Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Open Heart. 2024 Jan 18;11(1):e002526. doi: 10.1136/openhrt-2023-002526.
The Heart Failure Association Pretest assessment, echocardiography and natriuretic peptide, functional testing and final aetiology (HFA-PEFF) score has been developed for diagnosing heart failure with preserved ejection fraction (HFpEF), which is frequently associated with atrial fibrillation (AF). We aimed to investigate whether preprocedural HFA-PEFF score could be used to predict clinical outcomes in patients with AF who underwent catheter ablation (CA).
Overall, 1679 patients with AF who underwent primary CA (71±10 years, 1218 males (72.5%), median follow-up duration 3.3 years) from July 2011 to December 2019 were included in this retrospective study. HFpEF was defined as an HFA-PEFF score ≥5. The primary study outcome was 5-year major adverse cardiovascular and cerebrovascular events (MACCE), which is a composite of all-cause death, hospitalisation for heart failure (HF) and hospitalisation for stroke.
The prevalence of HFpEF was 32.3%, but only 7.7% were diagnosed with HF at the time of CHADS scoring. Five-year MACCE occurred in 77 patients (4.6%). The cumulative 5-year incidence of MACCE was significantly higher in the HFpEF group than in the non-HFpEF group (11.2% vs 4.8% at 5 years, p<0.001). In the multivariable analysis, HFpEF by the HFA-PEFF score was associated with MACCE (adjusted HR 1.65, 95% CI 1.02 to 2.65, p=0.041).
Early detection of HFpEF using the HFA-PEFF score may have clinical applications in guiding therapeutic decision-making and improving prognosis by preventing HF and stroke in patients with AF undergoing CA.
心力衰竭协会预测试评估、超声心动图和利钠肽、功能测试和最终病因（HFA-PEFF）评分已被开发用于诊断射血分数保留的心力衰竭（HFpEF），HFpEF 常与心房颤动（AF）相关。我们旨在研究 HFA-PEFF 评分是否可用于预测接受导管消融（CA）的 AF 患者的临床结局。
本回顾性研究共纳入 1679 名接受原发性 CA（71±10 岁，1218 名男性（72.5%），中位随访时间 3.3 年）的 AF 患者，这些患者来自 2011 年 7 月至 2019 年 12 月。HFpEF 定义为 HFA-PEFF 评分≥5。主要研究结局为 5 年主要不良心血管和脑血管事件（MACCE），其包括全因死亡、心力衰竭（HF）住院和中风住院。
HFpEF 的患病率为 32.3%，但在 CHADS 评分时仅 7.7%被诊断为 HF。77 名患者（4.6%）发生 5 年 MACCE。HFpEF 组的累积 5 年 MACCE 发生率明显高于非 HFpEF 组（5 年时分别为 11.2%和 4.8%，p<0.001）。多变量分析显示，HFA-PEFF 评分的 HFpEF 与 MACCE 相关（调整后的 HR 1.65，95%CI 1.02 至 2.65，p=0.041）。
使用 HFA-PEFF 评分早期检测 HFpEF 可能通过预防 AF 患者接受 CA 后的 HF 和中风，在指导治疗决策和改善预后方面具有临床应用价值。
