What question did this study set out to answer?

To assess the prognostic capability of an Asian-modified H2FPEF score for predicting all-cause mortality and heart failure hospitalization in severe primary mitral regurgitation with preserved ejection fraction.

September 8, 2026Journal of Cardiovascular Development and DiseaseOpen Access

High modified H2FPEF score linked to ~9-fold higher risk of mortality and HFH versus low scores.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe primary mitral regurgitation with preserved ejection fraction (n=388). Intervention: High modified H2FPEF score (6-9) vs. Low modified H2FPEF score (0-1). Primary outcome: Composite of all-cause mortality and first heart failure hospitalization (HFH) (HR 9.17, 95% CI 2.15-39.1).

Q: What does this research mean for the field?

A modified H2FPEF score, adjusted for Asian obesity cutoffs, effectively stratifies the risk of all-cause mortality and first heart failure hospitalization in patients with severe primary mitral regurgitation and preserved ejection fraction. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Why the study?

Severe MR causes significant morbidity and mortality, but whether a modified H2FPEF score provides prognostic utility in severe primary MR with preserved ejection fraction was unknown.

Does a higher modified H2FPEF score predict all-cause mortality and first heart failure hospitalization in patients with severe primary mitral regurgitation and preserved ejection fraction?

Population

388 patients with severe primary MR and preserved LVEF at a tertiary center

Comparison

Modified H2FPEF score groups: low (0-1) vs intermediate (2-5) vs high (6-9)

Design

Single-center observational cohort study

Follow-up

Median 4.53 years

Key result

A high modified H2FPEF score was significantly associated with an increased risk of all-cause mortality and first heart failure hospitalization compared to a low score (HR 9.17; 95% CI 2.15-39.1).

Authors

HWHon Jen Wong TKTze Siang Koh ZBZong Rui Bai

Discussion

Member takes

Overview

May support risk stratification in severe primary MR with preserved EF; extends H2FPEF validation but remains hypothesis-generating.

Key Points

To assess the prognostic capability of an Asian-modified H2FPEF score for predicting all-cause mortality and heart failure hospitalization in severe primary mitral regurgitation with preserved ejection fraction.
Analyzed 388 patients with severe primary mitral regurgitation and LVEF ≥ 50% from a tertiary cardiovascular referral center, followed for a median of 4.53 years (IQR 2.61–6.60).
Modified the H2FPEF score using an Asian-specific obesity threshold (BMI > 25 kg/m²) and categorized patients into low (0–1), intermediate (2–5), and high (6–9) risk tiers.
Evaluated the primary composite endpoint of all-cause mortality and first heart failure hospitalization using multivariable Cox regression and Fine–Gray subdistribution hazard models.
Intermediate and high modified H2FPEF scores were independently associated with the primary composite endpoint compared to low scores (intermediate: HR 6.71, 95% CI 1.62–27.9; high: HR 9.17, 95% CI 2.15–39.1).
Fine–Gray regression showed no significant difference in the subdistribution hazards of first heart failure hospitalization between intermediate and high score tiers.

Study Design

Type

Cohort (n=388)

Multicenter

Structured PICO

Does a higher modified H2FPEF score predict all-cause mortality and first heart failure hospitalization in patients with severe primary mitral regurgitation and preserved ejection fraction?

Population

388 patients with severe primary mitral regurgitation and preserved ejection fraction, followed for a median of 4.53 years.

Exposure

High (6-9) or intermediate (2-5) modified H2FPEF score (using BMI > 25 kg/m2 cutoff for obesity)

Comparator

Low (0-1) modified H2FPEF score

Outcome

Composite of all-cause mortality and first heart failure hospitalization (HFH)composite

Main Result

Hazard Ratio: 9.17 (95% CI 2.15–39.1)

The modified H2FPEF score (using an Asian-specific BMI cutoff) effectively risk-stratifies patients with severe primary mitral regurgitation and preserved ejection fraction for mortality and heart failure hospitalization.

