Application of the H<sub>2</sub>FPEF score to a global clinical trial of patients with heart failure with preserved ejection fraction: the TOPCAT trial

Myhre, Peder L.; Vaduganathan, Muthiah; Claggett, Brian; Lam, Carolyn S.P.; Desai, Akshay S.; Anand, Inder; Sweitzer, Nancy K.; Fang, James C.; O’Meara, Eileen; Shah, Sanjiv J.; Shah, Amil M.; Lewis, Eldrin F.; Rouleau, Jean L.; Pitt, Bertram; Solomon, Scott D.

doi:10.1002/ejhf.1542

Cited by 21 publications

(23 citation statements)

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“…Both the HFA-PEFF and H 2 FPEF scores have been reported to have important prognostic implications in predicting adverse clinical events in patients with HFpEF. 10,11,16,17 Our results differ from the prior works in the TOPCAT trial due to differences in the population selection and analytical approach. The findings from our study add to the growing evidence for the prognostic value of both the scoring systems and their use in daily practice for risk stratification of HFpEF patients.…”

Section: Discussioncontrasting

confidence: 96%

“…10,25 Our findings substantiate the diagnostic validity of the HFA-PEFF and H 2 FPEF scoring systems for the identification of HFpEF patients. 10,11,16,17 We also advance these findings by comparing the two study cohorts with a group of individuals that had a low pre-test probability of cardiovascular disease to identify test characteristics. The differences in scores within the TOPCAT and RELAX cohorts highlight the significant heterogeneity in the populations identified and classified by the two scores.…”

Section: Discussionmentioning

confidence: 92%

“…Analyses were adjusted for age, sex, race (Whites vs. non-White), body mass index, enrolment strata (hospitalization vs. natriuretic peptides), and treatment group. 16,17 The Kaplan-Meier method was used to plot the cumulative incidence of cardiovascular events by score categories. The log-rank test was used to compare the outcome across the categories of the two scoring systems.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems

et al. 2021

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Aims We sought to compare the generalizability and prognostic implications of heart failure with preserved ejection fraction (HFpEF) scores (HFA-PEFF and H 2 FPEF score) in Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) and Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction (RELAX) trial participants and matched controls from the Atherosclerosis Risk in Community (ARIC) study. Methods and results Based on the respective scores, the study participants from the TOPCAT (N = 356), RELAX (N = 216), and ARIC (N = 379) studies were categorized as having a low, intermediate, or high likelihood of HFpEF. Age, sex, and race matched controls free of cardiovascular disease who had unexplained dyspnoea were used to evaluate the diagnostic performance. The prognostic value of scores was assessed using multivariable-adjusted Cox regression analyses. The median HFA-PEFF scores in the TOPCAT, RELAX, and ARIC studies were 5.0 [interquartile range (IQR): 5.0-6.0], 4.0 (IQR: 2.0-4.0), and 3.0 (IQR: 2.0-4.0), respectively. The median H 2 FPEF scores in the three studies were 5.5 (IQR: 4.0-7.0), 6.0 (IQR: 4.0-7.0), and 3.0 (IQR: 2.0-5.0), respectively. A low HFA-PEFF and H 2 FPEF score can rule out HFpEF with high sensitivity (99.5% and 99.6%, respectively) and negative predictive value (95.7% and 98.3%, respectively). A high HFA-PEFF and H 2 FPEF score can rule-in HFpEF with good specificity (82.8% and 95.6%, respectively) and positive predictive value (79.9% and 90.4%, respectively). Among TOPCAT participants, the hazard for adverse cardiovascular events per point increase in HFA-PEFF and H 2 FPEF score was 1.26 (95% confidence interval: 0.98-1.63) and 1.01 (95% confidence interval: 0.88-1.15), respectively. A higher H 2 FPEF score was associated with lower peak oxygen intake in RELAX trial participants (adjusted P = 0.01). Conclusions The HFA-PEFF and the H 2 FPEF scores are reliable diagnostic tools for HFpEF. The prognostic utility of HFpEF scores requires further validation in larger rigorously phenotyped populations.

