Key result
HFpEF-ABA and H2FPEF scores show high specificity but poor sensitivity for detecting HFpEF.
Why the study?
The HFpEF-ABA and H2FPEF scores estimate the likelihood of HFpEF in dyspneic patients with preserved LVEF, but their diagnostic performance in patients with structural changes compatible with HFpEF regardless of clinical features or symptoms of HF was unknown.
Do the HFpEF-ABA and H2FPEF scores accurately detect clinically diagnosed HFpEF in patients with preserved ejection fraction (LVEF ≥50%) and structural hallmarks of HFpEF (LVMI ≥70 g/m2) regardless of heart failure symptoms?
Cohort (n=542)
No
Do the HFpEF-ABA and H2FPEF scores accurately detect clinically diagnosed HFpEF in patients with preserved ejection fraction (LVEF ≥50%) and structural hallmarks of HFpEF (LVMI ≥70 g/m2) regardless of heart failure symptoms?
In patients with structural hallmarks of HFpEF on CMR regardless of symptoms, the HFpEF-ABA and H2FPEF scores have high specificity to rule out disease, but low sensitivity limits their utility for detecting early-stage or subclinical HFpEF.
High specificity supports ruling out HFpEF in CMR structural disease; leaves open prospective validation for subclinical detection.
Introduction The HFpEF-ABA and H2FPEF scores estimate the likelihood of HFpEF diagnosis in dyspneic patients with preserved left ventricular ejection fraction (LVEF). The performance of these scores in patients with structural changes compatible with HFpEF, regardless of the presence of clinical features or symptoms of heart failure (HF), is unknown. Purpose To evaluate the diagnostic performance of the HFpEF-ABA and H2FPEF scores in a cohort composed of patients with LVEF ≥50% and increased left ventricular mass index (LVMI ≥70 g/m2) regardless of the presence or absence of clinical features of HF. Methods In this retrospective monocentric study at our Hospital, we included 542 unique individuals with preserved LVEF, increased LVMI, and available echocardiography within 3 months, identified from 19,535 CMR examinations performed between 2010 and 2024. Patients with infiltrative or hypertrophic cardiomyopathy, severe valvular heart disease, or missing key data were excluded. Clinically diagnosed HFpEF was defined based on ICD-10 coding documented in medical records. Diagnostic performance of the HFpEF-ABA and H2FPEF scores was assessed by calculating AUC, sensitivity and specificity. Sensitivity and specificity were derived using an optimal cutoff ≥0.7 for HFpEF-ABA determined by the Youden index and a predefined cutoff ≥6 for H2FPEF. Results Dyspnea of cardiac origin was present in 61.1% of patients; 10.5% had clinically diagnosed HFpEF. The HFpEF-ABA and H2FPEF scores demonstrated high specificity (87.6% and 96.1%) but limited sensitivity (36.8% and 26.3%), with modest discrimination (AUC 0.66 and 0.73; DeLong p=0.011) for HFpEF detection. Conclusion In patients with structural HFpEF hallmarks on CMR but regardless of the presence or absence of HF symptoms, the HFpEF-ABA and H2FPEF scores reliably identify true negatives. However, sensitivity remains low, limiting their ability to detect HFpEF in this population. These findings highlight the need for refined diagnostic approaches in early-stage or subclinical HFpEF.Study population flowchart.ROC curves
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Rocca et al. (2026) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=542). HFpEF-ABA score (cutoff ≥0.7) vs. H2FPEF score (cutoff ≥6) was evaluated on Diagnostic performance (AUC, sensitivity, and specificity) for clinically diagnosed HFpEF (AUC 0.66 vs 0.73, p=0.011). HFpEF-ABA and H2FPEF scores showed high specificity (87.6% and 96.1%) but low sensitivity (36.8% and 26.3%) and modest discrimination (AUC 0.66 vs 0.73; p=0.011) for HFpEF detection.
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