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Updated: Mar 27, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Parsimonious echocardiography-based model for predicting long-term all-cause mortality in heart failure with
Lingyu Mi1, Jeffrey Shi Kai Chan2, Wing Tak Wong3
1Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Insights
A new echocardiography model accurately predicts long-term mortality in heart failure with preserved ejection fraction (HFpEF). This five-variable nomogram outperforms existing diagnostic scores, offering improved risk stratification for HFpEF patients.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) diagnosis relies on scores like HFA-PEFF and H2FPEF.
- These scores may not sufficiently stratify long-term mortality risk in HFpEF patients.
- There is a need for improved prognostic tools in HFpEF management.
Purpose of the Study:
- To develop and internally validate a parsimonious echocardiography-based model for predicting long-term all-cause mortality in HFpEF.
- To compare the prognostic discrimination of the new model against the HFA-PEFF and H2FPEF scores.
Main Methods:
- A real-world HFpEF echocardiography database was used, with 792 adults randomly assigned to training (n=554) and validation (n=238) cohorts.
- Least absolute shrinkage and selection operator (LASSO)-penalised Cox regression was employed to derive a parsimonious model.
- The primary endpoint was all-cause mortality, with follow-up extending to 5.75 years.
Main Results:
- A five-variable nomogram including age, LV posterior wall thickness, mitral E velocity, E/e' ratio, and pulmonary artery systolic pressure was developed.
- In the validation cohort, the nomogram demonstrated superior discrimination compared to HFA-PEFF and H2FPEF (AUCs 0.713 vs. 0.642 and 0.607 at 5 years).
- Survival curves separated by risk-score tertiles (log-rank p<0.001), indicating effective risk stratification.
Conclusions:
- An echocardiography-based, five-variable nomogram provides enhanced discrimination for predicting long-term mortality in HFpEF.
- The developed nomogram shows improved prognostic capability over repurposed diagnostic scores.
- External validation is recommended prior to widespread clinical adoption.
Background:
The Heart Failure Association Pre-test Assessment, Echocardiography and Natriuretic Peptide, Functional testing, Final aetiology (HFA-PEFF) score and the Heavy, Hypertensive, Atrial Fibrillation, Pulmonary Hypertension, Elder, Filling Pressure (H2FPEF) score facilitate heart failure with preserved ejection fraction (HFpEF) diagnosis but may not adequately stratify mortality risk. We developed and internally validated a parsimonious echocardiography-based model for long-term all-cause mortality in HFpEF and compared its prognostic discrimination with HFA-PEFF and H2FPEF.
Methods:
In a real-world HFpEF echocardiography database linked to territory-wide electronic health records, 792 adults with HFpEF (left ventricular ejection fraction ≥50%) diagnosed between 2010 and 2016 were randomly split in a prespecified 70:30 ratio into training (n=554) and validation (n=238) cohorts. The primary endpoint was all-cause mortality. A parsimonious model was derived using least absolute shrinkage and selection operator (LASSO)-penalised Cox regression and refitted as a multivariable Cox model.
Results:
The final nomogram included age, left ventricular posterior wall thickness at end-systole, mitral E velocity, E/e' ratio and pulmonary artery systolic pressure. During median follow-up of 5.17 years (IQR 2.26-9.14) in the training cohort and 5.75 years (IQR 2.17-9.25) in the validation cohort, 393/554 (70.9%) and 165/238 (69.3%) deaths occurred, respectively. In the validation cohort, the nomogram showed better discrimination than HFA-PEFF and H2FPEF, with 1/3/5-year area under the curves of 0.658/0.706/0.713 versus 0.507/0.561/0.642 and 0.516/0.533/0.607, respectively. Calibration was acceptable at 1 and 3 years but weaker at 5 years, and risk-score tertiles separated survival in both cohorts (log-rank p<0.001).
Conclusions:
A five-variable echocardiography-based nomogram showed better discrimination for long-term mortality prediction than the repurposed diagnostic scores evaluated in this cohort. External validation is needed before clinical implementation.
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