Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02302-4
Prevalence of HFpEF in patients referred for atrial fibrillation ablation: Applying HFA-PEFF, H2FPEF, ESC 2021, and DELIVER to a TRUST snapshot data set
J. Rieß1, J. Obergassel1, N. Pohlmann1, M. Nies1, L. Rottner1, M. Lemoine2, I. My2, J. Wenzel1, S. Kany1, F. Moser1, C. Pauschinger3, D. Ismaili1, B. Reißmann4, F. Ouyang1, C. Magnussen1, C. Sinning3, A. Metzner2, P. Kirchhof1, A. Rillig2, für die Studiengruppe: TRUST
1Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 2Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 3Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 4Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg;

Introduction

Shared pathophysiological mechanisms contribute to a significant overlap between atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). However, diagnosing HFpEF remains challenging, despite the availability of numerous diagnostic algorithms. At present, there is a lack of understanding of the proportion of patients referred for AF ablation who would concurrently be diagnosed with HFpEF in a contemporary setting.

 

Methods

The TRUST registry, a prospective, observational clinical cohort that has been recruiting patients with heart rhythm disorders at a large tertiary-care center since March 2021 was interrogated for AF patients. Then the HFAPEFF- and the H2FPEF score, the ESC 2021 algorithm for HFpEF and the inclusion criteria of the DELIVER trial were applied to the available clinical, laboratory, and imaging baseline characteristics evaluated in the TRUST study. 

 

Results

A total of 1000 patients were analyzed and 35,9% were female, median age was 67 (IQR 58;75) years, median BMI was 27.0 (IQR 24;30) kg/m2. NYHA class II was reported in 39.9% cases, NYHA class III in 19.5% and NYHA class IV in 0.9%. Median NT-proBNP was 831 (IQR 276;1658) mg/dl, median left ventricular ejection fraction was 55.0% (IQR 50;60%; 771/1000 EF ≥ 50%; 99/1000 EF 41-49%; 130/1000 EF ≤ 40%).

The inclusion criteria for DELIVER were met by 33.2% of the patients, 13.6% were considered to have HFpEF using the HFA-PEFF score, 18.3% using the H2FPEF score. According to the ESC HF guidelines 2021, 38.6% would be diagnosed with HFpEF (median age 70 (IQR 62;76) years, 48% female, median BMI 27.0 (IQR 24;31) kg/m2). 8.1% met the criteria of all 4 diagnostic tools. 55.7% were not diagnosed with HFPEF by any of them. Fleiss’ kappa coefficient () was moderate with 0.45.  

 

Conclusion

A large proportion (up to 44%) of patients referred for AF ablation in TRUST met the criteria for HFpEF of at least one of the evaluated algorithms. The prevalence of HFpEF was high, depending on the diagnostic tool utilized. These findings call for HF screening in clinical routine in AF patients.

 
 
 
 
 
 
 
 
https://dgk.org/kongress_programme/ht2023/aV447.html