High H2FPEF Score Research Articles

The relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction

Background The Synergy between Percutaneous Coronary Intervention (SYNTAX) score, has been used to estimate the extent and complexity of coronary artery disease (CAD). The H2FPEF score enables robust discrimination of heart failure with preserved ejection fraction (HFpEF) from non-cardiac aetiologies of dyspnea. In the present study, we aimed to investigate the relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction (NSTEMI). Method Two hundred eighty two consecutive patients with NSTEMI who underwent coronary angiographic examination were enrolled in this study. The H2FPEF score was calculated for each patient on admission. All patients underwent coronary angiography within 2 days following their admission. The SYNTAX scoring system was used to evaluate the severity and extent of CAD. Results The mean H2FPEF Score [3(2–4) vs 1(0.5–1.5), p < .001] and the frequencies of diabetes mellitus, hypertension and, atrial fibrillation were significantly higher and LVEF was significantly lower in patients with high SYNTAX score. High H2FPEF Score (OR: 3.61, 95%CI: 2.64–4.93; p = .001) and low left ventricular ejection fraction (OR: 0.94, 95%CI: 0.89–0.98; p = .013) were found to be independent associates for high SYNTAX score. H2FPEF Score above a cut-off level of 2.5 predicted high SYNTAX score with a sensitivity of 80% and a specificity of 82.5% (AUC: 0.890; 95%CI: 0.848–0.931; p < .001). There was a significant and moderate positive correlation between H2FPEF and SYNTAX Scores (r = 0.694, p < .001). Conclusion High H2FPEF score may be associated with high SYNTAX score and may be used to estimate the extent and complexity of CAD in NSTEMI patients.

The ventilatory abnormalities and prognostic values of H2 FPEF score in dyspnoeic patients with preserved left ventricle systolic function.

AimsHeart failure with preserved ejection fraction (HFpEF) is one of the major diagnoses in dyspnoeic subjects, and H2FPEF score enables robust differentiation of HFpEF. Given ventilatory abnormalities prevail in subjects with HFpEF, the associations between H2FPEF score and pulmonary function remain to be elucidated.Methods and resultsSubjects who presented with exertional dyspnoea and had left ventricular ejection fraction of >50% were eligible for this study. Total lung capacity, forced expiratory volume in the 1 s, and forced vital capacity (FVC) were obtained by pulmonary function tests. Pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e'), and left ventricular mass (LVM) were measured by echocardiogram. Among a total of 5849 participants (65.6 ± 6.4 years, 54% men), 2453 (41.9%) had low H2FPEF score (0 ~ 1) and 160 (2.7%) had high H2FPEF score,6~9 respectively. Subjects with high H2FPEF score were older and had higher proportion of restrictive and obstructive defect, more morbidities, poorer renal function, lower haemoglobin, higher LVM, E/e' ratio, and PASP. During a mean follow‐up duration of 30.0 ± 20.5 months, the H2FPEF score was significantly associated with mortality [hazard ratio and 95% confidence intervals, 1.063(1.010–1.18)], independent of sex, haemoglobin, renal function, LVM, and comorbidities.ConclusionsEither obstructive or restrictive ventilation defects prevail in subjects with high H2FPEF score, indicating chronic obstructive pulmonary disease (COPD) is commonly associated with HFpEF. In addition, H2FPEF score was correlated with long‐term survival in dyspnoeic subjects with or without concomitant diseases of HFpEF and COPD.

Association of the H2FPEF Risk Score with Recurrence of Atrial Fibrillation Following Pulmonary Vein Isolation.

While atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) commonly coexist, the efficacy of pulmonary vein isolation in the setting of HFpEF is unclear. In a cohort of patients who underwent cryoballoon ablation (CBA) from 2011 to 2016, we calculated the H2FPEF risk score, a novel 6-item score (scale: 0-9 points) that accurately predicts the probability of HFpEF. We compared characteristics of patients by H2FPEF score and evaluated the association of H2FPEF score with 12-month recurrence of AF post-procedure. Of patients with available data to calculate the H2FPEF score (n=105), the median H2FPEF score was 5 (interquartile range: 4-6), corresponding to >80% probability of HFpEF. Compared to patients with H2FPEF scores ≤4 (n=34), patients with H2FPEF scores of 5 and 6 (n=46) and ≥7 (n=25) carried higher rates of hypertension (≤4: 21% vs. 5 and 6: 63% vs. ≥7: 88%, P<0.001) and diabetes (≤4: 0% vs. 5 and 6: 9% vs. ≥7: 32%, P=0.001). The overall 12-month recurrence rate of AF was 21%. There was no association between H2FPEF score and recurrence of AF at 12 months (OR per SD increase in log-H2FPEF score: 0.87, 95% CI: 0.54-1.40, P=0.57). Among patients undergoing CBA for AF, median H2FPEF scores are elevated, and screening for occult HFpEF may be warranted in this population. There was no association of the H2FPEF score and AF recurrence at 12 months, suggesting efficacy of CBA even among patients with high H2FPEF scores.

