Validation of the HFA-PEFF score for the diagnosis of heart failure with preserved ejection fraction

Arantxa Barandiarán Aizpurua, Sandra Sanders-van Wijk, Hans Peter Brunner-La Rocca, Michiel Henkens, Stephane Heymans, Lauren Beussink-Nelson, Sanjiv J. Shah, Vanessa P.M. van Empel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Aims: Diagnosing heart failure with preserved ejection fraction (HFpEF) is challenging. The newly proposed HFA-PEFF algorithm entails a stepwise approach. Step 1, typically performed in the ambulatory setting, establishes a pre-test likelihood. The second step calculates a score based on echocardiography and natriuretic peptides. The aim of this study is to validate the diagnostic value and establish the clinical impact of the second step of the HFA-PEFF score. Methods and results: The second step of the HFA-PEFF score was evaluated in two independent, prospective cohorts, i.e. the Maastricht cohort (228 HFpEF patients and 42 controls) and the Northwestern Chicago cohort (459 HFpEF patients). In Maastricht, the HFA-PEFF score categorizes 11 (4%) of the total cohort with suspected HFpEF in the low-likelihood (0–1 points) and 161 (60%) in the high-likelihood category (5–6 points). A high HFA-PEFF score can rule in HFpEF with high specificity (93%) and positive predictive value (98%). A low score can rule out HFpEF with a sensitivity of 99% and a negative predictive value of 73%. The diagnostic accuracy of the score is 0.90 (0.84–0.96), by the area under the curve of the receiver operating characteristic curve. However, 98 (36%) are classified in the intermediate-likelihood category, where additional testing is advised. The distribution of the score shows a similar pattern in the Northwestern (Chicago) and Maastricht HFpEF patients (53% vs. 65% high, 43% vs. 34% intermediate, 4.8% vs. 1.3% low). Conclusion: This study validates and characterizes the HFA-PEFF score in two independent, well phenotyped cohorts. We demonstrate that the HFA-PEFF score is helpful in clinical practice for the diagnosis of HFpEF.

Original languageEnglish (US)
Pages (from-to)413-421
Number of pages9
JournalEuropean Journal of Heart Failure
Volume22
Issue number3
DOIs
StatePublished - Mar 1 2020

Keywords

  • Diagnosis
  • Diastolic dysfunction
  • Heart failure with preserved ejection fraction
  • Natriuretic peptides

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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