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Identification of patients with preclinical heart failure with preserved ejection fraction using the H2FPEF score

Nature Cardiovascular Research volume 1, pages 59–66 (2022)Cite this article

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Abstract

Heart failure with preserved ejection fraction (HFpEF) is a common disorder with few effective treatments, and there is currently no evidence-based method to identify preclinical HFpEF. The H2FPEF score is a validated instrument to identify patients with overt HFpEF. Here we show that the H2FPEF score can identify individuals with preclinical HFpEF. Among individuals where heart failure was excluded (n = 160), increasing H2FPEF score was shown to be associated with greater left atrial dilation, left ventricular hypertrophy and more severe diastolic dysfunction. Patients with increasing H2FPEF score displayed higher pulmonary artery pressures, higher left heart filling pressures, lower cardiac index and more severely impaired aerobic capacity during exercise. In summary, we show that, among adults without heart failure, higher H2FPEF score is associated with subclinical abnormalities that resemble those observed in HFpEF. These findings broaden the external validity of the H2FPEF score and suggest that this instrument might help identify patients positioned to benefit from preventive interventions.

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Fig. 1: H2FPEF score calculation.
Fig. 2: Exercise capacity and H2FPEF score.
Fig. 3: Exercise hemodynamics and H2FPEF score.

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De-identified participant data will be made available upon reasonable request. Requests should be directed to the corresponding author (B.A.B.). Requestors will be required to sign a data access agreement to ensure the appropriate use of the study data.

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Acknowledgements

K.E.K. was supported by F31 HL143952, and B.A.B. is supported by R01 HL128526, both from the National Institutes of Health.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Katlyn E. Koepp, Yogesh N. V. Reddy, Masaru Obokata, Hidemi Sorimachi, Frederik H. Verbrugge, C. Charles Jain, Alexander C. Egbe, Margaret M. Redfield, Thomas P. Olson & Barry A. Borlaug

  2. Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium

    Frederik H. Verbrugge

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Contributions

Study conception and design: K.E.K. and B.A.B.; Project supervision: B.A.B.; Data acquisition: K.E.K., Y.N.V.R., M.O., H.S., F.H.V., C.C.J., A.C.E., M.M.R., T.P.O. and B.A.B.; Data analysis: K.E.K., Y.N.V.R. and B.A.B.; Manuscript drafting: K.E.K., Y.N.V.R. and B.A.B.; Manuscript critical revision: K.E.K., Y.N.V.R., M.O., H.S., F.H.V., C.C.J., A.C.E., M.M.R., T.P.O. and B.A.B.

Corresponding author

Correspondence to Barry A. Borlaug.

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The authors declare no competing interests.

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Nature Cardiovascular Research thanks Rudolf de Boer and Domenico Bruno for their contribution to the peer review of this work.

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This file contains Supplemental/Extended Data Tables 1–7

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Koepp, K.E., Reddy, Y.N.V., Obokata, M. et al. Identification of patients with preclinical heart failure with preserved ejection fraction using the H2FPEF score. Nat Cardiovasc Res 1, 59–66 (2022). https://doi.org/10.1038/s44161-021-00005-5

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