Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems
In order to stratify the risk of having Heart failure with preserved ejection fraction (HFpEF) in patients with dyspnea, two scoring systems namely H2FPEF and HFA-PEFF score is being developed. However, there are limited studies comparing the diagnostic and prognostic potency of the two HFpEF scoring systems. Vibhu Parcha and colleague conducted a study titled “Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems” published in the ESC heart failure journal. The summary of the study is given below:
Objective:
To compare the generalizability and prognostic implications of HFpEF scores in Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction (RELAX) and Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial participants
To compare the diagnostic utility of the scores in matched controls from the Atherosclerosis Risk in Community (ARIC) study
Method:
Subjects were categorized as having a low, intermediate, or high likelihood of HFpEF based on the respective scores from the TOPCAT, RELAX, and ARIC studies. In individuals who had unexplained dyspnea; age, sex, and race-matched controls free of cardiovascular disease were used to evaluate the diagnostic performance. Multivariable-adjusted Cox regression analyses were used to assess the prognostic value of scores.
Findings:
Investigators report that both the scores are effective in ruling out HFpEF and can be used to for the diagnosis of HFpEF. Additionally, the HFA-PEFF and H2FPEF scores may also anticipate the risk for the development of adverse cardiovascular events. The study reports that the H2FPEF score has simplified scoring and high validity. Hence, it can be used in clinical settings as a reliable surrogate for underlying functional capacity in patients with HFpEF. On the other hand, the HFA-PEFF scoring system offers a greater focus on cardiac morphological features, biomarkers, and functional testing.
Both scoring systems have clear benefits for clinical use with the potential to allow diagnosis for the differentiation of HFpEF from many overlapping cardiorespiratory syndromes. The prognostic value of both scoring systems might also have significant benefits for clinical practice in order to select an optimal treatment approach.
Limitation:
The authors highlight several limitations such as participants in the trial were presumed to have HFpEF. Secondly, the HFpEF definitions differed in both trials. Although two systems score the patients on a different scale, the same point was directly compared between the two systems. There is a chance of selection bias as only a subset of the trial population with available data was included in the analyses. Due to the study design, investigators failed to estimate the results of Step 3 of the HFA-PEFF algorithm (invasive and/or exercise testing). Lastly, small sample size was included in the study.
Authors acknowledge future studies with a larger cohort of suspected HFpEF patients with gold standard invasive hemodynamic metrics in verifying the diagnostic validity and prognostic ability of the scoring systems.
Image Credit : Heart photo created by jcomp – www.freepik.com
