H2FPEF Scores May Help Predict CV Risk Among Patients With Repaired COA

Longitudinal changes in the H2FPEF score associated with CV event risk among patients with repaired COA with increased risk driven by hypertension, obesity, and heart filling pressure.

The heart failure with preserved ejection fraction (H2FPEF) score may have prognostic utility for cardiovascular (CV) outcomes among patients with repaired coarctation of aorta (COA), according to the findings of a retrospective cohort study published in JACC: Advances.

Patients (N=712) with repaired COA who received care at the Mayo Clinic between 2003 and 2019 were evaluated for H2FPEF scores at baseline and a 5-year follow-up. The primary objective of this study was to evaluate whether the change in H2FPEF score associated with risk for CV events.

The H2FPEF score was calculated awarding points for 6 patient characteristics:

  • 2 points for heavy obesity, defined as >30 kg/m2;
  • 1 point for hypertension requiring treatment with ³2 antihypertensive medications;
  • 3 points for current or history of atrial fibrillation (AF);
  • 1 point for pulmonary hypertension, defined as right ventricular (RV) systolic pressure >35 mmHg;
  • 1 point for elderly age, defined as age >60 years; and
  • 1 point for filling pressure, defined as septal E/e’ >9.

The patients were mean age, 33 (interquartile range [IQR], 21-45) years; 59% were men; they had undergone COA repair at 3 (IQR, 1-6) years of age; and 75% had isolated COA.

The H2FPEF score at baseline and the temporal change in the H2FPEF score during follow-up were associated with cardiovascular events in patients with COA, and hence can be used to identify patients at higher risk of adverse events.

At baseline, the average H2FPEF score was 2.2 points, in which:

  • 39% had hypertension,
  • 17% were obese,
  • 7% had AF,
  • 31% had pulmonary hypertension,
  • 15% were elderly, and
  • 52% had high filling pressure.

Stratified by H2FPEF risk groups, 81% had low scores (0-3 points), 17% had intermediate scores (4-6 points), and 2% had high scores (7-9 points).

At the 5-year follow-up, the proportion of patients with low H2FPEF scores decreased to 67% (P =.01) and the proportion with intermediate or high scores increased to 30% (P =.02) and 3% (P =.2), respectively. Compared with baseline, the proportion of patients with hypertension (P =.01), obesity (P =.04), and high filling pressure (P =.02) increased significantly at 5 years.

During a median follow-up of 8.1 years, 69 patients were hospitalized for heart failure (HF), 5 underwent heart transplant for end-stage left HF, and 75 died, of which 64 were CV deaths.

In the multivariate analysis, risk for CV events was associated with:

  • hypertension (hazard ratio [HR], 1.34; 95% CI, 1.10-1.57; P =.01),
  • H2FPEF score (HR, 1.16; 95% CI, 1.07-1.24; P =.006),
  • left ventricular mass index (HR, 1.03; 95% CI, 1.01-1.05; P =.009),
  • age (HR, 1.02; 95% CI, 1.01-1.04; P =.005), and
  • RV fractional age change (FAC; HR, 0.96; 95% CI, 0.94-0.98; P =.01).

Among only the subset of patients with isolated COA (n=531), CV event risk associated with hypertension (HR, 1.55; P =.009), H2FPEF score (HR, 1.19; P =.004), age (HR, 1.04; P =.01), left atrial volume index (HR, 1.04; P =.03), and RV FAC (HR, 0.95; P =.009).

These findings may not be generalizable for patients with unrepaired COA or with repaired COA and significant residual coarctation.

The researchers concluded that “The H2FPEF score at baseline and the temporal change in the H2FPEF score during follow-up were associated with cardiovascular events in patients with COA, and hence can be used to identify patients at higher risk of adverse events.”

References:

Egbe A, Miranda WR, Reddy YNV, et al. Prognostic value of the H2FPEF score in adults with repaired coarctation of aorta. JACC Adv. Published online November 16, 2022. doi:10.1016/j.jacadv.2022.100130