Heart failure with preserved ejection fraction: diagnostic value of HFA-PEFF score, H₂FPEF score, and the diastolic stress echocardiography.

Abstract

The aim of our study was to compare 3 diagnostic pathways: diastolic stress echocardiography (DSE) based on the ASE/EACVI 2016 guidelines, the 2018 H₂FPEF score, and the 2019 HFA-PEFF algorithm, in patients suspected of heart failure with preserved ejection fraction (HFpEF). The study group included 80 consecutive patients with a clinical suspicion of HFpEF. The H₂FPEF and HFA-PEFF scores and serum NT-proBNP concentrations were assessed in all the patients before they were sent for DSE. The DSE-based pathway confirmed HFpEF in 17 (21%) patients, the HFA-PEFF algorithm in 43 (54%), and H₂FPEF scoring in 4 (5%) patients. The ROC analysis showed that HFA-PEFF score > 5 predicts a DSE-positive test with a sensitivity of 70.5% and a specificity of 65%, (AUC = 0.711, p = 0.002) with a negative predictive value of 89.1% and positive predictive value of 35.3%. The H₂FPEF score > 3 had a negative predictive value of 90%, a positive predictive value of 29.8%, and predicted positive DSE result with a sensitivity of 82.3% but rather poor specificity of 47.6% (AUC = 0.692, p = 0.004). Both H₂FPEF and HFA-PEFF showed similar predictive values (AUC) in the prediction of positive DSE test (p = ns). The HFA-PEFF score overestimated the rate of HFpEF in comparison to DSE and the H₂FPEF score. The H₂FPEF and HFA-PEFF scores showed only modest predictive values of the positive DSE and had a diagnostic power to rule out the HFpEF.