Prognostic value of the H2FPEF score in patients undergoing transcatheter aortic valve implantation

Sebastian Ludwig, Costanza Pellegrini, Alina Gossling, Tobias Rheude, Lisa Voigtländer, Oliver D. Bhadra, Matthias Linder, Daniel Kalbacher, Benedikt Koell, Lara Waldschmidt, Johannes Schirmer, Moritz Seiffert, Hermann Reichenspurner, Stefan Blankenberg, Dirk Westermann, Lenard Conradi, Michael Joner, Niklas Schofer

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Aims: The aim of this study was to assess the prognostic value of the H2FPEF score in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) and preserved left ventricular ejection fraction (EF). Methods and results: In this multicentre study, a total of 832 patients from two German high-volume centres, who received TAVI for severe AS and preserved EF (≥50%), were identified for calculation of the H2FPEF score. Patients were dichotomized according to low (0–5 points; n = 570) and high (6–9 points; n = 262) H2FPEF scores. Kaplan–Meier and Cox regression analyses were applied to assess the prognostic impact of the H2FPEF score. We observed a decrease in stroke volume index (−2.04 mL/m2/point) and mean transvalvular gradients (−1.14 mmHg/point) with increasing H2FPEF score translating into a higher prevalence of paradoxical low-flow, low-gradient AS among patients with high H2FPEF score. One year after TAVI, the rates of all-cause (low vs. high H2FPEF score: 8.0% vs. 19.4%, P < 0.0001) and cardiovascular (CV) mortality (1.9% vs. 9.0%, P < 0.0001) as well as the rate of CV mortality or rehospitalization for congestive heart failure (6.4% vs. 23.2%, P < 0.0001) were higher in patients with high H2FPEF score compared with those with low H2FPEF score. After multivariable analysis, a high H2FPEF score remained independently predictive of all-cause mortality [hazard ratio 1.59 (1.28–2.35), P = 0.018] and CV mortality or rehospitalization for congestive heart failure [hazard ratio 2.92 (1.65–5.15), P < 0.001]. Among the H2FPEF score variables, atrial fibrillation, pulmonary hypertension, and elevated left ventricular filling pressure were the strongest outcome predictors. Conclusions: The H2FPEF score serves as an independent predictor of adverse CV and heart failure outcome among TAVI patients with preserved EF. A high H2FPEF score is associated with the presence of paradoxical low-flow, low-gradient AS, the HFpEF in patients with AS. By identifying patients in advanced stages of HFpEF, the H2FPEF score might be useful as a risk prediction tool in patients with preserved EF scheduled for TAVI.

Original languageEnglish
Pages (from-to)461-470
Number of pages10
JournalESC Heart Failure
Volume8
Issue number1
DOIs
StatePublished - Feb 2021
Externally publishedYes

Keywords

  • Aortic stenosis
  • HFPEF score
  • HFpEF
  • Paradoxical low gradient
  • TAVI

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