The role of HFA-PEFF and H2FPEF scales in the diagnosis of heart failure with preserved ejection fraction and prediction of cardiovascular outcomes in patients with type 2 diabetes mellitus and suspected heart failure with preserved ejection fraction
Abstract. Heart failure with preserved left ventricular ejection fraction (HFpEF) accounts for approximately 50% of all cases of chronic heart failure. Type 2 diabetes mellitus (T2DM) complicates the clinical course of HFpEF, increasing the risk of decompensation and mortality. HFA-PEFF and H2FPEF scales have been developed for diagnosing HFpEF; however, their prognostic value in patients with T2DM has not been adequately studied. The aim: to evaluate the prognostic value of HFA-PEFF and H2FPEF scales for the risk of major adverse cardiovascular events in patients with T2DM and suspected HFpEF over a 12-month follow-up period. Material and methods. This prospective, single-center observational study included 164 patients with T2DM complaining of dyspnea and an EF ≥50%. All patients underwent echocardiography, NT-proBNP measurement, and stratification according to the HFA-PEFF and H2FPEF scales. Diastolic stress test with exercise was performed in patients with intermediate HFpEF probability (n = 58). The composite endpoint was all-cause death and cardiovascular hospitalization. Results. A high probability of HFpEF was determined in 36% of patients using the HFA-PEFF scale and in 30% using the H2FPEF scale. According to the diastolic stress test, HFpEF was verified in 29.3% of patients with intermediate disease probability. The agreement coefficient between the scales was κ = 0.71, with a category agreement rate of 82.3%. Over 12 months of follow-up, 30 adverse events (5 deaths and 25 hospitalizations) were recorded. Hazard ratio for the high-probability category of HFpEF (versus low-probability category) was 2.89 (95% CI: 2.01–4.16; p <0.001) for the H2FPEF scale and 2.41 (95% CI: 1.66–3.51; p <0.001) for the HFA-PEFF scale. A gradient increase in the risk of adverse outcomes was found when moving from low to high probability of HFpEF for both scales. The obtained hazard ratio values are comparable with data from international registries. The incomplete agreement between the scales (82.3% agreement) suggests the feasibility of their combined use, especially for intermediate HFpEF probability. Conclusion. In patients with T2DM and suspected HFpEF, the HFA-PEFF and H2FPEF scores have prognostic value: high scores are associated with a significantly increased risk of death and cardiovascular hospitalizations within 1 year.N.I. Khutsishvili, I.S. Nazarov, A.F. Safarova, V.V. Tolkacheva, E.I. Luchina, Zh.D. Kobalava
Keywords
heart failure with preserved ejection fraction
type 2 diabetes mellitus
HFA-PEFF scale
H2FPEF scale
diastolic stress test
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About the Authors
Nutsiko I. Khutsishvili, MD, assistant at the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow, Russian Federation.E-mail: nutsiko.khutsishvili@gmail.com
ORCID: https://orcid.org/0009-0009-2669-8092. Scopus ID: 58558552800. eLibrary SPIN: 3322-4387
Ivan S. Nazarov, MD, assistant at the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow, Russian Federation.
E-mail: nazarovradomla@mail.ru
ORCID: https://orcid.org/0000-0002-0950-7487. Scopus ID: 57686928900. eLibrary SPIN: 5954-7828
Ayten F. Safarova, MD, Dr. Sci. (Medicine), professor of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow, Russian Federation.
E-mail: aytensaf@mail.ru
ORCID: https://orcid.org/0000-0003-2412-5986. eLibrary SPIN: 2661-6501
Veronika V. Tolkacheva, MD, Dr.Sci. (Medicine), professor of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow, Russian Federation.
E-mail: tolkachevav@mail.ru
ORCID: https://orcid.org//0000-0001-6847-8797. eLibrary SPIN: 2282-2127
Evgeniya I. Luchina, MD, head of the Department of endocrinology of V.V. Vinogradov University Clinical Center (branch), RUDN University of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0001-9911-2376. eLibrary SPIN: 3102-0107
Zhanna D. Kobalava, MD, Dr. Sci. (Medicine), professor, corresponding member of RAS, head of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow, Russian Federation.
E-mail: zkobalava@mail.ru
ORCID: https://orcid.org/0000-0002-5873-1768. Scopus ID: 7004399203. eLibrary SPIN: 9828-5409
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