HFpEF: diagnosis
H2FPEF, HFA-PEFF & HFpEF-ABA score
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
Diastolic stress test
-
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
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Pericardial (pericarditis), endomyocardial
-
High output, volume overload (CKD)
-
Arrhythmia (atrial arrhythmia/ ventricular arrhythmia, pacing, conduction disorder)
Functional
Morphological
Biomarker
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
0
0
0
History
Echocardiographic & Natriuretic peptide score
History
0
Functional
0
Morphological
0
Biomarker
0
Probability
Result
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HFpEF-ABA Score
Probability of heart failure with preserved EF =Z/(1+Z)*100 where Z = e^y and
y =-7.78875077116607 + 0.0625642747159337 x age + 0.135149246234458 x BMI + 2.04080564803471 x AF (1 for Yes and 0 for No)
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 x age + 0.130730156015681 x BMI + 0.0858634402456586 x (E/e') + 0.051963758732548 x PASP + 1.69968057294513 x 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
2) 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
3) van Dalen BM, Chin JF, Motiram PA, Hendrix A, Emans ME, Brugts JJ, Westenbrink BD, de Boer RA. Challenges in the diagnosis of heart failure with preserved ejection fraction in individuals with obesity. Cardiovasc Diabetol. 2025 Feb 7;24(1):71. doi: 10.1186/s12933-025-02612-z. PMID: 39920805; PMCID: PMC11806779.
4) Reddy YNV, Carter RE, Sundaram V, Kaye DM, Handoko ML, Tedford RJ, Andersen MJ, Sharma K, Obokata M, Verbrugge FH, Borlaug BA. An evidence-based screening tool for heart failure with preserved ejection fraction: the HFpEF-ABA score. Nat Med. 2024 Aug;30(8):2258-2264. doi: 10.1038/s41591-024-03140-1. Epub 2024 Jul 12. PMID: 38997608; PMCID: PMC11570987.
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