Prognostic Implications of High HFpEF Probability in Patients With Chronic Thromboembolic Pulmonary Hypertension

Q: What are the key findings of this study?

Each SD increase in HFpEF-ABA score independently increased the risk of clinical worsening by 73% (HR 1.730, 95% CI 1.368-2.188, p < 0.001) in patients with CTEPH.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic thromboembolic pulmonary hypertension (CTEPH) (n=466). Intervention: HFpEF-ABA score (per SD increase or high probability ≥75%) vs. Lower HFpEF-ABA score (<75% or <25% low probability). Primary outcome: Clinical worsening (composite of all-cause mortality, unplanned rehospitalization due to worsening pulmonary hypertension or right heart failure, or escalation of targeted pulmonary hypertension therapy) (HR 1.730, 95% CI 1.368-2.188, p=<0.001).

Q: What does this research mean for the field?

Higher HFpEF probability assessed by the HFpEF-ABA score is independently associated with a 73% increase in the risk of clinical worsening per standard deviation in patients with chronic thromboembolic pulmonary hypertension. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate heart failure with preserved ejection fraction (HFpEF) pretest probability using the HFpEF-ABA algorithm in patients with chronic thromboembolic pulmonary hypertension and examine its link to clinical worsening.

Yijia Wang; Xin Li; Zhihua Huang; Anqi Duan; Qi Wang; Luyang Gao; Sicong Li; Qing Zhao; Tao Yang; Zhihui Zhao; Qin Luo; Zhihong Liu

doi:10.1002/clc.70503

November 1, 2026Clinical CardiologyOpen Access

Prognostic Implications of High HFpEF Probability in Patients With Chronic Thromboembolic Pulmonary Hypertension

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Key result

Higher HFpEF-ABA score is linked to ~73% higher clinical worsening risk per SD in CTEPH.

HR 1.730
95% CI 1.368-2.188
P<0.001
n=466

Figures

Graphical abstract published by Clinical Cardiology — Graphical abstract · Published by Clinical Cardiology · CC BY

Why the study?

CTEPH and HFpEF share overlapping clinical features despite distinct pathophysiology, motivating evaluation of the HFpEF-ABA algorithm to characterize HFpEF pretest probability in CTEPH and its association with left heart disease and clinical worsening.

Does a higher pretest probability of HFpEF quantified by the HFpEF-ABA score predict clinical worsening and improve risk stratification beyond COMPERA 2.0 in patients with chronic thromboembolic pulmonary hypertension?

Key Points

To evaluate heart failure with preserved ejection fraction (HFpEF) pretest probability using the HFpEF-ABA algorithm in patients with chronic thromboembolic pulmonary hypertension and examine its link to clinical worsening.
Analyzed 466 patients with chronic thromboembolic pulmonary hypertension stratified by HFpEF-ABA score into low (< 25%), intermediate (25%–74%), and high (≥ 75%) probability groups.
Tracked clinical worsening (all-cause death, unplanned rehospitalization for right heart failure or pulmonary hypertension, or targeted therapy escalation) over a median follow-up of 27 months.
Evaluated independent prognostic value using multivariable Cox regression and assessed discrimination improvement when adding the score to COMPERA 2.0.
Intermediate and high HFpEF probabilities were observed in 52.4% (n = 244) and 9.0% (n = 42) of patients, respectively, with clinical worsening occurring in 115 patients (24.7%).
Each standard deviation increase in HFpEF-ABA score was associated with a 73.0% higher risk of clinical worsening in the fully adjusted model (HR 1.730, 95% CI 1.368–2.188, p < 0.001); high probability (≥ 75%) versus low (< 25%) had an HR of 3.464 (95% CI 1.634–7.344, p = 0.001).
Adding the HFpEF-ABA score to the COMPERA 2.0 model improved discrimination, increasing the C-index from 0.532 to 0.634 (p = 0.012).

Study Design

Type

Cohort (n=466)

Multicenter

No

Structured PICO

Does a higher pretest probability of HFpEF quantified by the HFpEF-ABA score predict clinical worsening and improve risk stratification beyond COMPERA 2.0 in patients with chronic thromboembolic pulmonary hypertension?

P

Population

466 adult patients with chronic thromboembolic pulmonary hypertension and LVEF ≥ 50% (median age 57 years, 49.4% female) at Fuwai Hospital, followed for a median of 27 months.

