Heart Failure with Preserved Ejection Fraction Diagnosis in Unexplained Dyspnea

Human heart attack, computer illustration.
Researchers sought to examine H2FPEF and HFA-PEFF scores and pulmonary capillary wedge pressure/cardiac output slope in diagnosis of HFpEF.

The pulmonary capillary wedge pressure (PCWP)/cardiac output (CO) slope test is outperformed by the H2FPEF algorithm in the assessment of unexplained dyspnea and heart failure with preserved ejection fraction (HFpEF) among outpatients. The H2FPEF score requires fewer data and also outperforms the HFA-PEFF algorithm in this evaluation. These are among the study findings published in the Journal of the American Medical Association Cardiology.

Researchers aimed to evaluate HFA-PEFF and H2FPEF scores compared with PCWP/CO slope test to diagnose HFpEF. They initiated a retrospective case-control study from March 2016 to October 2020 in 6 centers in Australia, Denmark, the Netherlands, and the United States of patients with unexplained dyspnea, and distinguished cases of HFpEF with the elevated PCWP/CO slope test vs control individuals with normal rest and exercise scores.

The researchers included 736 patients of whom 76% were diagnosed with HFpEF (aged 69±11 years; 59% women) and 24% were control individuals (aged 60±15 years; 63% women). Among the patients with HFpEF, 82% were over 60 years of age, 59% were obese, and 67% were treated with 2 or more antihypertensives. In the control group 56% were over 60 years of age, 29% were obese, and 37% were treated with 2 or more antihypertensives. Both H2FPEF and HFA-PEFF discriminated patients with HFpEF from control individuals, but a greater area under the curve was seen in the H2FPEF (0.845; 95% CI, 0.810-0.875) score than the HFA-PEFF (0.710; 95% CI, 0.659-0.756) score, (difference, -0.134; 95% CI, -0.177 to -0.094; P <.001).

They found that sensitivity was lower for the HFA-PEFF test (false-negative rate of 55% for low-probability scores vs 25% with the H2FPEF score) though specificity was robust for both tests. The PCWP/CO slope reclassified 20% of patients from HFpEF to the control group, a potential misclassification because those reclassified showed clinical, echocardiographic, and hemodynamic features consistent with HFpEF.

Study limitations include selection bias, lack of generalizability, and the individual interpretation of pressure waveforms instead of interpretation through a central laboratory.

“…both the H2FPEF and the HFA-PEFF algorithms discriminated patients with HFpEF from controls with high specificity among patients presenting with unexplained dyspnea, but the H2FPEF score provided superior sensitivity and overall diagnostic accuracy despite the requirement of fewer input variables,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Reddy YNV, Kaye DM, Handoko ML, et al. Diagnosis of heart failure with preserved ejection fraction among patients with unexplained dyspnea. JAMA Cardiol. Published online July 13, 2022. doi:10.1001/jamacardio.2022.1916