Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye.
Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye.
Anatol J Cardiol. 2023 Sep;27(9):539-548. doi: 10.14744/AnatolJCardiol.2023.3345.
Heart failure with preserved ejection fraction is a complex and heterogeneous clinical syndrome, poses significant diagnostic challenges. The HFA-PEFF [Heart Failure Association of ESC diagnostic algorithm, P (Pretest Assessment), E (Echocardiographic and Natriuretic Peptide score), F1 (Functional testing in Case of Uncertainty), F2 (Final Aetiology)] and H2FPEF [Heavy (BMI>30 kg/m2), Hypertensive (use of ≥2 antihypertensive medications), atrial Fibrillation (paroxysmal or persistent), Pulmonary hypertension (Doppler Echocardiographic estimated Pulmonary Artery Systolic Pressure >35 mm Hg), Elderly (age >60 years), Filling pressure (Doppler Echocardiographic E/e' >9)] scoring systems were developed to aid in diagnosing heart failure with preserved ejection fraction. This study aimed to assess the concordance and clinical accuracy of these scoring systems in the 'A comPrehensive, ObservationaL registry of heart faiLure with mildly reduced and preserved ejection fractiON' cohort.
A comPrehensive, ObservationaL registry of heart faiLure with mildly reduced and preserved ejection fractiON study was conducted as a multicenter, cross-sectional, and observational study; to evaluate a group of Heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction patients who were seen by cardiologists in 13 participating centers across 12 cities in Türkiye.
The study enrolled 819 patients with heart failure with preserved ejection fraction, with high probability heart failure with preserved ejection fraction rates of 40% and 26% for HFA-PEFF and H2FPEF scorings, respectively. The concordance between the 2 scoring systems was found to be low (Kendall's taub correlation coefficient of 0.242, P < .001). The diagnostic performance of both scoring systems was evaluated, revealing differences in their approach and ability to accurately identify heart failure with preserved ejection fraction patients.
The low concordance between the HFA-PEFF and H2FPEF scoring systems underscores the ongoing challenge of accurately diagnosing and managing patients with heart failure with preserved ejection fraction. Clinicians should be aware of the strengths and limitations of each scoring system and use them in conjunction with other clinical and laboratory findings to arrive at an accurate diagnosis. Future research should focus on identifying additional diagnostic factors, developing more accurate and comprehensive diagnostic algorithms, and investigating alternative methods of diagnosis or stratification of patients based on different clinical characteristics.
射血分数保留的心力衰竭是一种复杂且异质的临床综合征，诊断极具挑战性。HFA-PEFF [心力衰竭协会 ESC 诊断算法，P（预评估）、E（超声心动图和利钠肽评分）、F1（不确定时的功能检查）、F2（最终病因）]和 H2FPEF [肥胖（BMI>30kg/m2）、高血压（使用≥2 种降压药物）、心房颤动（阵发性或持续性）、肺动脉高压（多普勒超声心动图估测肺动脉收缩压>35mmHg）、老年人（年龄>60 岁）、充盈压（多普勒超声心动图 E/e' >9）]评分系统旨在帮助诊断射血分数保留的心力衰竭。本研究旨在评估这些评分系统在“全面、观察性心力衰竭伴轻度射血分数降低和保留射血分数登记”队列中的一致性和临床准确性。
作为一项多中心、横断面和观察性研究，进行了一项全面、观察性心力衰竭伴轻度射血分数降低和保留射血分数登记研究；以评估一组在土耳其 12 个城市的 13 个参与中心由心脏病专家就诊的射血分数轻度降低的心力衰竭和射血分数保留的心力衰竭患者。
该研究纳入了 819 例射血分数保留的心力衰竭患者，HFA-PEFF 和 H2FPEF 评分的高概率射血分数保留的心力衰竭率分别为 40%和 26%。两种评分系统之间的一致性较低（肯德尔 tau 相关系数为 0.242，P<.001）。评估了两种评分系统的诊断性能，发现它们的方法和准确识别射血分数保留的心力衰竭患者的能力存在差异。
HFA-PEFF 和 H2FPEF 评分系统之间的低一致性突显了准确诊断和管理射血分数保留的心力衰竭患者的持续挑战。临床医生应该了解每个评分系统的优势和局限性，并结合其他临床和实验室发现做出准确的诊断。未来的研究应侧重于确定其他诊断因素，开发更准确和全面的诊断算法，并研究基于不同临床特征的替代诊断或患者分层方法。
