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. 2023 Aug 4;25(1):141.
doi: 10.1186/s13075-023-03131-6.

Value of the HFA-PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the inflammatory myopathy population

Yunjing Shi #  1 , Hao Zhang #  2 , Zeping Qiu  1 , Yanjia Chen  1 , Xiuxiu Su  1 , Huihui Chi  2 , Tienan Feng  3 , Yue Sun  2 , Honglei Liu  2 , Xiaobing Cheng  2 , Junna Ye  2 , Hui Shi  2 , Qiongyi Hu  2 , Zhuochao Zhou  2 , Jianfen Meng  2 , Jialin Teng  2 , Chengde Yang  2 , Yutong Su  4 , Wei Jin  5
Affiliations

Value of the HFA-PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the inflammatory myopathy population

Yunjing Shi et al. Arthritis Res Ther. .

Abstract

Objectives: The HFA-PEFF score has been validated to hold great diagnostic and prognostic utility for heart failure with preserved ejection fraction (HFpEF). Idiopathic inflammatory myopathy (IIM) is recognized as one of the potential etiologies underlying HFpEF. Here, we intended to investigate the real prevalence of HFpEF in IIM via the HFA-PEFF score and explore the prognostic value of this score.

Methods: Two hundred twenty IIM patients were enrolled for assessment. The cohort was divided into low, intermediate and high tertiles of the HFA-PEFF score. Spearman's correlation analysis was used to explore the association between the score and disease activity. Chi-square test was applied to investigate the distribution discrepancy of HFA-PEFF tertiles among patients with different myositis-specific antibodies (MSAs) or myositis-associated antibodies (MAAs). Univariate and multivariate ordinal regression analyses were performed to screen risk factors for high HFA-PEFF scores. Survival curves were obtained using the Kaplan-Meier method and log-rank tests.

Results: In total, 79 (35.9%), 107 (48.6%) and 34 (15.5%) patients were rated low, intermediate and high probability of HFpEF, respectively. The HFA-PEFF score correlated well with disease activity. Patients with positive AMA-M2 scored higher in the HFA-PEFF score (p = 0.011). During follow-up, patients with positive AMA-M2 or anti-SRP antibody developed an inclination towards concentric hypertrophy on echocardiography. Additionally, palpitation symptom, AMA-M2 positivity and elevated serum levels of LDH, cTnI were independent risk factors for high HFA-PEFF scores. Finally, a high-tertile HFA-PEFF score was related to lower overall survival rate (p < 0.001). Patients with positive AMA-M2 had poorer outcomes (p = 0.002).

Conclusion: HFpEF was prevailing in IIM patients according to the HFA-PEFF score. The HFA-PEFF score correlated well with disease activity and held significant prognostic value. Patients with AMA-M2 antibody were prone to have poor outcomes.

Keywords: AMA-M2; Anti-SRP antibody; HFA-PEFF score; Heart failure with preserved ejection fraction; Idiopathic inflammatory myopathy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patient enrollment. IIM Idiopathic inflammatory myopathy, NT-proBNP N-terminal pro-B-type natriuretic peptide, LVEF Left ventricular ejection fraction, HFpEF Heart failure with preserved ejection fraction, HFA-PEFF Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final etiology
Fig. 2
Fig. 2
Subgroup analysis of the HFA-PEFF score distribution between myositis patients with or without ILD, dyspnea and palpitation. IIM Idiopathic inflammatory myopathy, ILD Interstitial lung disease
Fig. 3
Fig. 3
The HFA-PEFF score distribution among subgroups with different positive myositis-specific antibodies. HFA-PEFF Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final etiology, MSA Myositis specific antibodies
Fig. 4
Fig. 4
Comparisons of follow-up echocardiographic parameter changes in patients with IIM. The comparisons of (a) ΔLAD, (b) ΔIVST, (c) ΔLVPWT, (d) ΔRWT and (e) ΔLVMi in patients with positive or negative AMA-M2. The comparisons of (f) ΔLAD, (g) ΔIVST, (h) ΔLVPWT, (i) ΔRWT and (j) ΔLVMi in patients with positive or negative anti-SRP antibody. All data are presented as mean ± SEM. *p < 0.05, **p < 0.01, ***p < 0.01. LAD Left atrial diameter, IVST Interventricular septal wall thickness, LVPWT Left ventricular posterior wall thickness, RWT Relative wall thickness, LVMi Left ventricular mass indexed to body surface area
Fig. 5
Fig. 5
Kaplan–Meier survival curves among myositis patients with different HFA-PEFF score tertiles. HFA-PEFF Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final etiology
Fig. 6
Fig. 6
Kaplan–Meier survival curves in myositis patients with AMA-M2 or anti-SRP antibody. Kaplan–Meier survival curves between myositis patients with (a) positive or negative AMA-M2 and (b) positive or negative anti-SRP antibody
See this image and copyright information in PMC

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