Improving the Diagnosis of HFpEF

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2026-02-01 Epub Date: 2025-10-25 DOI:10.1016/j.jcmg.2025.09.011

Wissam Rahi MD , Hossam Lababidi MD , Imad Hussain MD, Miguel A. Quinones MD, Sherif F. Nagueh MD

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引用次数: 0

Abstract

Background

The H₂FPEF score was developed for heart failure with preserved ejection fraction (HFpEF) diagnosis based on clinical parameters, septal E/e′ ratio and pulmonary artery systolic pressure. Diagnostic accuracy can be improved by additional echocardiographic parameters.

Objectives

This report aims to study the impact of echocardiography in improving the accuracy of The H₂FPEF score, using the score as the initial step for HFpEF diagnosis.

Methods

Stable patients with ejection fraction ≥50% who underwent right heart catheterization and echocardiographic imaging within 30 days were included. H₂FPEF score was computed. Echocardiographic measurements recommended in ASE (American Society of Echocardiography) 2025 diastolic function guidelines update were included.

Results

There were 511 patients with 237 having pulmonary capillary wedge pressure >15 mm Hg at rest or >25 mm Hg with exercise. Heart failure probability of <30% was present in 60 patients, whereas 58 had a probability of 30%-49%, 113 had a probability of 50%-80%, and 280 had a probability of >80%. Accuracy of The H₂FPEF score was not improved with the addition of echocardiographic assessment when HF probability was <30% (P = 0.083). For all other probabilities, echocardiographic assessment significantly added to H₂FPEF score accuracy. Net reclassification improvement was 1.38 (P < 0.001), and integrated discrimination improvement was 0.38 (P < 0.001).

Conclusions

The H₂FPEF score has good accuracy in excluding HF diagnosis when HF probability based on the score is <30%. When probability is >30%, 2025 ASE diastolic function guidelines approach to the estimation of mean left atrial pressure adds to accuracy.

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提高HFpEF的诊断：以有创血流动力学为金标准比较H2FPEF评分和2025 ASE舒张功能指南建议。

H2FPEF评分是基于临床参数、间隔E/ E比值和肺动脉收缩压来诊断保留射血分数（HFpEF）的心力衰竭。超声心动图附加参数可提高诊断准确性。目的本报告旨在研究超声心动图对提高H2FPEF评分准确性的影响，并将其作为诊断HFpEF的第一步。方法选取射血分数≥50%、30 d内行右心导管及超声心动图检查的稳定患者。计算H2FPEF评分。包括美国超声心动图学会（ASE） 2025舒张功能指南更新中推荐的超声心动图测量。结果511例患者中237例静息时肺毛细血管楔压>5 mm Hg，运动时bbb25 mm Hg。心力衰竭的概率为80%。当HF概率为30%时，超声心动图评估对H2FPEF评分的准确性没有提高，2025 ASE舒张功能指南方法对平均左房压的估计增加了准确性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.