Abstract 24 Validation of heart failure with preserved ejection fraction diagnosis in obese vs. non-obese hospital patients using the HFA-PEFF score

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Validation of heart failure with preserved ejection fraction diagnosis in obese vs. non-obese hospital patients using the HFA-PEFF score
A. J. Hobbach¹, T. Brix², J. Varghese², H. Reinecke¹, W. A. Linke³
¹Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster; ²Institut für Medizinische Informatik, Universitätsklinikum Münster, Münster; ³Institut für Physiologie II, Universitätsklinikum Münster, Münster;
Aims: Heart failure with preserved ejection fraction (HFpEF) is a growing disease; however, the pathomechanisms are incompletely understood and diagnosis is still challenging. Here, we characterized a ‘real world’ cohort of daily clinical HFpEF by retrospectively assigning an HFA-PEFF score to university hospital patients with preserved ejection fraction (EF). Obesity was considered an independent risk factor for HFpEF by grouping patients according to body mass index (BMI). Methods: Patients who visited the University Hospital Münster in 2020/2021 were screened for either the diagnosis of HFpEF or for fulfilling the diagnostic criteria of HFpEF according to the European Society of Cardiology (2021) algorithm, which involves clinical symptoms, the HFA-PEFF score, and invasive hemodynamics. BMI was used to categorize patients into two subgroups (<25 kg/m² and >30 kg/m²). Results: HFpEF could have been diagnosed in 57.7 % of all cases using the HFA-PEFF score without necessitating invasive measurements. The median HFA-PEFF score was indistinguishable between obese (5; N=87) and non-obese (5; N=61) HFpEF, whereas the H2FPEF score, which considers obesity, distinguished these groups (8 vs. 5, respectively). HFpEF patients were highly symptomatic and on average had four comorbidities, on top of obesity in BMI >30 kg/m² patients. Obesity was associated with a higher presence of diabetes (p < 0.001), sleep apnea (p < 0.001), edema (p = 0.002) and increased drug intake (p < 0.001). Medical therapy was mainly based on the treatment of comorbidities and/or heart failure with reduced EF (HFrEF). Conclusion: The HFA-PEFF score is useful for diagnosing HFpEF as shown in a retrospective approach. While HFpEF treatment was indistinguishable from HFrEF treatment, the presence of obesity in HFpEF was associated with worse symptoms and a higher incidence of comorbidities. Future therapeutic approaches in HFpEF should focus on reducing weight. Figure 1: Plus–minus values are means ±SD. NYHA class and degree of diastolic dysfunction are described by median. Categorial variables are described by absolute numbers and percentages. ACEi, angiotensin-converting enzyme inhibitor; AHT, arterial hypertension; AF, atrial fibrillation; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor; ASA, acetylsalicylic acid; BMI, body-mass-index; CCB, calcium channel blocker; CHD, coronary heart disease; CI cardiac index; COPD, chronic obstructive pulmonary disease; CVD, cerebrovascular disease; eGFR, estimated glomerular filtration rate; IASD, implanted interatrial shunt device; LAVI, left atrial volume index; LVEF, left ventricular ejection fraction; MI, myocardial infarction; MRA, mineralocorticoid receptor antagonist; NT-proBNP, N‐terminal pro‐brain natriuretic peptide; NYHA, New York Heart Association; OACs, oral anticoagulants; PAD, peripheral artery disease; PAH, pulmonary hypertension; PCWP, pulmonary capillary wedge pressure; SGLT-2i, sodium glucose cotransporter-2 inhibitor; TIA, transient ischemic attack; TR, tricuspid valve regurgitation.
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