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems

et al. 2021

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“…Recently, the H 2 FPEF score has been extrapolated to the TOPCAT trial in two independent analyses and a Canadian HF cohort, observing that the score has a high sensitivity and specificity to diagnose HFpEF and can be a helpful tool to detect regional heterogeneity with, however, lower sensitivity in the Canadian cohort. [15][16][17] The HFA-PEFF score uses a more comprehensive stepwise approach including more known pathophysiologic markers for the presence of HFpEF.…”

Section: Need For Validated Diagnostic Criteriamentioning

confidence: 99%

Validation of the HFA‐PEFF score for the diagnosis of heart failure with preserved ejection fraction

Aizpurua

Wijk

Rocca

et al. 2019

European J of Heart Fail

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Aims Diagnosing heart failure with preserved ejection fraction (HFpEF) is challenging. The newly proposed HFA‐PEFF algorithm entails a stepwise approach. Step 1, typically performed in the ambulatory setting, establishes a pre‐test likelihood. The second step calculates a score based on echocardiography and natriuretic peptides. The aim of this study is to validate the diagnostic value and establish the clinical impact of the second step of the HFA‐PEFF score. Methods and results The second step of the HFA‐PEFF score was evaluated in two independent, prospective cohorts, i.e. the Maastricht cohort (228 HFpEF patients and 42 controls) and the Northwestern Chicago cohort (459 HFpEF patients). In Maastricht, the HFA‐PEFF score categorizes 11 (4%) of the total cohort with suspected HFpEF in the low‐likelihood (0–1 points) and 161 (60%) in the high‐likelihood category (5–6 points). A high HFA‐PEFF score can rule in HFpEF with high specificity (93%) and positive predictive value (98%). A low score can rule out HFpEF with a sensitivity of 99% and a negative predictive value of 73%. The diagnostic accuracy of the score is 0.90 (0.84–0.96), by the area under the curve of the receiver operating characteristic curve. However, 98 (36%) are classified in the intermediate‐likelihood category, where additional testing is advised. The distribution of the score shows a similar pattern in the Northwestern (Chicago) and Maastricht HFpEF patients (53% vs. 65% high, 43% vs. 34% intermediate, 4.8% vs. 1.3% low). Conclusion This study validates and characterizes the HFA‐PEFF score in two independent, well phenotyped cohorts. We demonstrate that the HFA‐PEFF score is helpful in clinical practice for the diagnosis of HFpEF.

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“…The generalizability and prognostic value of the score have been demonstrated in several independent analyses. [25][26][27][28] 24 Interestingly, the use of NTproBNP levels did not incrementally add the diagnostic ability to the H 2 FPEF score. 24 A major advantage of the H 2 FPEF score is that the probability that HFpEF is the cause of symptoms can be estimated accurately, which helps to guide further evaluation.…”

Section: H 2 Fpef Scorementioning

confidence: 99%

<p>Diagnosis and Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): Current Perspectives and Recommendations</p>

Джиоева¹,

Belyavskiy²

2020

TCRM

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Heart failure with preserved ejection fraction (HFpEF) is a major global public health problem. Diagnosis of HFpEF is still challenging and built based on the comprehensive echocardiographic analysis. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. This review attempts to summarize the current advances in the diagnosis of HFpEF and provide future directions of the patients´ management with this very widespread, heterogeneous clinical syndrome.

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Application of the H₂FPEF score to a global clinical trial of patients with heart failure with preserved ejection fraction: the TOPCAT trial

Cited by 21 publications

References 8 publications

Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems

Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems

Validation of the HFA‐PEFF score for the diagnosis of heart failure with preserved ejection fraction

<p>Diagnosis and Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): Current Perspectives and Recommendations</p>

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Application of the H2FPEF score to a global clinical trial of patients with heart failure with preserved ejection fraction: the TOPCAT trial

Cited by 21 publications

References 8 publications

Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems

Diagnostic and prognostic implications of heart failure with preserved ejection fraction scoring systems

Validation of the HFA‐PEFF score for the diagnosis of heart failure with preserved ejection fraction

<p>Diagnosis and Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): Current Perspectives and Recommendations</p>

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Application of the H₂FPEF score to a global clinical trial of patients with heart failure with preserved ejection fraction: the TOPCAT trial