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Prognostic Value of HFA-PEFF Score in Patients Undergoing Transcatheter Aortic Valve Implantation
Sultan Alotaibi1,2,3, Karim Elbasha1, Martin Landt1
1Heart Center, Segeberger Kliniken, Bad Segeberg, DEU.
Insights
The HFA-PEFF score has limited predictive value for long-term outcomes in patients with preserved ejection fraction (EF) undergoing transcatheter aortic valve implantation (TAVI). Additional clinical factors may be needed for improved risk assessment in this TAVI population.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Diagnostics
Background:
- The HFA-PEFF score is a tool for predicting outcomes in heart failure patients.
- Its utility in severe aortic stenosis patients with preserved ejection fraction (EF) undergoing transcatheter aortic valve implantation (TAVI) requires evaluation.
Purpose of the Study:
- To assess the prognostic value of the HFA-PEFF score in predicting long-term adverse events.
- To determine the score's effectiveness in patients with preserved EF undergoing TAVI.
Main Methods:
- Data from 1,022 patients with preserved EF (≥50%) undergoing TAVI were analyzed.
- Patients were stratified by an HFA-PEFF score cut-off of five.
- Kaplan-Meier survival and multivariate analyses were performed over 24 months.
Main Results:
- Patients with an HFA-PEFF score ≥5 were older and had higher rates of atrial fibrillation and chronic kidney disease.
- This group showed increased cardiovascular mortality and heart failure rehospitalization (p<0.05).
- However, the HFA-PEFF score did not independently predict these outcomes in multivariate analysis.
Conclusions:
- The HFA-PEFF score demonstrated limited prognostic value for long-term mortality and heart failure events in TAVI patients with preserved EF.
- Incorporating specific clinical variables relevant to this population may enhance risk prediction accuracy.
Abstract:
Background The HFA-PEFF score may help in predicting long-term outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis and preserved left ventricular ejection fraction (EF). Methods We retrieved data from 1,332 patients undergoing TAVI between 2010 and 2019 from the Prospective Segeberg TAVI Registry (ClinicalTrials.gov Identifier: NCT03192774). We calculated the HFA-PEFF score for 1,022 patients who had preserved EF (≥50%). To assess the prognostic value of the HFA-PEFF score in predicting adverse events, we dichotomised the patients according to a cut-off score of five (score <5 group: n=528 (51.6%), score ≥5 group: n=494 (48.3%)). Results The HFA-PEFF score ≥5 groups were older (81.9±6.3 years vs. 80.3±6.9 years; p<0.001) and had a higher prevalence of atrial fibrillation (35.1% vs 20.8%; p<0.001) and chronic kidney disease (30.1% vs 26.1%; p<0.001). Kaplan-Meier survival analyses over 24 months showed increased cardiovascular (CV) mortality (12.5% vs. 7.7%, log-rank; p=0.028) and first heart failure-related rehospitalisation (7.7% vs. 4.0%, log-rank p=0.014) in the HFA-PEFF score ≥5 groups compared with those of lower scores. No significant difference in all-cause mortality between both groups was observed (22.0% vs. 17.9%, log-rank p=0.127). In multivariate analysis, HFA-PEFF score ≥5 failed to predict CV mortality (aHR 1.37, 95% CI: 0.90-2.08, p=0.140) and time to first heart failure-related rehospitalisation (aHR 1.49, 95% CI: 0.83-2.65, p=0.181). Conclusion The HFA-PEFF score showed limited value in predicting long-term mortality and adverse heart failure-related events in patients with preserved EF undergoing TAVI. Clinical variables specific to this population could complement the HFA-PEFF score for better risk prediction.