E

Exposure

High pretest probability of HFpEF assessed by the noninvasive HFpEF-ABA algorithm (integrating age, BMI, and atrial fibrillation status; stratified as low < 25%, intermediate 25%–74%, and high ≥ 75%, or evaluated per standard deviation increase)

C

Comparator

Low (< 25%) or medium-low (< 75%) HFpEF pretest probability on the HFpEF-ABA score, as well as the standalone COMPERA 2.0 risk score for model discrimination comparison

O

Outcome

Clinical worsening, defined as the first occurrence of all-cause mortality, unplanned rehospitalization due to worsening pulmonary hypertension or right heart failure, or escalation of targeted pulmonary hypertension therapy over a median follow-up of 27 months (IQR 13–45 months)composite

Main Result

Hazard Ratio: 1.73 (95% CI 1.368–2.188)

p-value: p=<0.001

Quantifying HFpEF pretest probability using the simple clinical HFpEF-ABA score independently predicts clinical worsening and significantly enhances the discriminative accuracy of the COMPERA 2.0 risk model in patients with CTEPH.

Limitations

Single-center retrospective study with potential unmeasured confounding and selection bias
Residual confounding from unmeasured variables (e.g., medication adherence, socioeconomic status, longitudinal changes in treatment)
Findings indicate high pretest probability of HFpEF rather than confirmed left heart dysfunction by direct invasive filling pressure measurements
Unclear whether patients with high HFpEF probability require specific treatment modification
Single-center retrospective study subject to unmeasured confounding and selection bias
Residual confounding from unmeasured variables such as medication adherence, socioeconomic status, and longitudinal treatment changes
HFpEF-ABA indicates pretest probability of HFpEF rather than invasively confirmed left heart dysfunction
Requires external validation in larger prospective cohorts and investigation of whether treatment modification is needed

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

HFpEF-ABA score was associated with clinical worsening in CTEPH; leaves open whether it enhances COMPERA 2.0 stratification in prospective studies.

Abstract

Background Chronic thromboembolic pulmonary hypertension (CTEPH) and left heart disease, particularly heart failure with preserved ejection fraction (HFpEF), show overlapping clinical features despite distinct pathophysiology. Objectives The HFpEF‐ABA algorithm (age, body mass index, atrial fibrillation) was used to characterize HFpEF pretest probability in patients with CTEPH and evaluate its association with left heart disease and clinical worsening. Methods Among 466 patients with CTEPH stratified by HFpEF‐ABA score (low < 25%, intermediate 25%–74%, high ≥ 75%), Spearman's correlation assessed associations with common left heart disease comorbidities. Kaplan‐Meier analysis and Cox regression evaluated associations with clinical worsening, with restricted cubic splines assessing the dose‐response relationship and non‐linearity. Subgroup analyses by sex, smoking, alcohol use, hypertension, coronary artery disease, and obstructive sleep apnea assessed the consistency. We also evaluated whether adding the HFpEF‐ABA score improved COMPERA 2.0 discrimination for clinical worsening. Results Intermediate and high HFpEF probability was found in 52.4% ( n = 244) and 9.0% ( n = 42), respectively. After adjustment, each standard deviation increase in HFpEF probability was associated with an approximately 73% increase in clinical worsening ( p < 0.001). Results were consistent for HFpEF probability ( p < 0.05), with no significant subgroup interactions. Adding HFpEF‐ABA with COMPERA 2.0 improved discrimination, increasing the C‐index increasing from 0.532 to 0.634 ( p = 0.012). Conclusions Assessing HFpEF probability in patients with CTEPH identifies those at high risk for this comorbidity and improves the precision when integrated with existing risk models.

Discussion

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Cite This Study

Wang et al. (2026) conducted a cohort in Chronic thromboembolic pulmonary hypertension (CTEPH) (n=466). HFpEF-ABA score (per SD increase or high probability ≥75%) vs. Lower HFpEF-ABA score (<75% or <25% low probability) was evaluated on Clinical worsening (composite of all-cause mortality, unplanned rehospitalization due to worsening pulmonary hypertension or right heart failure, or escalation of targeted pulmonary hypertension therapy) (HR 1.730, 95% CI 1.368-2.188, p=<0.001). Each SD increase in HFpEF-ABA score independently increased the risk of clinical worsening by 73% (HR 1.730, 95% CI 1.368-2.188, p < 0.001) in patients with CTEPH.

synapsesocial.com/papers/6aee6be671a7594806220cf2 https://doi.org/10.1002/clc.70503

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Prognostic Implications of High HFpEF Probability in Patients With Chronic Thromboembolic Pulmonary Hypertension

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prognostic Implications of High HFpEF Probability in Patients With Chronic Thromboembolic Pulmonary Hypertension

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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