H2FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors

AimsThe prediction of future heart failure (HF) in stable outpatients is often difficult for general practitioners and cardiologists. Recently, the H2FPEF score (0–9 points) has been proposed for the discrimination of HF with preserved ejection fraction from non‐cardiac causes of dyspnoea. The six clinical and echocardiographic variables that constitute the H2FPEF score include the following: (i) obesity (H); (ii) the use of ≥2 antihypertensive drugs (H); (iii) atrial fibrillation (F); (iv) pulmonary hypertension (P); (v) an age > 60 years (E); and (vi) E/e' > 9 (F). We performed an external validation study that investigated whether the H2FPEF score could predict future HF‐related events in stable outpatients with cardiovascular risk factor(s) in Japan.Methods and resultsIn this prospective cohort study, after exclusion of 195 from 551 consecutive, stable Japanese outpatients with at least one cardiovascular risk factor who were enrolled between September 2010 and July 2013, the remaining 356 outpatients (171 men, 185 women, mean age 73.2 years) were eligible for the analysis. We calculated the H2FPEF score (0–9 points), and followed up the patients for an average of 517 days. In all of the 356 patients, the mean H2FPEF score was 3.1 ± 1.8, and 15 developed HF‐related events during the follow‐up period, including cardiovascular death (n = 2) and hospitalization for HF decompensation (n = 13). Multivariate Cox proportional hazards analysis showed that the H2FPEF score was an independent predictor of future HF‐related events (P < 0.001 for all three models). Kaplan–Meier survival curves showed a significantly higher probability of HF‐related events in the outpatients with a high H2FPEF score (P < 0.001). In receiver operating characteristic (ROC) curve analysis, the H2FPEF score was significantly associated with the occurrence of future HF‐related events (P < 0.001). In ROC curve analysis, the sensitivity, specificity, and positive likelihood ratio of a H2FPEF score of 7 points to predict HF‐related events were 47%, 96%, and 11.4%, respectively.ConclusionsThe H2FPEF score could provide useful information for future HF‐related events in stable outpatients with cardiovascular risk factor(s) in Japan.

H2FPEF Score for the Prediction of Exercise Intolerance and Abnormal Hemodynamics in Japanese - Evaluation by Exercise Stress Echocardiography Combined With Cardiopulmonary Exercise Testing.

Both the H2FPEF-score and nomogram-score, which consist of simple clinical parameters, can assist in diagnosing "early" heart failure with preserved ejection fraction (HFpEF) and only exertional dyspnea, but their these usefulness in Japanese remains unclear. We sought to investigate the correlation between these scores and exercise response, including the peak oxygen uptake (V̇O2), the pulmonary artery systolic pressure (PASP), the ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e') and stroke volume (SV) using exercise stress echocardiography (ESE) combined with cardiopulmonary exercise testing (CPET).Methods and Results:In this single-center, retrospective cross-sectional study the H2FPEF-score and nomogram-score were calculated in a total of 139 patients who underwent ESE combined with CPET. The scores correlated with peak V̇O2(r=-0.48, r=-0.44), PASP (r=0.23, r=0.29) and SV (r=-0.32, r=-0.19) at peak exercise. The nomogram-score correlated with E/e' (r=0.24). The prevalence of exercise intolerance (percent predicted peak V̇O2<75% and <50%) increased as the H2FPEF-score increased and reached 88.9% and 22.2% among the patients with high H2FPEF-score (6-9 points). The H2FPEF-score may be useful as the initial step to diagnosing 'early' HFpEF. The nomogram-score may be more useful in Japanese because of its more universal association with exercise response than the H2FPEF-score.

P3858High H2FPEF score is an independent predictor of adverse outcome in patients with severe aortic stenosis and preserved ejection fraction undergoing TAVR

Abstract Background Recently, the H2FPEF score has been developed in an evidence-based approach relying on simple clinical and echocardiographic variables. It enables the identification of patients with high probability of prevalent heart failure with preserved ejection fraction (HFpEF) which is associated with a dismal prognosis. Left ventricular diastolic dysfunction, a key mechanism in HFpEF, is also a common finding in patients with severe aortic stenosis. Objective To assess the prognostic impact of the H2FPEF score in patients with preserved ejection fraction and severe aortic stenosis undergoing Transcatheter Aortic Valve Replacement (TAVR). Methods Among 1148 patients with preserved ejection fraction who received TAVR at our institution between 2013 and 2018, data for calculation of the H2FPEF score was available in 535 patients. Score variables include BMI &gt;30 kg/m2, arterial hypertension, atrial fibrillation, pulmonary hypertension &gt;35 mmHg, age &gt;60 years, and elevated LV filling pressure. Patients were dichotomized according to “low” (1–5 points; n=377) and “high” H2FPEF scores (6–9; n=158). Kaplan-Meier survival curves and Cox regression analyses were used to assess the prognostic impact of H2FPEF scores. Median follow-up time was 0.3 years. Results TAVR patients presenting with high H2FPEF scores had higher prevalence of moderate to severe mitral regurgitation (19.4% vs. 33.6%, p&lt;0.001) as well as tricuspid regurgitation (15.2% vs. 35.1%, p&lt;0.001), and presented with lower stroke volume index (42.2 ml/m2 vs. 36.0 ml/m2, p&lt;0.001) compared to those with low H2FPEF scores. All-cause mortality one year after TAVR was significantly higher in patients in the high H2FPEF score group (10.5% vs. 21.0%, p=0.0019, Figure 1). Multivariate analysis revealed a high H2FPEF score to be independently predictive for 1-year all-cause mortality (HR 2.66, 95% CI: 1.41–5.02, p=0.025). Among the single H2FPEF score variables, atrial fibrillation (HR 3.45, 95% CI: 1.86–6.40, p&lt;0.001) and systolic pulmonary hypertension &gt;55 mmHg (HR=2.68, 95% CI: 0.97–7.40, p=0.057) were strong independent predictors of adverse outcome. Figure 1. All-cause mortality of patients undergoing TAVR after one year stratified by low (1–5 points) and high (6–9) H2FPEF score Conclusion An elevated H2FPEF score of &gt;6 is independently predictive for mortality in patients with preserved ejection fraction undergoing TAVR for severe aortic stenosis. Our findings provide evidence that the H2FPEF score, which was meant for diagnostic use originally, is able to serve as a prognostic tool in patients with preserved ejection fraction undergoing TAVR, highlighting the adverse impact of diastolic dysfunction in patients with preserved ejection fraction and aortic stenosis.