Department of Cardiology in Cieszyn, Upper Silesia Medical Center, Medical University of Silesia, Katowice, Poland.
Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland.
Cardiol J. 2024;31(5):708-715. doi: 10.5603/cj.95191. Epub 2024 Apr 8.
The aim of our study was to compare 3 diagnostic pathways: diastolic stress echocardiography (DSE) based on the ASE/EACVI 2016 guidelines, the 2018 H₂FPEF score, and the 2019 HFA-PEFF algorithm, in patients suspected of heart failure with preserved ejection fraction (HFpEF).
The study group included 80 consecutive patients with a clinical suspicion of HFpEF. The H₂FPEF and HFA-PEFF scores and serum NT-proBNP concentrations were assessed in all the patients before they were sent for DSE.
The DSE-based pathway confirmed HFpEF in 17 (21%) patients, the HFA-PEFF algorithm in 43 (54%), and H₂FPEF scoring in 4 (5%) patients. The ROC analysis showed that HFA-PEFF score > 5 predicts a DSE-positive test with a sensitivity of 70.5% and a specificity of 65%, (AUC = 0.711, p = 0.002) with a negative predictive value of 89.1% and positive predictive value of 35.3%. The H₂FPEF score > 3 had a negative predictive value of 90%, a positive predictive value of 29.8%, and predicted positive DSE result with a sensitivity of 82.3% but rather poor specificity of 47.6% (AUC = 0.692, p = 0.004). Both H₂FPEF and HFA-PEFF showed similar predictive values (AUC) in the prediction of positive DSE test (p = ns).
The HFA-PEFF score overestimated the rate of HFpEF in comparison to DSE and the H₂FPEF score. The H₂FPEF and HFA-PEFF scores showed only modest predictive values of the positive DSE and had a diagnostic power to rule out the HFpEF.
本研究旨在比较三种诊断路径：基于 ASE/EACVI 2016 指南、2018 年 H₂FPEF 评分和 2019 年 HFA-PEFF 算法的舒张性应激超声心动图（DSE）、2018 年 H₂FPEF 评分和 2019 年 HFA-PEFF 算法在疑似射血分数保留型心力衰竭（HFpEF）患者中的应用。
研究组纳入 80 例疑似 HFpEF 的连续患者。所有患者在接受 DSE 检查前均进行 H₂FPEF 和 HFA-PEFF 评分及血清 NT-proBNP 浓度评估。
基于 DSE 的路径确诊 17 例（21%）、HFA-PEFF 算法 43 例（54%）、H₂FPEF 评分 4 例（5%）HFpEF。ROC 分析显示，HFA-PEFF 评分>5 预测 DSE 阳性试验的敏感性为 70.5%，特异性为 65%（AUC=0.711，p=0.002），阴性预测值为 89.1%，阳性预测值为 35.3%。H₂FPEF 评分>3 的阴性预测值为 90%，阳性预测值为 29.8%，预测 DSE 阳性的敏感性为 82.3%，但特异性较差为 47.6%（AUC=0.692，p=0.004）。H₂FPEF 和 HFA-PEFF 对 DSE 阳性试验的预测均具有相似的 AUC 值（p=ns）。
与 DSE 和 H₂FPEF 评分相比，HFA-PEFF 评分高估了 HFpEF 的发生率。H₂FPEF 和 HFA-PEFF 评分对 DSE 阳性的预测价值仅为中等，具有排除 HFpEF 的诊断能力。
