Diagnostic performance of H2FPEF and HFpEF-ABA scores in patients with preserved ejection fraction and structural hallmarks of HFpEF
A Rocca, C Ryan, J Richiardi, R B van Heeswijk, J Banus, C Georgantas, P Meyer, A Masi, P Antiochos, P Monney, H Lu, J Schwitter, R HullinAbstract
Introduction
The HFpEF-ABA and H2FPEF scores estimate the likelihood of HFpEF diagnosis in dyspneic patients with preserved left ventricular ejection fraction (LVEF). The performance of these scores in patients with structural changes compatible with HFpEF, regardless of the presence of clinical features or symptoms of heart failure (HF), is unknown.
Purpose
To evaluate the diagnostic performance of the HFpEF-ABA and H2FPEF scores in a cohort composed of patients with LVEF ≥50% and increased left ventricular mass index (LVMI ≥70 g/m2) regardless of the presence or absence of clinical features of HF.
Methods
In this retrospective monocentric study at our Hospital, we included 542 unique individuals with preserved LVEF, increased LVMI, and available echocardiography within 3 months, identified from 19,535 CMR examinations performed between 2010 and 2024. Patients with infiltrative or hypertrophic cardiomyopathy, severe valvular heart disease, or missing key data were excluded. Clinically diagnosed HFpEF was defined based on ICD-10 coding documented in medical records. Diagnostic performance of the HFpEF-ABA and H2FPEF scores was assessed by calculating AUC, sensitivity and specificity. Sensitivity and specificity were derived using an optimal cutoff ≥0.7 for HFpEF-ABA determined by the Youden index and a predefined cutoff ≥6 for H2FPEF.
Results
Dyspnea of cardiac origin was present in 61.1% of patients; 10.5% had clinically diagnosed HFpEF. The HFpEF-ABA and H2FPEF scores demonstrated high specificity (87.6% and 96.1%) but limited sensitivity (36.8% and 26.3%), with modest discrimination (AUC 0.66 and 0.73; DeLong p=0.011) for HFpEF detection.
Conclusion
In patients with structural HFpEF hallmarks on CMR but regardless of the presence or absence of HF symptoms, the HFpEF-ABA and H2FPEF scores reliably identify true negatives. However, sensitivity remains low, limiting their ability to detect HFpEF in this population. These findings highlight the need for refined diagnostic approaches in early-stage or subclinical HFpEF.Study population flowchart.ROC curves