TY - JOUR
T1 - Validation of the HFA-PEFF score for the diagnosis of heart failure with preserved ejection fraction
AU - Barandiarán Aizpurua, Arantxa
AU - Sanders-van Wijk, Sandra
AU - Brunner-La Rocca, Hans Peter
AU - Henkens, Michiel
AU - Heymans, Stephane
AU - Beussink-Nelson, Lauren
AU - Shah, Sanjiv J.
AU - van Empel, Vanessa P.M.
N1 - Funding Information:
This work was funded by the Dutch Heart Foundation CVON2015‐10‐Early HFpEF and CVON2017‐21‐SHE PREDICTS HF (VvE, SH, MH), by the Health Foundation Limburg (VvE) and by the American Heart Association Scientist Development grant #0835488N and National Institutes of Health (NIH) grants R01 HL107577 and R01 HL127028 (SJS) and by the Netherlands Heart Institute (research fellowship SSvW). Conflict of interest: none declared.
Funding Information:
This work was funded by the Dutch Heart Foundation CVON2015-10-Early HFpEF and CVON2017-21-SHE PREDICTS HF (VvE, SH, MH), by the Health Foundation Limburg (VvE) and by the American Heart Association Scientist Development grant #0835488N and National Institutes of Health (NIH) grants R01 HL107577 and R01 HL127028 (SJS) and by the Netherlands Heart Institute (research fellowship SSvW). Conflict of interest: none declared.
Publisher Copyright:
© 2019 European Society of Cardiology
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - Diagnosis
KW - Diastolic dysfunction
KW - Heart failure with preserved ejection fraction
KW - Natriuretic peptides
UR - http://www.scopus.com/inward/record.url?scp=85076749320&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076749320&partnerID=8YFLogxK
U2 - 10.1002/ejhf.1614
DO - 10.1002/ejhf.1614
M3 - Article
C2 - 31472035
AN - SCOPUS:85076749320
VL - 22
SP - 413
EP - 421
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
IS - 3
ER -