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. 2025 Aug 5;13(10):102526.
doi: 10.1016/j.jchf.2025.102526. Online ahead of print.

Utility of HFpEF Diagnostic Scores to Stratify Cardiac Reserve Among Patients With Dyspnea

Tatsuro Ibe  1 , Yogesh N V Reddy  1 , Tomonari Harada  1 , Shunichi Doi  1 , Atsushi Tada  1 , Jwan A Naser  1 , Ryan T Demmer  2 , Barry A Borlaug  3
Affiliations

Utility of HFpEF Diagnostic Scores to Stratify Cardiac Reserve Among Patients With Dyspnea

Tatsuro Ibe et al. JACC Heart Fail. .

Abstract

Background: The heart failure with preserved ejection fraction (HFpEF) scores were initially developed to facilitate diagnosis of HFpEF in patients with dyspnea. Whether these diagnostic scores also relate to severity of cardiopulmonary reserve limitations across the broad range of patients with dyspnea, with or without confirmed HFpEF, remains unclear.

Objectives: The purpose of this study was to investigate the association between HFpEF scores and disease severity in patients with dyspnea.

Methods: Patients undergoing invasive cardiopulmonary exercise testing for unexplained dyspnea were studied. Cardiac structure, function, and cardiopulmonary reserve were compared based on H2FPEF, HFA-PEFF, and HFpEF-ABA scores.

Results: A total of 1,130 subjects were included in this study, of whom 902 had HFpEF and 228 had noncardiac dyspnea. Patients were categorized by HFpEF-ABA score into low (probability <25%, n = 91), intermediate (probability 25%-80%, n = 559), and high HFpEF probabilities (probability >80%, n = 480). Patients with high HFpEF-ABA score exhibited more severe structural and functional abnormalities characteristic of HFpEF, across virtually all morphological and functional indices, as well as hemodynamic and cardiopulmonary indices. Similar findings were observed using the H2FPEF and HFA-PEFF scores, and when analyses were restricted to those with HFpEF or to those with noncardiac dyspnea.

Conclusions: The HFpEF scores stratify the extent of cardiac dysfunction, hemodynamic severity, and functional limitation in a broad cohort of individuals with chronic dyspnea, across the overall cohort and within individuals with or without HFpEF. These data indicate that HFpEF probability scores may also be used as markers of disease severity and preclinical HFpEF.

Keywords: H(2)FPEF score; HFA-PEFF diagnostic algorithm; HFpEF; HFpEF-ABA score; dyspnea; noncardiac dyspnea.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Borlaug is supported by research grants from the National Heart, Lung, and Blood Institute (R01 HL128526, R01 HL162828, and U01 HL160226), the U.S. Department of Defense (W81XWH2210245), and the Schoen Foundation; has received research support from the National Institutes of Health and the U.S. Department of Defense, as well as research grant funding from AstraZeneca, Axon, GlaxoSmithKline, Medtronic, Mesoblast, Novo Nordisk, Rivus, and Tenax Therapeutics; has served as a consultant for Actelion, Amgen, Aria, Axon Therapies, BD, Boehringer Ingelheim, Cytokinetics, Edwards Lifesciences, Eli Lilly, Imbria, Janssen, Merck, Novo Nordisk, NGM, NXT, and VADovations; and is named inventor (U.S. Patent number 10,307,179) for the tools and approach for a minimally invasive pericardial modification procedure to treat heart failure. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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