The CPET-HFpEF score: simplifying the diagnosis of heart failure with preserved ejection fraction

Introduction Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging. For noninvasive diagnosis, two multiparameter risk scores are commonly used: the HFA-PEFF and the H2FPEF-scoring systems. Both integrate morphological evidence of structural heart disease from echocardiography, historical features, and/or laboratory assessment of natriuretic peptides. However, diagnostic uncertainty persists when these assessments are inconclusive. To simplify HFpEF diagnosis in patients with unexplained exercise intolerance and dyspnoea, we developed a noninvasive score that is based on cardiopulmonary exercise testing (CPET) parameters. Methods / results CPET is the gold standard for determining the cause of unexplained dyspnoea and/or exercise intolerance, the key symptoms of heart failure. We combined the five CPET parameters VO2 peak indexed by bodyweight, VE/VCO2 slope, oxygen uptake efficiency slope (OUES), VO2/WR slope, the increase in PetCO2 during exercise (PetCO2 delta) and added the NT-proBNP value. Thresholds were defined as follows: VO2peak indexed by body weight < 20 ml/min/kg, VE/VCO2 slope > 30, OUES ≤ 1,6, VO2/WR slope < 8 ml/min/W, PetCO2 delta ≤ 4, and NT-proBNP ≥ 300 pg/ml. Patients received 1 point for each parameter laying above threshold, with a total score of ≥ 4 points confirming the diagnosis of HFpEF. The score was applied to 130 patients: 61 with the diagnosis of HFpEF (confirmed by a HFA-PEFF-score 5 or 6) and 69 patients with an unlikely diagnosis of heart failure. Of the 61 patients with the diagnosis of HFpEF, 58 had a CPET-HFpEF score ≥ 4, and only one patient in the group with no heart failure had a positive score. Conclusion The CPET-HFpEF score enables confirmation of HFpEF in patients with exercise intolerance and dyspnoea using a single, comprehensive whole-body testing approachGraphical abstract