Table 1.
HFA-PEFF score.
| Step 1: Initial overview | ||
|---|---|---|
| •Comorbidities and risk factors •Symptoms and/or signs of HF •Rule out other cardiac/non cardiac causes | •Standard diagnostic tests: ECG, standard echocardiography, natriuretic peptides, ergometry, 6-MWT, Cardiopulmonary exercise testing | |
| ||
| Results suggestive of HFpEF | ||
| Step 2: Echocardiographic and biomarker scoring | ||
|
Functional domain: Major: •septal e' <7 cm/s or •lateral e' <10 cm/s or •average E/e' ≥ 15 or •TR velocity > 2.8 m/s (PASP > 35 mmHg) |
Morphological domain: Major:- LAVI > 34 ml/m2 in sinus rhythm or - LAVI > 40 ml/m2 in atrial fibrillation or - LVMI ≥ 149/122 g/m2 (M/W) and RWT > 0,42 |
Biomarker domain: Major: - NT-proBNP > 220 pg/ml or BNP > 80 pg/ml in sinus rhythm - NT-proBNP > 660 pg/ml or BNP > 240 pg/ml in atrial fibrillation |
| Minor: - Average E/e' 9–14 or - GLS <16% |
Minor: - LAVI 29–34 ml/m2 in sinus rhythm or - LAVI 34–40 ml/m2 in atrial fibrillation or - LVMI > 115/95 g/m2 (M/W) or - RWT > 0,42 or - LV wall thickness ≥ 12 mm | Minor: - NT-proBNP 125–220 pg/ml or BNP 35–80 pg/ml in sinus rhythm - NT-proBNP 365–660 pg/ml or BNP 105–240 pg/ml in atrial fibrillation |
| Major and Minor criteria are scored with 2 and 1 points, respectively. Points are added only when they come from different domains. | ||
| ≥5 points: definite diagnosis of HFpEF | ||
| 2–4 points: uncertain diagnosis of HFpEF | ||
| Step 3: Functional testing in Case of Uncertainty | ||
|
Diastolic echo stress test: - Average E/e' ≥ 15: 2 points - Average E/e' ≥ 15 and TR velocity > 3.4 m/s: 3 points |
If Echo inconclusive, perform invasive haemodynamic measurements (right heart catheterization at rest or during exercise) |
|
| If Step (2) + Step (3) ≥5 points -> definite diagnosis of HFpEF | ||
| Step 4: Final etiology | ||
| Cardiovascular Magnetic Resonance | ||
| Scintigraphy / CT / PET | ||
| Cardiac or Non-Cardiac Biopsies | ||
| Genetic testing | ||
| Specific Laboratory Tests | ||
The table shows the proposed score that relies on four diagnostic steps and embraces validated functional and structural parameters together with natriuretic peptides assessment leading the confirmation or exclusion of HFpEF.
HF, heart failure; ECG, electrocardiogram; 6-MWT, 6-minute walking test; HFpEF, heart failure preserved ejection fraction; TR, tricuspid valve; PASP, pulmonary artery systolic pressure; GLS, global longitudinal strain; LAVI, left atrium volume index; LVMI, left ventricle mass index; RWT, right wall thickness; NT-proBNP, Nterminal-pro Brain Natriuretic Peptide; CT, computed tomography; PET, positron emission tomography [modified from Pieske et al. (36)].