Heart failure & cardiomyopathies
Haemodynamic Validation of the Three-Step HFA-PEFF Algorithm to Diagnose Heart Failure with Preserved Ejection Fraction
Authors' conclusion
As compared with rest/exercise RHC, the HFA-PEFF score lacks sensitivity: Half of the patients were wrongly classified as non-cardiac dyspnoea after non-invasive tests, with a minimal impact of DSE in modifying HFpEF likelihood.
Study context
- Population
- Individuals with exertional dyspnoea
- Participants
- 73 individuals
- Comparison
- HFA-PEFF algorithm vs rest/exercise right heart catheterization
- Outcome
- Diagnostic performance of the HFA-PEFF algorithm vs haemodynamic HFpEF diagnosis by RHC
Performance
As reported in the abstract
Haemodynamic diagnosis of HFpEF
| Test or model | Sensitivity | Specificity |
|---|---|---|
| HFA-PEFF step 2 | 45% | 100% |
| HFA-PEFF step 3 | 46% | 88% |
Sensitivity
HFA-PEFF step 245%
HFA-PEFF step 346%
Specificity
HFA-PEFF step 2100%
HFA-PEFF step 388%
- HFA-PEFF score associated with invasive haemodynamic heart failure with preserved ejection fraction (HFpEF) diagnosis
- P < 0.001
- HFpEF after right heart catheterization (RHC)
- 89%
- Non-cardiac dyspnoea after RHC
- 11%
Further findings
| Outcome | HFA-PEFF step 2 | HFA-PEFF step 3 |
|---|---|---|
| HFpEF probability low/intermediate/high | 8%/52%/40% | 8%/49%/43% |
| Step 2 sensitivity with rule-in threshold >3 | ||
| Sensitivity | 60% | — not stated in the abstract |
— not stated in the abstract
- Step 2 sensitivity with rule-in threshold >3 — Non-significant improvement
- P = 0.08
Left atrial (LA) strain < 24.5% alone and corrected for E/E'
- LA strain alone sensitivity/specificity
- 39% and 14%
- LA strain corrected for E/E' sensitivity/specificity
- 55% and 22%
Influence of age, sex, BMI, obesity, COPD, paroxysmal AF
- Did not influence HFA-PEFF performance
Original publication
Haemodynamic Validation of the Three-Step HFA-PEFF Algorithm to Diagnose Heart Failure with Preserved Ejection Fraction. ESC Heart Fail. Published 15 June 2023. doi:10.
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