Application of the HFA-PEFF algorithm to characterize and score cardiac abnormalities in women with preeclampsia.

OBJECTIVE

Preeclampsia imposes significant cardiovascular stress and frequently diastolic dysfunction. New recommendations advise multimodal assessments of cardiac function. The Heart Failure Association - Pretest assessment, Echocardiography and Functional testing, and Final etiology (HFA-PEFF) scoring system integrates echocardiographic indices and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and provides a structured way to characterize cardiac function. This study applied the HFA-PEFF algorithm to assess cardiac function in preeclampsia and its association with maternal and fetal outcomes.

METHODS

This prospective observational study was conducted between 2019 and 2022. Ninety women with preeclampsia and 46 normotensive controls were assessed using echocardiography and NT-proBNP levels according to the HFA-PEFF scoring system. Patients were categorized into high (≥5 points), intermediate (2-4 points), or low (0-1 points) score groups. Maternal and fetal outcomes were recorded.

RESULTS

Women with preeclampsia were more frequent in the high (27 vs. 0%) and intermediate (56 vs. 28%) score groups and less frequent in the low-score group (18 vs. 72%, P  < 0.001) compared to controls. The median HFA-PEFF score was 3 points [interquartile range (IQR) 2-5] in women with preeclampsia and 1 point (IQR 0-2) in controls ( P  < 0.001). The HFA-PEFF score groups did not relate to core outcomes overall but small-for-gestational age neonates and higher soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFLT/PlGF) ratios were more common in the HFA-PEFF high-score group ( P  = 0.011, P  = 0.036).

CONCLUSION

The HFA-PEFF algorithm effectively detected cardiac dysfunction - reflected in structural changes, functional impairment, and elevated heart failure biomarkers - in women with preeclampsia. NT-proBNP may serve as potential screening tool for HFA-PEFF score.