Prognostic value of the H₂FPEF score in patients undergoing transcatheter aortic valve implantation

Abstract

Aims The aim of this study was to assess the prognostic value of the H2FPEF score in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) and preserved left ventricular ejection fraction (EF). Methods and results In this multicentre study, a total of 832 patients from two German high‐volume centres, who received TAVI for severe AS and preserved EF (≥50%), were identified for calculation of the H2FPEF score. Patients were dichotomized according to low (0–5 points; n = 570) and high (6–9 points; n = 262) H2FPEF scores. Kaplan–Meier and Cox regression analyses were applied to assess the prognostic impact of the H2FPEF score. We observed a decrease in stroke volume index (−2.04 mL/m2/point) and mean transvalvular gradients (−1.14 mmHg/point) with increasing H2FPEF score translating into a higher prevalence of paradoxical low‐flow, low‐gradient AS among patients with high H2FPEF score. One year after TAVI, the rates of all‐cause (low vs. high H2FPEF score: 8.0% vs. 19.4%, P < 0.0001) and cardiovascular (CV) mortality (1.9% vs. 9.0%, P < 0.0001) as well as the rate of CV mortality or rehospitalization for congestive heart failure (6.4% vs. 23.2%, P < 0.0001) were higher in patients with high H2FPEF score compared with those with low H2FPEF score. After multivariable analysis, a high H2FPEF score remained independently predictive of all‐cause mortality [hazard ratio 1.59 (1.28–2.35), P = 0.018] and CV mortality or rehospitalization for congestive heart failure [hazard ratio 2.92 (1.65–5.15), P < 0.001]. Among the H2FPEF score variables, atrial fibrillation, pulmonary hypertension, and elevated left ventricular filling pressure were the strongest outcome predictors. Conclusions The H2FPEF score serves as an independent predictor of adverse CV and heart failure outcome among TAVI patients with preserved EF. A high H2FPEF score is associated with the presence of paradoxical low‐flow, low‐gradient AS, the HFpEF in patients with AS. By identifying patients in advanced stages of HFpEF, the H2FPEF score might be useful as a risk prediction tool in patients with preserved EF scheduled for TAVI.

Prognostic Value of HFA-PEFF Score in Patients Undergoing Transcatheter Aortic Valve Implantation

“…It proved its value as an independent predictor of adverse outcomes [18]. Contrary to our results regarding the HFA-PEFF score, a higher H2PEF score acted as an independent predictor of adverse cardiovascular and heart failure outcomes among patients with preserved EF undergoing TAVI [19].…”

HFA‐PEFF score: prognosis in patients with preserved ejection fraction after transcatheter aortic valve implantation

“…This was also observed in the study using the H 2 FPEF score in TAVI patients. 23 It should be noted that the HFA-PEFF score in our study was presumably still influenced by the haemodynamic effects caused by long-standing AS. Based on our study design, caution should thus be exercised when making a definitive diagnosis of HFpEF in our patient cohort despite the fact that the patient characteristics are highly indicative of HFpEF.…”

“…A recent study found that the H 2 FPEF score, another score that has been developed to facilitate the diagnosis of HFpEF, was an independent predictor of all-cause mortality and a composite of cardiovascular mortality or heart failure rehospitalization in patients with preserved ejection fraction undergoing TAVI. 23 The H 2 FPEF score is based on evaluation of clinical and echocardiographic characteristics, whereas the HFA-PEFF score includes echocardiographic morphological and functional parameters and a biomarker. 12,24 In contrast to the aforementioned study, the parameters for the calculation of the HFA-PEFF score in our analysis were obtained after TAVI, that is, after the correction of AS.…”

“…A difference in pacemaker implantations was not noted between patients with high vs. low scores in the study investigating the H 2 FPEF score. 23 Patients with HFpEF have a worse prognosis than those without heart failure, and patients in the advanced stages of AS and HFpEF have been reported to be at increased risk. Some studies have found that among TAVI patients with severe AS, in-hospital mortality rates were similar in those with HFpEF and those with heart failure with a reduced ejection fraction, while others have found a better prognosis at 1 year in those with HFpEF compared with those with reduced ejection fraction.…”

Impact of Modified H₂FPEF Score on Chronic Limb-Threatening Ischemia in Patients With Lower Extremity Artery Disease Who Underwent Endovascular Therapy

“…15 Regarding the H2FPEF score, research attention has shifted from diagnostic markers for HFpEF to prognostic markers in a broad spectrum of heart diseases. [16][17][18] In addition, the Atherosclerosis Risk in Communities (ARIC) study used the H2FPEF score with community participants with no other common cardiopulmonary causes of dyspnea and found increase in the incidence of HF hospitalization or deaths with increasing L ower extremity artery disease (LEAD) is an arterial occlusive disease of the lower limb arteries associated with increased morbidity and mortality. [1][2][3][4][5] Despite advances in revascularization of LEAD, chronic limbthreatening ischemia (CLTI) in end-stage LEAD remains an important medical issue, resulting in limb amputation and extremely high mortality rates.…”