA-PEFF ≥5 had higher values of NTproBNP and more impaired cardiac function. However, neither H2FPEF nor HFA-PEFF score showed a meaningful association with elevated mean LAP (respectively, OR 1.05 [95%CI 0.83–1.34] p = 0.64, and OR 1.09 [95%CI: 0.86–1.39] p = 0.45). The addition of LA indexed minimal volume (LAVi min) improved the ability of the scores (baseline C-statistic 0.51 [95%CI 0.41–0.61] for the H2FPEF score and 0.53 [95%CI 0.43–0.64] for the HFA-PEFF score) to diagnose elevated filling pressure (H2FPEF + LAVi min: C-statistic 0.70 [95%CI 0.60–0.80], p-value = 0.005; HFA-PEFF + LAVi min: C-statistic 0.70 [95%CI 0.60–0.80], p-value = 0.02). ConclusionIn a cohort of patients with a history of AF, the use of the available diagnostic scores did not predict elevated mean LAP. The integration of LAVi min improved the ability to correctly identify elevated filling pressure.