Prognostic value of HFA-PEFF and H2FPEF scores in patients with advanced cancer: a prospective observational study

Background Cancer patients are at risk for developing heart diseases. The need for risk stratification tools applicable to patients with cancer has increased. HFA-PEFF and H2FPEF became essential for the diagnostic of heart failure with preserved ejection fraction (HFpEF). Their prognostic value and clinical importance in patients with cancer has yet to be investigated. Purpose The purpose of the study was to identify the potential use of HFA-PEFF and H2FPEF scores in patients with cancer. Methods This observational prospective study enrolled 516 hospitalized patients with active cancer (61 ± 14 years, 52% female, 86% advanced cancer stage). None of the patients had significant cardiovascular disease or antibiotic treated infection. Echocardiographic, clinical and medical history were assessed at baseline. The HFpEF likelihood was assessed using the HFA-PEFF score (low: 0-1 points, intermediate: 2-4 points and high: 5-6 points, N=516) and H2FPEF score (low: 0-1 points, intermediate: 2-5 points and high: 6-9 points, N=495). All-cause mortality follow-up was conducted over up to 75 months. Results A low, intermediate and high HFA-PEFF score was seen in 105 [20%], 272 [53%] and 139 [27%] patients; and a low, intermediate and high H2FPEF score was seen in 272 [55%], 214 [43%] and 9 [2%] of patients, respectively. Both scores were independent predictors of all-cause mortality in univariable (HFA-PEFF: hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.09-1.24, p < 0.001; H2FPEF: HR 1.11 [95% CI 1.04-1.19], p < 0.001) and multivariable analyses (HFA-PEFF: HR 1.09 [95% CI 1.01-1.18], p=0.017; H2FPEF: HR 1.09 [95% CI 1.00-1.19], p=0.033) each adjusted for age, sex, cancer stage, cancer type, time since cancer diagnosis, anti-cancer therapy, cachexia, high-sensitivity troponin T [hsTnT], and estimated glomerular filtration rate. HsTnT correlated with HFA-PEFF score (r = 0.425, p < 0.001) and with H2FPEF score (r = 0.353, p < 0.001). Conclusions Both HFA-PEFF and H2FPEF scores hold independent prognostic value for all-cause mortality in patients with cancer. Significant associations have been observed between both scores and high-sensitivity troponin T. Further studies are needed to better understand to which extent cancer patients develop HFpEF.