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Application of the HFA-PEFF algorithm to characterize and score cardiac abnormalities in women with preeclampsia
Malin B L Andersson1, Magnus C Johansson2, Lina Bergman3,4
1Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences.
Insights
Preeclampsia patients show higher cardiac dysfunction scores using the HFA-PEFF system. Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) may help screen for this dysfunction.
Area of Science:
- Cardiology
- Obstetrics
- Biomarkers
Background:
- Preeclampsia causes significant cardiovascular stress, often leading to diastolic dysfunction.
- Current guidelines recommend comprehensive cardiac function assessments.
- The Heart Failure Association - Pretest assessment, Echocardiography and Functional testing, and Final etiology (HFA-PEFF) scoring system offers a structured approach to evaluate cardiac function using echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Purpose of the Study:
- To apply the HFA-PEFF scoring system to assess cardiac function in women with preeclampsia.
- To investigate the association between HFA-PEFF scores and maternal/fetal outcomes in preeclampsia.
- To evaluate the utility of NT-proBNP as a screening tool within the HFA-PEFF framework.
Main Methods:
- Prospective observational study (2019-2022) involving 90 women with preeclampsia and 46 controls.
- Echocardiography and NT-proBNP measurements were performed.
- Patients were classified into HFA-PEFF score groups: high (≥5), intermediate (2-4), or low (0-1).
Main Results:
- Women with preeclampsia had significantly higher HFA-PEFF scores compared to controls (median 3 vs. 1, P < 0.001).
- Preeclamptic women were more frequently in the high (27% vs. 0%) and intermediate (56% vs. 28%) score groups.
- While overall outcomes weren't directly linked to score groups, small-for-gestational age neonates and elevated sFLT/PlGF ratios were more common in the high-score group.
Conclusions:
- The HFA-PEFF algorithm effectively identifies cardiac dysfunction in preeclampsia, encompassing structural, functional, and biomarker aspects.
- Elevated NT-proBNP levels correlate with HFA-PEFF scores, suggesting its potential as a screening biomarker.
- The HFA-PEFF system provides a valuable framework for characterizing cardiac involvement in preeclampsia.
Objective:
Preeclampsia imposes significant cardiovascular stress and frequently diastolic dysfunction. New recommendations advise multimodal assessments of cardiac function. The Heart Failure Association - Pretest assessment, Echocardiography and Functional testing, and Final etiology (HFA-PEFF) scoring system integrates echocardiographic indices and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and provides a structured way to characterize cardiac function. This study applied the HFA-PEFF algorithm to assess cardiac function in preeclampsia and its association with maternal and fetal outcomes.
Methods:
This prospective observational study was conducted between 2019 and 2022. Ninety women with preeclampsia and 46 normotensive controls were assessed using echocardiography and NT-proBNP levels according to the HFA-PEFF scoring system. Patients were categorized into high (≥5 points), intermediate (2-4 points), or low (0-1 points) score groups. Maternal and fetal outcomes were recorded.
Results:
Women with preeclampsia were more frequent in the high (27 vs. 0%) and intermediate (56 vs. 28%) score groups and less frequent in the low-score group (18 vs. 72%, P < 0.001) compared to controls. The median HFA-PEFF score was 3 points [interquartile range (IQR) 2-5] in women with preeclampsia and 1 point (IQR 0-2) in controls ( P < 0.001). The HFA-PEFF score groups did not relate to core outcomes overall but small-for-gestational age neonates and higher soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFLT/PlGF) ratios were more common in the HFA-PEFF high-score group ( P = 0.011, P = 0.036).
Conclusion:
The HFA-PEFF algorithm effectively detected cardiac dysfunction - reflected in structural changes, functional impairment, and elevated heart failure biomarkers - in women with preeclampsia. NT-proBNP may serve as potential screening tool for HFA-PEFF score.
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