Discriminative Role of Invasive Left Heart Catheterization in Patients Suspected of Heart Failure With Preserved Ejection Fraction

Abstract

Background Recently, diastolic stress testing and invasive hemodynamic measurements have been emphasized for diagnosis of heart failure with preserved ejection fraction (HFpEF) because when determined using noninvasive parameters it can fall into a nondiagnostic intermediate range. The current study evaluated the discriminative and prognostic roles of invasive measured left ventricular end‐diastolic pressure in the population with suspected HFpEF, particularly for patients with intermediate Heart Failure Association Pre‐test Assessment, Echocardiography & Natriuretic Peptide, Functional Testing, Final Etiology (HFA‐PEFF) score. Methods and Results A total of 404 patients with symptoms or signs of HF and preserved left ventricular systolic function were enrolled. All subjects underwent left heart catheterization with left ventricular end‐diastolic pressure measurement for confirmation of HFpEF (≥16 mm Hg). The primary outcome was all‐cause death or readmission due to HF within 10 years. Among the study population, 324 patients (80.2%) were diagnosed as invasively confirmed HFpEF, and 80 patients (19.8%) were as noncardiac dyspnea. The patients with HFpEF showed a significantly higher HFA‐PEFF score than the patients with noncardiac dyspnea (3.8±1.8 versus 2.6±1.5, P <0.001). The discriminative ability of the HFA‐PEFF score for diagnosing HFpEF was modest (area under the curve, 0.70 [95% CI, 0.64–0.75], P <0.001). The HFA‐PEFF score was associated with a significantly higher 10‐year risk of death or HF readmission (per‐1 increase, hazard ratio [HR], 1.603 [95% CI, 1.376–1.868], P <0.001). Among the 226 patients with an intermediate HFA‐PEFF score (2–4), those with invasively confirmed HFpEF had a significantly higher risk of death or HF readmission within 10 years than the patients with noncardiac dyspnea (24.0% versus 6.9%, HR, 3.327 [95% CI, 1.109–16.280], P =0.030). Conclusions The HFA‐PEFF score is a moderately useful tool for predicting future adverse events in suspected HFpEF, and invasively measured left ventricular end‐diastolic pressure can provide additional information to discriminate patient prognosis, particularly in those with intermediate HFA‐PEFF scores. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04505449.

Comparing the value of left atrial strain and HFA-PEFF score in diagnosing heart failure with preserved ejection fraction: a cross-sectional study

“…However, evaluating this HFA-PEFF is a widely used scoring system for diagnosing HFpEF. However, evaluating this scoring system requires numerous parameters, including echocardiography, NT-proBNP, and atrial fibrillation diagnosis [17,25]. Through our study, LA strain indices have demonstrated an AUC equivalent to that of the HFA-PEFF score.…”

“…However, evaluating this scoring system requires numerous parameters, including echocardiography, NT-proBNP, and atrial fibrillation diagnosis [17,25]. Through In conclusion, LA parameters on speckle tracking echocardiography may be useful in diagnosing HFpEF and integration into the 2016 EACVI/ASE criteria will improve diagnostic effectiveness with accuracy not inferior to conventional echocardiographic parameters for diagnosing HFpEF.…”

Diagnosis of Heart Failure With Preserved Ejection Fraction Relies on Detection of Increased Diastolic Filling Pressure, But How?

“…In this issue of the Journal of the American Heart Association ( JAHA ), Ki Hong Choi et al publish an important study in a Korean population to show the diagnostic and prognostic value of left ventricular end‐diastolic pressure (LVEDP) in patients with suspected heart failure with preserved ejection fraction (HFpEF). 1 Of 404 patients with suspected HFpEF, LVEDP was ≥16 mm Hg in 80%, consistent with HFpEF, and this group of patients was found to have higher heart failure assoication‐pretest assessment, echocardiography, functional testing, and final etiology (HFA‐PEFF) scores than the 20% of patients with noncardiac dyspnea who had LVEDP <16 mm Hg. Although the HFA‐PEFF score was associated with a significantly higher 10‐year risk of death‐ or heart failure‐related events, the score was in the intermediate range for a significant proportion (56%) of the study patients.…”

Combination of SVI/S′ and diagnostic scores for heart failure with preserved ejection fraction

“…34 A portion of studies examined the value of the H 2 FPEF and HFA-PEFF scores for predicting unfavourable outcomes in HFpEF patients, and the conclusions are not consistent. Most studies have shown that both tools can be used to assessing HFpEF prognosis, 35,36 and higher scores are associated with more all-cause mortality and rehospitalisation, [37][38][39][40] including in patients with cardiac valve surgery or cardiac amyloidosis. [41][42][43] Compared to HFA-PEFF algorithm, H 2 FPEF score can also be useful to predetermine cardiovascular and HF-related events.…”