Heart Failure with Preserved Ejection Fraction Diagnostic Scores in an Asian Population

Heart failure with preserved ejection fraction (HFpEF) is a global epidemic, with increasing prevalence especially in aging societies such as Asia.1 Non-invasive diagnosis of HFpEF is especially challenging and currently relies on a combination of symptoms and signs, increased natriuretic peptides as well as structural and/or functional alterations on echocardiography signifying increased left ventricular filling pressures.2 Recently, the H2FPEF score3 and a novel algorithm by the Heart Failure Association of the European Society of Cardiology (HFA-PEFF)4 have been proposed for the diagnosis of HFpEF. The H2FPEF score includes a combination of clinical characteristic [age, obesity and atrial fibrillation (AF)] and echocardiographic parameters, while the new HFA-PEFF score includes echocardiographic characteristics such as left atrial enlargement combined with natriuretic peptide elevation. Asian patients with HFpEF are almost a decade younger than their western counterparts, have a lower prevalence of obesity and AF, and generally have smaller heart sizes with less concomitant left atrial enlargement.1 Thus, we hypothesized that both scores may be less sensitive for the diagnosis of HFpEF in Asian patients with HFpEF. Accordingly, we aimed to test the ability of the HFA-PEFF and H2FPEF scores to distinguish HFpEF from hypertensive controls in an Asian population.