HFpEF: diagnosis
H2FPEF & HFA-PEFF

H2FPEF score

Heavy
Hypertension
F atrial Fibrillation
Pulmonary hypertension
Elder
Filling pressure

BMI, kg/m²

2 or more antihypertensive medicines

Yes

Paroxysmal or persistent AF

Yes

PASP (mmHg)

Age, year

E/e'

Pretest Assessment

Echocardiographic & Natriuretic peptide score

Functional testing in case of uncertainty

Final etiology

septal e', cm/s (<7 cm/s)

lateral e', cm/s (<10 cm/s)

Average E/e' (9-14, ≥15)

TR Vmax, m/s (>2.8 m/s)

Sex

Male

Female

LAVI, ml/m² (29-34, >34 ml/m²)

LVMI, g/m² (>115 m/95 w, >149 m/122 w g/m²)

RWT ( >0.42)

LV wall thickness, mm (≥ 12 mm)

NT-proBNP, pg/ml (125-220, > 220 pg/ml SR, 365-660, > 660 pg.ml AF)

BNP, pg/ml (35-80, > 80 pg/ml SR, 105-240, > 240 pg.ml AF)

Atrial fibrillation

Yes

Diastolic stress test

Average E/e' (≥ 15)

TR Vmax, m/s (> 3.4 m/s)

Metabolic (hormonal/nutritional)
Immune/inflammatory (infection/autoimmune)
Ischemic heart disease (CAD/microvascular dysfunction)
Drugs/toxic (substance abuse, cardiotoxic drugs, radiation, metals)
Genetics (HCM/RCM, cardiac amyloidosis/muscular dystrophies)
Infiltrative disease (malignancy, others)
Endomyocardial fibrosis
Hypertension, congenital heart disease, valvular heart disease
Pericardial (pericarditis), endomyocardial
High output, volume overload (CKD)
Arrhythmia (atrial arrhythmia/ ventricular arrhythmia, pacing, conduction disorder)

Functional

Morphological

Biomarker

GLS ( <16% )

Symptom & Signs of HF: Breathlessness, Exercise intolerlance, Othopnea, PND, Edema

Comorbidities/Risk factors: Age, sex, hypertension, atrial fibrillation, CAD, diabetes, CKD, anemia, COPD, Obesity/overweight

Laboratory test: NPs, Hb, HbA1C, ferritin, Creatinine, eGFR, ALT, TSH, electrolyte (Na, K)

EKG: AF, LVH by voltage criteria, LAA

Echocardiography: LVEF, LVH, LA enlargement

Exercise test: Ergometry, 6MWT, CPET

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The authors present two prediction models. The first model uses simple point addition with yes/no variables. The second model is more accurate and uses continuous variables. The simpler model includes hypertension, but it is not significant in the more complex model, so hypertension was excluded.

Probability of heart failure with preserved EF = (Z / (1 + Z)) x 100 where Z = e^y and

y = -9.19174463966566 + 0.0451129471272832*age + 0.130730156015681*BMI + 0.0858634402456586*(E/e') + 0.051963758732548*PASP + 1.69968057294513*AF(1 for Yes and 0 for No)

References

1) Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BA. A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction. Circulation [Internet]. 2018 Aug 28 [cited 2025 May 31];138(9):861–70. Available from: https://doi.org/10.1161/CIRCULATIONAHA.118.034646

Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, et al. How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European Heart Journal [Internet]. 2019 Oct 21 [cited 2025 Jun 1];40(40):3297–317. Available from: https://doi.org/10.1093/eurheartj/ehz641

HFpEF: diagnosis H2FPEF & HFA-PEFF

H2FPEF score

Heavy Hypertension F atrial Fibrillation Pulmonary hypertension Elder Filling pressure

Pretest Assessment Echocardiographic & Natriuretic peptide score ​ ​ Functional testing in case of uncertainty

Final etiology

HFpEF: diagnosis
H2FPEF & HFA-PEFF

Heavy
Hypertension
F atrial Fibrillation
Pulmonary hypertension
Elder
Filling pressure

Pretest Assessment

Echocardiographic & Natriuretic peptide score

Functional testing in case of uncertainty