The H2FPEF and HFA-PEFF Algorithms for Predicting Exercise Intolerance and Abnormal Hemodynamics in Heart Failure with Preserved Ejection Fraction
Abstract Exercise intolerance is a primary manifestation of patients with heart failure with preserved ejection fraction (HFpEF) and is associated with abnormal hemodynamics and poor quality of life. Two multiparametric scoring systems have been proposed to diagnose HFpEF. This study sought to determine the performance of the H2FPEF and HFA-PEFF scores for predicting exercise capacity and echocardiographic measures of intracardiac pressures during exercise. Patients with HFpEF (n = 83) and control subjects without HF (n = 104) underwent bicycle exercise echocardiography. In a subset, simultaneous expired gas analysis was performed to measure peak oxygen consumption (VO2). The H2FPEF score was obtainable in all patients while the HFA-PEFF score could not be calculated in 23 patients (feasibility 88%). Both H2FPEF and HFA-PEFF scores were correlated with higher E/e’ ratio (r = 0.49 and r = 0.46), lower systolic tricuspid annular velocity (r=-0.44 and =-0.24), and lower cardiac output (r=-0.28 and r=-0.24) during peak exercise. Peak VO2 and exercise duration decreased with increasing the H2FPEF score (r=-0.40 and r=-0.32), and the H2FPEF score predicted reduced aerobic capacity (AUC 0.71, p = 0.0005), but the HFA-PEFF score did not (p = 0.07). These data provide new insights into the role of the H2FPEF and HFA-PEFF scores for predicting exercise intolerance and abnormal hemodynamics in patients HFpEF.