Clin Res Cardiol (2025). DOI 10.1007/s00392-025-02737-x
1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 2Universitätsklinikum Hamburg-Eppendorf Klinik für Kardiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 4Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; 5Universitäres Herz- und Gefäßzentrum Hamburg Klinik und Poliklinik für Kardiologie Hamburg, Deutschland
The prevalence of heart failure with preserved ejection fraction (HFpEF) among patients with atrial fibrillation (AF) is high and varies depending on the diagnostic score applied. Established tools such as the HFA-PEFF- and H2FPEF-scores are infrequently used in routine clinical practice due to their complexity. Therefore, among patients classified as having HFpEF according to ESC guideline, we investigated the overlap with criteria defined by the HFA-PEFF- and H2FPEF-scores.
Methods
Data from all patients referred for AF ablation to a large tertiary care center between March 2021 and August 2023 were collected within the prospective TRUST cohort. HFpEF was diagnosed according to the ESC-HF guideline 2021. In these patients, we assessed the concordance with individual components of the HFA-PEFF- and H2FPEF-scores.
Results
A total of 434 patients (48.2% women, median age 70 years (IQR 62;76), median BMI 27.0 kg/m2 (IQR 24;31)) met the HFpEF criteria according to the ESC-HF guideline and were further analyzed. Median left ventricular ejection fraction was 56.0% (IQR 55;60). In addition to atrial fibrillation (100 %) and the presence of signs and symptoms of heart failure (100%), more than 80% of patients exceeded the threshold values for NT-proBNP (at sinus rhythm: > 220 pg/ml; at AF: > 660 pg/ml; median of all patients: 859 pg/ml (IQR 370;1650)) and left atrial volume index (LAVI; ≥ 29 ml/m2). Threshold values for E/e′ (≥ 9), age > 60 years, hypertension and relative wall thickness (RWT; > 0.42) were met in up to 70% and more of patients, whereas e′ velocity (< 7cm/s) and left ventricular mass index (LVMI; ≥ 122g/m2 (female) resp. ≥ 149g/m2 (male)) were less frequently fulfilled (< 10%).
Conclusion
Enlarged left atrial volume, elevated NT-proBNP, age above 60, and hypertension were commonly present in AF patients fulfilling ESC HFpEF criteria and showing concordance with domains of the HFA-PEFF- and H2FPEF-scores. These accessible parameters may serve as a pragmatic basis for guiding further diagnostic refinement.
Figure 1: Phenotypic characteristics of AF patients classified as HFpEF according to the ESC-HF guideline - displayed are the proportions of patients meeting individual criteria across clinical, biomarker, morphological, and functional domains used in the two HFpEF scores: HFA-PEFF- and H2FPEF-score. [AF, atrial fibrillation; BMI, body mass index; HFpEF, heart failure with preserved ejection fraction; LAVI, left atrial volume index; LVMI, left ventricular mass index; NT‐proBNP, N‐terminal pro‐brain natriuretic peptide; RWT, relative wall thickness; SR, sinus rhythm]