Improving the Diagnosis of HFpEF: A Comparison of the H2FPEF Score and the 2025 ASE Diastolic Function Guideline Recommendations Using Invasive Hemodynamics as the Gold Standard.

BACKGROUND: The H2FPEF score was developed for heart failure with preserved ejection fraction (HFpEF) diagnosis based on clinical parameters, septal E/e' ratio and pulmonary artery systolic pressure. Diagnostic accuracy can be improved by additional echocardiographic parameters.

OBJECTIVES: This report aims to study the impact of echocardiography in improving the accuracy of The H2FPEF score, using the score as the initial step for HFpEF diagnosis.

METHODS: Stable patients with ejection fraction ≥50% who underwent right heart catheterization and echocardiographic imaging within 30 days were included. H2FPEF score was computed. Echocardiographic measurements recommended in ASE (American Society of Echocardiography) 2025 diastolic function guidelines update were included.

RESULTS: There were 511 patients with 237 having pulmonary capillary wedge pressure >15 mm Hg at rest or >25 mm Hg with exercise. Heart failure probability of <30% was present in 60 patients, whereas 58 had a probability of 30%-49%, 113 had a probability of 50%-80%, and 280 had a probability of >80%. Accuracy of The H2FPEF score was not improved with the addition of echocardiographic assessment when HF probability was <30% (P = 0.083). For all other probabilities, echocardiographic assessment significantly added to H2FPEF score accuracy. Net reclassification improvement was 1.38 (P < 0.001), and integrated discrimination improvement was 0.38 (P < 0.001).

CONCLUSIONS: The H2FPEF score has good accuracy in excluding HF diagnosis when HF probability based on the score is <30%. When probability is >30%, 2025 ASE diastolic function guidelines approach to the estimation of mean left atrial pressure adds to accuracy.