The LEDA Score: An Integrated Echocardiographic Score for the Diagnosis of HFpEF

Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging because clinical findings may not reflect hemodynamic disease expression.

The aim of the study was to evaluate the diagnostic performance of LEDA (Left ventricular concentricity, E/e', left ventricle-to-left atrium Diastasis volume ratio, left Atrial reservoir function), an integrated echocardiographic score, for identifying HFpEF and elevated left-sided filling pressure (LSFP).

In this prospective single-center study, 171 selected patients with unexplained dyspnea underwent echocardiography and an invasive hemodynamic assessment within 24 hours. HFpEF was defined by symptoms or signs of heart failure with elevated levels of N-terminal pro-B-type natriuretic peptide and/or invasively measured LSFP ≥15 mm Hg. LEDA integrates left ventricular concentricity, E/e', left ventricular-left atrial diastasis coupling, and left atrial reservoir function. Diagnostic performance was compared with H₂FPEF (Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure score) and HFA-PEFF (Heart Failure Association Pre-test assessment, Echocardiography & natriuretic peptide, Functional testing, Final etiology diagnostic algorithm); 2025 American Society of Echocardiography diastolic criteria were analyzed as an echocardiographic filling-pressure framework rather than as a standalone HFpEF diagnostic score.

HFpEF was present in 42% of patients. LEDA showed higher discrimination for HFpEF than for H₂FPEF, HFA-PEFF, and American Society of Echocardiography criteria, with area under the curve of 0.85, 0.74, 0.74, and 0.61, respectively (P ≤ 0.010). At LEDA ≥3, the positive likelihood ratio was 7.4, compared with 3.0, 1.8, and 1.6, respectively. For invasive LSFP endpoints, LEDA achieved area under the curve up to 0.90, specificity up to 95.5%, and positive likelihood ratio up to 16.3.

In this selected cohort undergoing an invasive hemodynamic assessment for diagnostic uncertainty, LEDA showed stronger diagnostic performance than contemporary HFpEF diagnostic algorithms and an echocardiographic filling-pressure framework. External validation is required before application to broader outpatient populations.