The LEDA Score

Figures

• 

  Figure 1. LSFP by LEDA Score and HFpEF Status Box-and-whisker plots showing invasively measured LSFP across LEDA scores from 0 to 4, stratified by HFpEF status. Higher LEDA scores were associated with higher LSFP, with patients with HFpEF clustering at higher LEDA scores and higher filling pressures. Boxes represent median and interquartile range; whiskers indicate the most extreme nonoutlier values according to the Tukey method; blue circles represent patients without HFpEF, and red squares represent patients with HFpEF. HFpEF = heart failure with preserved ejection fraction; LEDA = Left ventricular concentricity, E/e′, left ventricle-to-left atrium Diastasis volume ratio, left Atrial reservoir function; LSFP = left-sided filling pressure.

• 

  Figure 2. Receiver Operating Characteristic Analysis for Heart Failure With Preserved Ejection Fraction Diagnosis LEDA showed stronger discrimination in this selected cohort (AUC: 0.85; 95% CI: 0.79-0.91) than H2FPEF (0.74), HFA-PEFF (0.74), and ASE 2025 criteria analyzed as a filling-pressure framework (0.61). ASE = American Society of Echocardiography; AUC = area under the curve; HFA-PEFF = Heart Failure Association Pretest assessment, Echocardiography & natriuretic peptide, Functional testing, Final etiology diagnostic algorithm; H2FPEF = Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure score; LEDA = Left ventricular concentricity, E/e′, left ventricle-to-left atrium Diastasis volume ratio, left Atrial reservoir function.

• 

  Figure 3. Clinical Utility and Multivariable Association Analysis (A) Decision curve analysis comparing LEDA with the clinical model. LEDA demonstrated greater net clinical benefit than the clinical model across clinically relevant threshold probabilities in this selected cohort. (B) Multivariable association analysis showing factors associated with heart failure with preserved ejection fraction after adjustment for clinical covariates. Odds ratios are shown with 95% confidence intervals. LEDA was included as the echocardiographic variable of interest; age, sex, atrial fibrillation, hypertension, diabetes mellitus type 2, coronary artery disease, body mass index, and estimated glomerular filtration rate were included as adjustment covariates. LEDA = Left ventricular concentricity, E/e′, left ventricle-to-left atrium Diastasis volume ratio, left Atrial reservoir function.

• 

  Central Illustration. LEDA: Bridging Phenotype and Hemodynamic Disease Expression in HFpEF In this selected cohort, LEDA linked clinical phenotype to hemodynamic congestion by integrating LV concentricity, E/e′, LV-to-LA diastasis coupling, and LA reservoir function. Risk categories were LEDA 0-1 low, 2 intermediate, and 3-4 high probability. ASE = American Society of Echocardiography; AUC = area under the curve; HFA-PEFF = Heart Failure Association Pretest assessment, Echocardiography & natriuretic peptide, Functional testing, Final etiology diagnostic algorithm; HFpEF = heart failure with preserved ejection fraction; H2FPEF = Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure score; LA = left atrial; LEDA = left ventricular concentricity; LSFP = left-sided filling pressure; LV = left ventricular; NT-proBNP = N-terminal pro–B-type natriuretic peptide.