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. 2024 Jun;12(6):1015-1025.
doi: 10.1016/j.jchf.2024.01.015. Epub 2024 Mar 20.

Utility and Validity of the HFA-PEFF and H2FPEF Scores in Patients With Symptomatic Atrial Fibrillation

Jonathan P Ariyaratnam  1 , Ricardo S Mishima  1 , Kadhim Kadhim  1 , Mehrdad Emami  1 , John L Fitzgerald  1 , Anand Thiyagarajah  1 , Jenelle K Dziano  1 , Jackson O Howie  1 , Melissa E Middeldorp  1 , Prashanthan Sanders  1 , Adrian D Elliott  2
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Free article

Utility and Validity of the HFA-PEFF and H2FPEF Scores in Patients With Symptomatic Atrial Fibrillation

Jonathan P Ariyaratnam et al. JACC Heart Fail. 2024 Jun.
Free article

Abstract

Background: Diagnosis of heart failure with preserved ejection fraction (HFpEF) in patients with atrial fibrillation (AF) represents a significant clinical challenge. Two diagnostic scoring tools have been developed to aid the noninvasive diagnosis of HFpEF: the HFA-PEFF (Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final etiology) and the H2FPEF scoring systems.

Objectives: The purpose of this study was to evaluate the performance of these 2 scoring tools for the diagnosis of HFpEF against a gold standard of invasive evaluation in a cohort of patients with AF.

Methods: The authors recruited consecutive patients with symptomatic AF and preserved ejection fraction who were scheduled for an AF ablation procedure. Gold-standard invasive diagnosis of HFpEF was performed at the AF ablation procedure using mean left atrial pressure at rest and following infusion of 500 mL fluid. Each participant was scored according to the noninvasive HFA-PEFF and H2FPEF scoring systems. Sensitivity and specificity analyses were performed to assess the accuracy of these scoring systems in diagnosing HFpEF.

Results: In total, 120 participants were recruited. HFpEF was diagnosed invasively in 88 (73.3%) participants, whereas 32 (26.7%) had no HFpEF. Using the HFA-PEFF score, 38 (31.7%) participants had a high probability of HFpEF and 82 (68.3%) had low/intermediate probability of HFpEF. Using the H2FPEF tool, 72 (60%) participants had a high probability of HFpEF and 48 (40%) had intermediate probability. A high HFA-PEFF (≥5 points) score could diagnose HFpEF with a sensitivity of 40% and a specificity of 91%, and a high H2FPEF score (≥6 points) could diagnose HFpEF with a sensitivity of 69% and specificity of 66%. Overall diagnostic accuracy was similar using both tools (AUC: 0.663 vs 0.707, respectively; P = 0.636).

Conclusions: Against a gold standard of invasively diagnosed HFpEF, the HFA-PEFF and H2FPEF scores demonstrate only moderate accuracy in patients with AF and should be utilized with caution in this cohort of patients. (Characterising Left Atrial Function and Compliance in Atrial Fibrillation; ACTRN12620000639921).

Keywords: atrial fibrillation; heart failure with preserved ejection fraction; invasive hemodynamics; noninvasive diagnostic tools; sensitivity.

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Conflict of interest statement

Funding Support and Author Disclosures Drs Ariyaratnam, Mishima, Kadhim, Emami, Fitzgerald, Stokes, and Thiyagarajah are supported by Postgraduate Scholarships from the University of Adelaide. Dr Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia; and the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic, Boston Scientific, and Abbott Medical, and research funding from Medtronic, Abbott Medical, Boston Scientific, and Microport CRM. Dr Elliott is supported by a Future Leader Fellowship from the National Heart Foundation of Australia. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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