Akao Kousuke, Imamura Teruhiko, Tanaka Shuhei, Onoda Hiroshi, Ushijima Ryuichi, Sobajima Mitsuo, Fukuda Nobuyuki, Ueno Hiroshi, Kinugawa Koichiro
The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan.
J Clin Med. 2023 Aug 19;12(16):5396. doi: 10.3390/jcm12165396.
H2FPEF is a recently introduced score for the diagnosis of heart failure with preserved ejection fraction (HFpEF). Many patients with severe aortic stenosis have clinical/subclinical HFpEF and have worsening heart failure even after trans-catheter aortic valve replacement (TAVR). We investigated the prognostic impact of the H2FPEF score in TAVR candidates.
Patients undergoing TAVR procedures at a single academic center between 2015 and 2022 were included. The H2FPEF score was calculated using baseline characteristics before TAVR. The prognostic impact of the score on the post-TAVR composite endpoint, consisting of all-cause death and heart failure readmissions during the 2-year observation period, was evaluated.
A total of 244 patients (median age 86 years, 70 males) were included. The median value of H2FPEF score was 3 (2, 4). The score was significantly associated with the primary outcome with a hazard ratio of 1.33 (95% confidence interval 1.02-1.74, = 0.036). We constructed a modified H2FPEF score by adjusting cutoffs of several items for better prognostic stratification (i.e., age and body mass index). A modified score had a higher area under the curve than the original one (0.65 vs. 0.59, = 0.028) and was independently associated with the primary outcome with an adjusted hazard ratio of 1.22 (95% confidence interval 1.01-1.49, = 0.047).
A modified H2FPEF score, which was originally developed to diagnose the presence of HFpEF, could be used to risk-stratify elderly patients receiving TAVR. The clinical utility of this score should be validated in future studies.
H2FPEF是最近推出的用于诊断射血分数保留的心力衰竭（HFpEF）的评分系统。许多严重主动脉瓣狭窄患者存在临床/亚临床HFpEF，甚至在经导管主动脉瓣置换术（TAVR）后心力衰竭仍会恶化。我们研究了H2FPEF评分对TAVR候选患者的预后影响。
纳入2015年至2022年在单一学术中心接受TAVR手术的患者。使用TAVR前的基线特征计算H2FPEF评分。评估该评分对TAVR后复合终点的预后影响，复合终点包括2年观察期内的全因死亡和心力衰竭再入院。
共纳入244例患者（中位年龄86岁，男性70例）。H2FPEF评分的中位数为3（2，4）。该评分与主要结局显著相关，风险比为1.33（95%置信区间1.02 - 1.74，P = 0.036）。我们通过调整几个项目的临界值构建了改良的H2FPEF评分，以实现更好的预后分层（即年龄和体重指数）。改良评分的曲线下面积高于原始评分（0.65对0.59，P = 0.028），并且与主要结局独立相关，调整后的风险比为1.22（95%置信区间1.01 - 1.49，P = 0.047）。
最初用于诊断HFpEF的改良H2FPEF评分可用于对接受TAVR的老年患者进行风险分层。该评分的临床实用性应在未来研究中得到验证。
