Prognostic Value of the H2FPEF Score in Adults With Repaired Coarctation of Aorta

Risk stratification is challenging in adults with repaired coarctation of aorta (COA) because of the complex interaction of multiple hemodynamic factors and differences in left ventricular adaptation to these factors. The H2FPEF score was originally developed for differentiating between heart failure with preserved ejection fraction and noncardiac dyspnea, but it has been shown to be useful for prognostication in other cardiovascular pathologies. The purpose of this study was to assess the prognostic role of the H2FPEF score in adults with repaired COA. This is a retrospective cohort study of adults with repaired COA at the Mayo Clinic (2003-2019). The H2FPEF score was calculated at baseline and at 5-year follow-up. Cardiovascular events (heart failure hospitalization, transplant, or cardiovascular death) were ascertained from medical records. We identified 712 patients (age 33 years [range 21-45 years]; 419 [59%] males). The baseline H2FPEF score was 2.2 ± 1.4. There was a temporal increase in the H2FPEF score at 5 years (ΔH2FPEF score 0.34 ± 0.11) due to the increase in the prevalence of hypertension, obesity, and high filling pressures. The H2FPEF score correlated with left atrial volume (r = 0.73, P < 0.001), right atrial volume (r = 0.41, P < 0.001), right ventricular fractional area change (r = −0.46, P < 0.001), and left ventricular e’ (r = −0.52, P < 0.001). Both the baseline H2FPEF score and ΔH2FPEF score were independently associated with cardiovascular events. These results suggest that the H2FPEF score can be used for prognostication in patients with COA. The temporal increase in the H2FPEF score was due to factors such as hypertension, obesity, and high filling pressures, and hence, it provides potential therapeutic targets to improve outcomes in this population.