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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Heart failure risk assessment in patients with hypertrophic cardiomyopathy based on the H2FPEF score
Dorien Laenens1, Thomas Zegkos2, Vasileios Kamperidis1,2
1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Insights
The H2FPEF score effectively predicts heart failure (HF) outcomes in hypertrophic cardiomyopathy (HCM) patients. Higher scores indicate increased risk for HF hospitalizations and death, aiding in patient risk stratification.
Area of Science:
- Cardiology
- Heart Failure Research
- Cardiovascular Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a significant cause of heart failure (HF).
- The H2FPEF score was developed to diagnose HF with preserved ejection fraction (HFpEF).
- Its utility in predicting HF outcomes in HCM patients with preserved ejection fraction (PEF) is not well-established.
Purpose of the Study:
- To evaluate the association between the H2FPEF score and HF outcomes in patients with HCM and PEF.
- To determine if the H2FPEF score can be used for risk stratification in this patient population.
Main Methods:
- A multicentre registry was used to identify 955 patients with HCM and LVEF ≥50%.
- The H2FPEF score was calculated, and patients were categorized into low, intermediate, and high score groups.
- Primary endpoint: composite of all-cause death and HF admissions. Secondary endpoints: all-cause death and HF admissions separately.
- Multivariate Cox regression analysis was performed to identify independent predictors of outcomes.
Main Results:
- Patients with high H2FPEF scores were more likely to be female and have more symptoms and comorbidities.
- Higher H2FPEF scores correlated with lower LVEF, impaired diastolic function, and increased left ventricular outflow tract obstruction.
- Event-free survival was lower in intermediate and high H2FPEF score groups.
- The H2FPEF score was an independent predictor of adverse HF outcomes (HR 3.689 for high score).
Conclusions:
- The H2FPEF score is independently associated with HF outcomes in patients with HCM and PEF.
- The H2FPEF score demonstrates potential utility for risk stratification in HCM patients.
- Further research may refine the use of H2FPEF in managing HCM.
Aims:
The aim of this study was to investigate whether the H2FPEF score, which was developed to improve the diagnosis of heart failure (HF) with preserved ejection fraction, is associated with HF outcomes in patients with hypertrophic cardiomyopathy (HCM).
Methods And Results:
Patients with HCM and preserved left ventricular ejection fraction (LVEF ≥50%) were included from a multicentre registry and the H2FPEF score was calculated. Patients were divided into three groups: low (0-1), intermediate (2-5) and high (6-9) H2FPEF score. The primary combined endpoint was a composite of all-cause death and HF admissions, while the secondary endpoints were all-cause death and HF admissions separately. A total of 955 patients were included (age 51 ± 17 years, 310 [32.5%] female). Patients with a high H2FPEF score (n = 105) were more often female, and presented with more symptoms and comorbidities. On echocardiography, patients with a high H2FPEF score had lower LVEF, more impaired diastolic function and more frequently left ventricular outflow tract obstruction. During follow-up (median 90 months [interquartile range 49-176]), 103 (11%) patients died and 57 (6%) patients had a first HF hospitalization. Event-free survival rate for the primary combined and secondary endpoints was lower for patients with an intermediate and high H2FPEF score. On multivariate Cox regression analysis, female sex (hazard ratio [HR] 1.670, 95% confidence interval [CI] 1.157-2.410; p = 0.006), Asian ethnicity (HR 6.711, 95% CI 4.076-11.048; p < 0.001), ischaemic heart disease (HR 1.732, 95% CI 1.133-2.650; p = 0.011), left atrial diameter (HR 1.028, 95% CI 1.005-1.051; p = 0.016) and intermediate (HR 2.757, 95% CI 1.612-4.713; p < 0.001) or high H2FPEF score (HR 3.689, 95% CI 1.908-7.134; p < 0.001) were independently associated with the primary combined endpoint.
Conclusion:
The H2FPEF score is independently associated with HF outcome in patients with HCM and may be considered for risk stratification.
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