Photo Credit: Mohammed Haneefa Nizamudeen

The H2FPEF score, a prognostic tool for diagnosing heart failure with preserved ejection fraction, proved useful for risk stratification in HCM.

The H₂FPEF score, a metric developed to help diagnose heart failure with preserved ejection fraction, was independently linked with poorer heart failure outcomes among people with hypertrophic cardiomyopathy (HCM), researchers reported in the European Journal of Heart Failure.

“Patients with HCM are at increased risk for HF, particularly HFpEF,” wrote Dorien Laenens, MD, and colleagues. “However, risk stratification in patients with HCM has been primarily focused on predicting sudden cardiac death, and only a few studies have proposed specific parameters that might help [identify] HF development in these patients. Therefore, the present study aimed to assess the prognostic value of the H₂FPEF score in patients with HCM and preserved LVEF.”

Evaluating H₂FPEF Score’s Utility

Dr. Laenens and colleagues gathered data from a registry of patients with HCM. The study included 955 patients from the Netherlands, Greece, and Singapore. To be included, patients had to be at least 18 years old and diagnosed with HCM according to current guidelines. Patients were aged an average of 51 years, and most were male (32.5% of patients were female).

Patients had a maximum LV wall thickness of at least 15 mm in situations where there were no other possible systemic, cardiac, or metabolic causes of LV hypertrophy; however, a thickness of 13 mm or more was considered sufficient for diagnosing HCM when patients had a family history of the disease or positive genetic tests.

Patients were excluded from the study if they had reduced LV ejection fraction (<50%) or if their records were missing data necessary to calculate the score. The primary outcome was a composite of all-cause mortality and patients’ first hospitalizations for heart failure. Secondary outcomes were all-cause mortality and first-time hospitalization for heart failure evaluated individually.

The researchers calculated all patients’ H₂FPEF scores, stratifying patients into low (0-1), intermediate (2-5), and high (6-9) score groups. These scores were developed from six different domains, each given equal weight: obesity, defined as a BMI of more than 30 kg/m², history of atrial fibrillation, age of more than 60 years, arterial hypertension, E/e’ ratio of more than 9, and systolic pulmonary artery pressure at echocardiography more than 35 mmHg.

How Did the Score Perform?

A total of 105 patients had a high H₂FPEF score. These patients were primarily women and tended to have a higher burden of symptoms and comorbidities. Patients with higher scores also had lower LVEF upon echocardiography, experienced more diastolic dysfunction, and more often had left ventricular outflow tract obstruction.

Follow-up lasted for a median of 90 months (interquartile range, 49–176). Eleven percent (n=103) of patients died during the study, while another 6% (n=57) experienced their first hospitalization for heart failure. Patients with high and intermediate H₂FPEF scores had lower event-free survival rates for both the primary and secondary outcomes compared with those with lower scores.

Factors Linked With H₂FPEF Score

Multivariate Cox regression analyses showed that several variables were related to the study outcomes, including:

• high H₂FPEF score (HR, 3.689; 95% CI, 1.908-7.134; P<0.001);
• intermediate H₂FPEF score (HR, 2.757; 95% CI, 1.612-4.713; P< 001);
• female sex (HR, 1.67; 95% CI, 1.157-2.41; P =0.006);
• Asian ethnicity (HR, 6.711; 95% CI, 4.076-11.048; P<0.001);
• left atrial diameter (HR, 1.028; 95% CI, 1.005-1.051; P=0.016); and
• ischemic heart disease (HR, 1.732; 95% CI, 1.133-2.65; P=0.011).

“The H₂FPEF score can easily be applied in patients with HCM, using simple demographic, clinical, and echocardiographic parameters,” Dr. Laenens and colleagues concluded. “A high H₂FPEF score was independently associated with worse heart failure outcomes and therefore holds promise as a tool for specific HF risk stratification in these patients.”