Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Eur J Heart Fail. 2020 Mar;22(3):413-421. doi: 10.1002/ejhf.1614. Epub 2019 Dec 16.
Diagnosing heart failure with preserved ejection fraction (HFpEF) is challenging. The newly proposed HFA-PEFF algorithm entails a stepwise approach. Step 1, typically performed in the ambulatory setting, establishes a pre-test likelihood. The second step calculates a score based on echocardiography and natriuretic peptides. The aim of this study is to validate the diagnostic value and establish the clinical impact of the second step of the HFA-PEFF score.
The second step of the HFA-PEFF score was evaluated in two independent, prospective cohorts, i.e. the Maastricht cohort (228 HFpEF patients and 42 controls) and the Northwestern Chicago cohort (459 HFpEF patients). In Maastricht, the HFA-PEFF score categorizes 11 (4%) of the total cohort with suspected HFpEF in the low-likelihood (0-1 points) and 161 (60%) in the high-likelihood category (5-6 points). A high HFA-PEFF score can rule in HFpEF with high specificity (93%) and positive predictive value (98%). A low score can rule out HFpEF with a sensitivity of 99% and a negative predictive value of 73%. The diagnostic accuracy of the score is 0.90 (0.84-0.96), by the area under the curve of the receiver operating characteristic curve. However, 98 (36%) are classified in the intermediate-likelihood category, where additional testing is advised. The distribution of the score shows a similar pattern in the Northwestern (Chicago) and Maastricht HFpEF patients (53% vs. 65% high, 43% vs. 34% intermediate, 4.8% vs. 1.3% low).
This study validates and characterizes the HFA-PEFF score in two independent, well phenotyped cohorts. We demonstrate that the HFA-PEFF score is helpful in clinical practice for the diagnosis of HFpEF.
诊断射血分数保留的心力衰竭（HFpEF）具有挑战性。新提出的 HFA-PEFF 算法需要采用逐步方法。第 1 步通常在门诊环境中进行，确定初步的可能性。第二步基于超声心动图和利钠肽计算分数。本研究旨在验证第二步 HFA-PEFF 评分的诊断价值并确定其临床影响。
在两个独立的前瞻性队列中评估了 HFA-PEFF 评分的第二步，即马斯特里赫特队列（228 例 HFpEF 患者和 42 例对照）和西北芝加哥队列（459 例 HFpEF 患者）。在马斯特里赫特，HFA-PEFF 评分将总队列中 11 例（4%）疑似 HFpEF 患者分为低可能性（0-1 分）和 161 例（60%）高可能性类别（5-6 分）。高 HFA-PEFF 评分可高度特异性（93%）和阳性预测值（98%）诊断 HFpEF。低评分可排除 HFpEF，敏感性为 99%，阴性预测值为 73%。该评分的诊断准确性为 0.90（0.84-0.96），曲线下面积的接收器工作特征。然而，98 例（36%）被归类为中等可能性类别，建议进行额外检查。该评分的分布在西北（芝加哥）和马斯特里赫特 HFpEF 患者中具有相似的模式（53%为高，43%为中，4.8%为低）。
本研究在两个独立的、表型良好的队列中验证和描述了 HFA-PEFF 评分。我们证明 HFA-PEFF 评分有助于临床诊断 HFpEF。
