Diagnosis of heart failure with preserved ejection fraction (HFpEF) in patients with atrial fibrillation (AF) represents a significant clinical challenge. Two diagnostic scoring tools have been developed to aid the noninvasive diagnosis of HFpEF: the HFA-PEFF (Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final etiology) and the HFPEF scoring systems. The purpose of this study was to evaluate the performance of these 2 scoring tools for the diagnosis of HFpEF against a gold standard of invasive evaluation in a cohort of patients with AF. The authors recruited consecutive patients with symptomatic AF and preserved ejection fraction who were scheduled for an AF ablation procedure. Gold-standard invasive diagnosis of HFpEF was performed at the AF ablation procedure using mean left atrial pressure at rest and following infusion of 500 mL fluid. Each participant was scored according to the noninvasive HFA-PEFF and HFPEF scoring systems. Sensitivity and specificity analyses were performed to assess the accuracy of these scoring systems in diagnosing HFpEF. In total, 120 participants were recruited. HFpEF was diagnosed invasively in 88 (73.3%) participants, whereas 32 (26.7%) had no HFpEF. Using the HFA-PEFF score, 38 (31.7%) participants had a high probability of HFpEF and 82 (68.3%) had low/intermediate probability of HFpEF. Using the HFPEF tool, 72 (60%) participants had a high probability of HFpEF and 48 (40%) had intermediate probability. A high HFA-PEFF (≥5 points) score could diagnose HFpEF with a sensitivity of 40% and a specificity of 91%, and a high HFPEF score (≥6 points) could diagnose HFpEF with a sensitivity of 69% and specificity of 66%. Overall diagnostic accuracy was similar using both tools (AUC: 0.663 vs 0.707, respectively; 0.636). Against a gold standard of invasively diagnosed HFpEF, the HFA-PEFF and HFPEF scores demonstrate only moderate accuracy in patients with AF and should be utilized with caution in this cohort of patients. (Characterising Left Atrial Function and Compliance in Atrial Fibrillation; )

中文翻译：

---

HFA-PEFF 和 H2FPEF 评分在有症状心房颤动患者中的实用性和有效性


房颤 (AF) 患者射血分数保留 (HFpEF) 心力衰竭的诊断是一项重大的临床挑战。已经开发了两种诊断评分工具来帮助 HFpEF 的无创诊断：HFA-PEFF（心力衰竭协会预测试评估、超声心动图和利钠肽、功能测试、最终病因）和 HFPEF 评分系统。本研究的目的是根据一组 AF 患者的侵入性评估黄金标准，评估这 2 种评分工具诊断 HFpEF 的性能。作者连续招募了有症状的 AF 且射血分数正常的患者，这些患者计划接受 AF 消融手术。 HFpEF 的金标准侵入性诊断是在 AF 消融过程中使用静息时和输注 500 mL 液体后的平均左心房压力进行的。根据无创 HFA-PEFF 和 HFPEF 评分系统对每位参与者进行评分。进行敏感性和特异性分析以评估这些评分系统诊断 HFpEF 的准确性。总共招募了 120 名参与者。 88 名 (73.3%) 参与者被侵入性诊断为 HFpEF，而 32 名 (26.7%) 参与者没有 HFpEF。根据 HFA-PEFF 评分，38 名 (31.7%) 参与者患有 HFpEF 的可能性较高，82 名 (68.3%) 参与者患有 HFpEF 的可能性较低/中等。使用 HFPEF 工具，72 名 (60%) 参与者患有 HFpEF 的概率较高，48 名 (40%) 参与者具有中等概率。 HFA-PEFF 高分（≥5 分）诊断 HFpEF 的敏感性为 40%，特异性为 91%；HFPEF 高分（≥6 分）诊断 HFpEF 的敏感性为 69%，特异性为 66 %。 使用这两种工具的总体诊断准确性相似（AUC：分别为 0.663 vs 0.707；0.636）。与侵入性诊断 HFpEF 的黄金标准相比，HFA-PEFF 和 HFPEF 评分在 AF 患者中的准确性仅为中等，在这组患者中应谨慎使用。 （心房颤动中左心房功能和顺应性的特征；）