Cite This Study

Wong et al. (2026) conducted a cohort in Severe primary mitral regurgitation with preserved ejection fraction (n=388). High modified H2FPEF score (6-9) vs. Low modified H2FPEF score (0-1) was evaluated on Composite of all-cause mortality and first heart failure hospitalization (HFH) (HR 9.17, 95% CI 2.15-39.1). A high modified H2FPEF score was significantly associated with an increased risk of all-cause mortality and first heart failure hospitalization compared to a low score (HR 9.17; 95% CI 2.15-39.1).

synapsesocial.com/papers/6a9fd80458e84d0ff5b47205 https://doi.org/10.3390/jcdd13090439

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September 8, 2026Journal of Cardiovascular Development and DiseaseOpen Access

High modified H2FPEF score linked to ~9-fold higher risk of mortality and HFH versus low scores.

View Full Paper

Ask AI

Bookmark

Why the study?

Severe MR causes significant morbidity and mortality, but whether a modified H2FPEF score provides prognostic utility in severe primary MR with preserved ejection fraction was unknown.

Does a higher modified H2FPEF score predict all-cause mortality and first heart failure hospitalization in patients with severe primary mitral regurgitation and preserved ejection fraction?

Population

388 patients with severe primary MR and preserved LVEF at a tertiary center

Comparison

Modified H2FPEF score groups: low (0-1) vs intermediate (2-5) vs high (6-9)

Design

Single-center observational cohort study

Follow-up

Median 4.53 years

Key result

A high modified H2FPEF score was significantly associated with an increased risk of all-cause mortality and first heart failure hospitalization compared to a low score (HR 9.17; 95% CI 2.15-39.1).

Authors

HWHon Jen Wong TKTze Siang Koh ZBZong Rui Bai

Discussion

Member takes

Overview

May support risk stratification in severe primary MR with preserved EF; extends H2FPEF validation but remains hypothesis-generating.

Key Points

To assess the prognostic capability of an Asian-modified H2FPEF score for predicting all-cause mortality and heart failure hospitalization in severe primary mitral regurgitation with preserved ejection fraction.
Analyzed 388 patients with severe primary mitral regurgitation and LVEF ≥ 50% from a tertiary cardiovascular referral center, followed for a median of 4.53 years (IQR 2.61–6.60).
Modified the H2FPEF score using an Asian-specific obesity threshold (BMI > 25 kg/m²) and categorized patients into low (0–1), intermediate (2–5), and high (6–9) risk tiers.
Evaluated the primary composite endpoint of all-cause mortality and first heart failure hospitalization using multivariable Cox regression and Fine–Gray subdistribution hazard models.
Intermediate and high modified H2FPEF scores were independently associated with the primary composite endpoint compared to low scores (intermediate: HR 6.71, 95% CI 1.62–27.9; high: HR 9.17, 95% CI 2.15–39.1).
Fine–Gray regression showed no significant difference in the subdistribution hazards of first heart failure hospitalization between intermediate and high score tiers.

Study Design

Type

Cohort (n=388)

Multicenter

Structured PICO

Does a higher modified H2FPEF score predict all-cause mortality and first heart failure hospitalization in patients with severe primary mitral regurgitation and preserved ejection fraction?

Population

388 patients with severe primary mitral regurgitation and preserved ejection fraction, followed for a median of 4.53 years.

Exposure

High (6-9) or intermediate (2-5) modified H2FPEF score (using BMI > 25 kg/m2 cutoff for obesity)

Comparator

Low (0-1) modified H2FPEF score

Outcome

Composite of all-cause mortality and first heart failure hospitalization (HFH)composite

Main Result

Hazard Ratio: 9.17 (95% CI 2.15–39.1)

Cite This Study

synapsesocial.com/papers/6a9fd80458e84d0ff5b47205 https://doi.org/10.3390/jcdd13090439

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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