Journal of the American Society of Echocardiography
Clinical InvestigationsValue of Stress Echocardiography in Evaluation of DyspneaPrognostic Value of the MAGGIC Score, H2FPEF Score, and HFA-PEFF Algorithm in Patients with Exertional Dyspnea and the Incremental Value of Exercise Echocardiography
Section snippets
Patient Selection
In this retrospective analysis, we included data prospectively collected from 201 patients with exertional dyspnea who were recruited from hospital clinics at a tertiary care cardiology center (University Hospital) and who met the HFpEF criteria in place at the time of recruitment (i.e., between 2012 and 2015): (1) signs and symptoms of HF (dyspnea, fatigue, and exercise intolerance) consistent with New York Heart Association (NYHA) functional class II or III with reduced exercise capacity
Patient Characteristics and Events
The studied population was characterized by a predominance of female sex and high frequency of hypertension, diabetes, and obesity or overweight. These characteristics as well as echocardiographic data are presented in Table 2. The average score was 14.8 for MAGGIC, 4.5 for H2FPEF, 4.2 for the HFA-PEFF step 2 algorithm, and 4.6 for the HFA-PEFF step 3 algorithm. Using the predefined diagnostic cutoffs recommended for the identification of HFpEF, 60 (30%) enrollees had H2FPEF score ≥6, while 83
Discussion
This study demonstrates that in patients with exertional dyspnea meeting the 2007 European Society of Cardiology criteria of HFpEF, the MAGGIC risk score, H2FPEF score, and HFA-PEFF algorithm including only resting echocardiographic evaluation (i.e., limited to the diagnostic workup step 2) show similar abilities to predict the risk of HF hospitalization or death. The addition of information from diastolic exercise echocardiography (advanced workup step 3) provides a significant improvement in
Conclusion
In patients with exertional dyspnea and a possible diagnosis of HFpEF according to the 2007 European Society of Cardiology criteria, the H2FPEF score and HFA-PEFF algorithm limited to step 2 provide prognostic value comparable to the MAGGIC risk score. The inclusion of exercise diastolic data is associated with a significant improvement in risk stratification by the HFA-PEFF algorithm. Accordingly, the HFpEF diagnostic scores, especially the HFA-PEFF algorithm with step 3, where appropriate,
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Conflicts of Interest: None.
This study was funded by grant ST-678 from the Wroclaw Medical University, Wroclaw, Poland.