Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Estimating HFpEF in Patients with Unexplained Dyspnea

Circulation; ePub 2018 May 23; Reddy, et al

The H2FPEF score enables discrimination of heart failure with preserved ejection fraction (HFpEF) from non-cardiac causes of dyspnea and can assist in determination of the need for further diagnostic testing in the evaluation of patients with unexplained exertional dyspnea. This according to a study that included consecutive patients with unexplained dyspnea referred for invasive hemodynamic exercise testing. Diagnosis of HFpEF (case) or non-cardiac dyspnea (control) was determined by invasive hemodynamic exercise testing. A scoring system was developed and then validated in a separate test cohort. Researchers found:

  • The derivation cohort included 414 consecutive patients (267 HFpEF and 147 controls, HFpEF prevalence 64%).
  • The test cohort included 100 consecutive patients (61 HFpEF, prevalence 61%).
  • A weighted score based on 6 variables (obesity, atrial fibrillation, age >60 years, treatment with ā‰„2 antihypertensives, echocardiographic E/eā€™ ratio >9, and echocardiographic pulmonary artery systolic pressure >35 mmHg) was used to create a composite score (H2FPEF score) ranging from 0-9.
  • The odds of HFpEF doubled for each 1-unit score increase.
  • The H2FPEF score was superior to a currently-used algorithm based upon expert consensus.


Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BA. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. [Published online ahead of print May 23, 2018]. Circulation. doi:10.1161/CIRCULATIONAHA.118.034646.

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