Heart failure & cardiomyopathies
H2FPEF and HFA-PEFF Scores for Heart Failure Risk Stratification in Hypertrophic Cardiomyopathy Patients
Authors' conclusion
There is discordance in the classification of patients with HCM using the H2FPEF and HFA-PEFF scores. Both scores demonstrated prognostic value in risk stratification for HF hospitalization and all-cause death in HCM patients. Future studies should develop and validate a new algorithm integrating both scores.
Study context
- Population
- Patients with hypertrophic cardiomyopathy (HCM)HCM patients included
- Participants
- 1,068 patients
- Exposure
- H2FPEF and HFA-PEFF score groups for heart failure (HF) risk stratification
- Outcome
- Composite of:
- The first HF hospitalization
- All-cause death
- Follow-up
- 3.1 ± 2.1 years
Main finding
As reported in the abstract
Hazard ratio (95% CI)P value
Intermediate H2FPEF scoreindependently associated with increased risk
1.820(1.135–2.919)
P = 0.013High H2FPEF scoreindependently associated with increased risk
3.464(1.774–6.765)
P < 0.001High HFA-PEFF scoreindependently associated with increased risk
2.414(1.501–3.882)
P < 0.001Intermediate-high H2FPEF scorevs high HFA-PEFF scoreequal risk
0.826(0.636–1.072)
P > 0.05Observational data: associations, not effects.
Further findings
Independent predictors of the primary endpoint (score components)
| HR (95% CI) | P value | ||
|---|---|---|---|
| ObesityH2FPEF component | 1.958 (1.140–3.363) | P = 0.015 | |
| Atrial fibrillationH2FPEF component | 1.686 (1.071–2.654) | P = 0.024 | |
| Pulmonary hypertensionH2FPEF component | 1.613 (1.032–2.521) | P = 0.036 | |
| Morphological major criterionHFA-PEFF component | 1.601 (1.084–2.364) | P = 0.018 | |
| Functional major criterionHFA-PEFF component | 2.340 (1.442–3.797) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Discordant classification
- Patients classified discordantly
- 594 (55.6%)
Events during follow-up · 3.1 ± 2.1 years
- Admitted for HF for the first time
- 85 (8.0%)
- Died
- 62 (5.8%)
Discrimination (C-index)
- H2FPEF score
- 0.594
- HFA-PEFF score
- 0.651
- New algorithm (functional major criterion 2 points, others 1 point)
- 0.681
Original publication
H2FPEF and HFA-PEFF Scores for Heart Failure Risk Stratification in Hypertrophic Cardiomyopathy Patients. ESC Heart Fail. Published 1 March 2025. doi:10.
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