Table 4.
Traditional Methods to Classify Patients as High or Low Likelihood of Having HFpEF Using Guideline Echocardiogram Cut Points or Validated Clinical Algorithms
| Criteria | n | No Class | Sensitivity (95% CI) | Specificity (95% CI) |
|---|---|---|---|---|
| AI HFpEF model | 1,284 | 94 | 87.8 (84.6–90.6) | 81.9 (78.0–85.3) |
| Echocardiogram guideline thresholds | ||||
| Left atrial volume indexa ≥34 mL/m2 | 457 | 39 | 83.5 (72.5–92.0) | 84.4 (73.9–94.0) |
| LV mass indexa >116/95 g/m2 | 1,256 | 93 | 65.8 (61.2–69.5) | 86.6 (83.9–90.2) |
| Relative wall thickness >0.42 | 1,257 | 93 | 75.3 (71.3–78.8) | 47.1 (41.4–51.5) |
| LV posterior wall thickness >12 mm | 1,259 | 94 | 52.2 (47.3–56.5) | 86.5 (83.3–89.3) |
| Global longitudinal strain ≥-16% | 101 | 3 | 72.4 (50.0–100.0) | 92.5 (16.7–100.0) |
| Average E/e’ ratio ≥15 | 1,259 | 93 | 78.2 (73.9–82.2) | 96.8 (95.1–98.3) |
| Septal mitral annular early diastolic tissue velocity (e’) <7 cm/s | 1,251 | 93 | 86.2 (82.9–90.0) | 73.8 (70.1–78.2) |
| Lateral mitral annular early diastolic tissue velocity (e’) <10 cm/s | 762 | 58 | 89.6 (84.8–94.0) | 56.4 (48.6–63.3) |
| Septal E/e’ >15 | 1,251 | 93 | 81.7 (77.9–84.4) | 96.8 (95.2–98.3) |
| Lateral E/e’>13 | 762 | 58 | 67.6 (60.1–74.1) | 95.1 (91.5–98.2) |
| Tricuspid regurgitation velocity >2.8 m/s | 965 | 72 | 60.2 (54.5–65.3) | 90.6 (87.0–93.9) |
| Pulmonary artery systolic pressure >35 mm Hg | 958 | 71 | 73.4 (67.5–78.4) | 84.7 (81.1–89.1) |
| BNP/NT-proBNP ≥125/35 | 459 | 29 | 97.6 (94.0–100.0) | 36.9 (22.6–56.6) |
| Clinical algorithm | ||||
| HFA-PEFF | 1,284 | 701 | 95 (92.0–97.8) | 97.1 (94.7–98.9) |
| H2FPEF | 1,284 | 776 | 98.2 (96.3–99.8) | 74.0 (66.9–79.0) |
Data presented are the total sample of patients with data available for use in the classification (“n”), number of patients with data available who receive a nondiagnostic output from the AI HFpEF model (“no class).
H2FPEF = Heavy, Hypertensive, Atrial Fibrillation, Pulmonary Hypertension, Elder, and Filling Pressure; HFA-PEFF = Heart Failure Association-Pretest Assessment, Echocardiographic and Natriuretic Peptide Score, Functional Testing, and Final Etiology; HFpEF = heart failure with preserved ejection fraction; LA = left atrial; LV = left ventricle.
Indexing was performed to body surface area. Average filling refers to the calculated mean of the septal and lateral mitral annular early diastolic tissue velocity when both metrics are available, or the available metric when only 1 is available. Pulmonary artery systolic pressure calculated as 4 (tricuspid regurgitation velocity)2 + estimated right atrial pressure (5 mm Hg). HFA-PEFF probability categories calculated according to Pieske et al12 Patients with a score of 0 or 1 were considered unlikely likelihood of HFpEF (negative output; predicted control), and 5 or more considered probable likelihood of HFpEF (positive output; predicted case). H2FPEF categorical scores were calculated according to Reddy et al11 Patients with a score of 0 or 1 were considered low probability of HFpEF (negative output; predicted control), and 6 or more considered high probability of HFpEF (positive output; predicted case).