Parsimonious echocardiography-based model for predicting long-term all-cause mortality in heart failure with...

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.