Enhancing predictive accuracy of H2FPEF score in suspected HFpEF by incorporating left atrial reservoir strain
Shinzato, Mariane; Santos, Natasha; Cancellier, Renato; Nishida, Gustavo; Moriya, Henrique Takachi; Maduro, Yuri; Assef, Jorge; Botelho, Roberto; Hossri, Carlos; Feres, Fausto; Franchini, Kleber; Hortegal, Renato.
Circulation
; 148(Suppl.1)Nov. 7, 2023. ilus.
Artículo
en Inglés
| CONASS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1523333
INTRODUCTION:
Diagnosing HFpEF can be challenging, but the H2FPEF score is a valuable tool for clinical decision-making. Atrial fibrillation (AF) plays a significant role in this score, creating challenges for diagnosis in patients without AF or with paroxysmal AF. Left atrial reservoir strain (LArS) has emerged as a promising indicator for both AF and HFpEF. This study explores how incorporating LArS can enhance the predictive ability of the H2FPEF score for exercise capacity in outpatients with suspected HFpEF.METHODS:
This cross-sectional study has a sample size of 283 patients with suspected HFpEF. We collected clinical and echocardiographic data and compared LArS values across different H2FPEF score categories. Additionally, we analyzed a subgroup of 129 patients who underwent a Cardiopulmonary Exercise Test (CPET) to evaluate the effectiveness of the H2FPEF score and LArS in predicting Peak VO2. To further comprehend the contribution of each feature in the performance of the H2FPEF score, we used Shapley Additive Explanations (SHAP) analysis.RESULTS:
Most patients were female (63%), age of 60 (±12) years and LVEF of 60 (±5.2)%. Patients with low scores had a LArS of 32.6 (± 6.8)%, while those with moderate and high scores had probabilities of 26(± 8.2)% and 16 (±8.2)%, respectively (p<0.001). The H2FPEF score demonstrated an AUC of 0.74 (95% CI 0.64-0.84) in predicting peak VO2, whereas LArS exhibited an AUC of 0.71 (95% CI 0.62-0.80). Incorporating LArS into the score improved its performance, resulting in an AUC of 0.82 (95% CI 0.75-0.89). The SHAP analysis revealed that LArS had a significant impact as the most important feature (Figure 1), while the importance of the atrial fibrillation criterion decreased significantly.CONCLUSIONS:
Our findings show that integrating LArS improves the diagnostic performance of the H2FPEF score and offers a valuable alternative to the AF criterion within the H2FPEF algorithm.
Biblioteca responsable:
BR79.1
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