Development and validation of a diagnostic prediction model reminiscent of systemic inflammation and organ interaction in heart failure preserved ejection fraction (HFpEF) patients

Abstract

Purpose Systemic inflammation and reciprocal organ interactions are associated with the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Herein, we proposed a simple diagnostic model with markers from complete routine blood test as well as liver and renal dysfunction for HFpEF. Patients and methods: This is a hospital-based single-center, cross-sectional observation study. 1808 eligible patients with documented cardiovascular diseases were enrolled. HFpEF was diagnosed independently by two expert cardiologists according to the clinical manifestation, echocardiography and the N-Terminal pro B-type natriuretic peptide. A diagnostic model for HFpEF was developed by logistic regression and assessed by ROC and Brier score. Then, the model was validated by the 10-fold cross-validation and presented as nomogram and a web-based online risk calculator as well. Results Patients with HFpEF account for 47.23% in development data. Univariate, multivariate and LASSO regression analysis revealed that age, Hb, NLR, AST/ALT ratio, Cr, UA, atrial fibrillation, and pulmonary arterial hypertension were associated with HFpEF. The predictive model exhibited reasonably accurate discrimination (ROC, 0.753, 95% CI, 0.732 to 0.772) and calibration (Brier score was 0.200). Subsequent internal validation showed good discrimination and calibration (AUC = 0.750, Brier score was 0.202). Conclusion Our new diagnostic model incorporating markers of inflammation, liver-heart and kidney-heart interactions has the predictive ability for HFpEF, and may be helpful for timely diagnosis of patients with HFpEF.