AIMS Diagnosing heart failure with preserved ejection fraction (HFpEF) is challenging. The newly proposed HFA-PEFF algorithm entails a stepwise approach. Step 1, typically performed in the ambulatory setting, establishes a pre-test likelihood. The second step calculates a score based on echocardiography and natriuretic peptides. The aim of this study is to validate the diagnostic value and establish the clinical impact of the second step of the HFA-PEFF score. METHODS AND RESULTS The second step of the HFA-PEFF score was evaluated in two independent, prospective cohorts, i.e. the Maastricht cohort (228 HFpEF patients and 42 controls) and the Northwestern Chicago cohort (459 HFpEF patients). In Maastricht, the HFA-PEFF score categorizes 11 (4%) of the total cohort with suspected HFpEF in the low-likelihood (0-1 points) and 161 (60%) in the high-likelihood category (5-6 points). A high HFA-PEFF score can rule in HFpEF with high specificity (93%) and positive predictive value (98%). A low score can rule out HFpEF with a sensitivity of 99% and a negative predictive value of 73%. The diagnostic accuracy of the score is 0.90 (0.84-0.96), by the area under the curve of the receiver operating characteristic curve. However, 98 (36%) are classified in the intermediate-likelihood category, where additional testing is advised. The distribution of the score shows a similar pattern in the Northwestern (Chicago) and Maastricht HFpEF patients (53% vs. 65% high, 43% vs. 34% intermediate, 4.8% vs. 1.3% low). CONCLUSION This study validates and characterizes the HFA-PEFF score in two independent, well phenotyped cohorts. We demonstrate that the HFA-PEFF score is helpful in clinical practice for the diagnosis of HFpEF.

中文翻译：

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验证HFA-PEFF分数用于诊断射血分数保留的心力衰竭。

AIMS使用保留的射血分数（HFpEF）诊断心力衰竭具有挑战性。新提出的HFA-PEFF算法需要一种逐步的方法。通常在非卧床环境中执行的步骤1建立了测试前的可能性。第二步基于超声心动图和利钠肽计算分数。这项研究的目的是验证HFA-PEFF评分第二步的诊断价值并确定其临床影响。方法和结果在两个独立的前瞻性队列中评估了HFA-PEFF评分的第二步，即马斯特里赫特队列（228名HFpEF患者和42名对照）和西北芝加哥队列（459 HFpEF患者）。在马斯特里赫特，HFA-PEFF评分将低可能性（0-1分）和高可能性（5-6分）的161人（60％）的可疑HFpEF纳入总队列中的11人（4％）。高HFA-PEFF评分可以以高特异性（93％）和阳性预测值（98％）来判定HFpEF。低分可以排除HFpEF，其敏感性为99％，阴性预测值为73％。得分的诊断准确度为0.90（0.84-0.96），这取决于接收器工作特性曲线的曲线下面积。但是，有98个（36％）属于中等可能性类别，建议您进行其他测试。分数分布在西北地区（芝加哥）和马斯特里赫特HFpEF患者中显示出相似的模式（53％vs. 65％高，43％vs. 34％中级，4.8％vs. 1.3％低）。结论本研究在两个独立的表型良好的队列中验证并表征了HFA-PEFF评分。我们证明，HFA-PEFF评分在临床实践中有助于诊断HFpEF。