Identification of patients with preclinical heart failure with preserved ejection fraction using the H₂FPEF score

Heart failure with preserved ejection fraction (HFpEF) is a common disorder with few effective treatments, and there is currently no evidence-based method to identify preclinical HFpEF. The H₂FPEF score is a validated instrument to identify patients with overt HFpEF. Here we show that the H₂FPEF score can identify individuals with preclinical HFpEF. Among individuals where heart failure was excluded (n = 160), increasing H₂FPEF score was shown to be associated with greater left atrial dilation, left ventricular hypertrophy and more severe diastolic dysfunction. Patients with increasing H₂FPEF score displayed higher pulmonary artery pressures, higher left heart filling pressures, lower cardiac index and more severely impaired aerobic capacity during exercise. In summary, we show that, among adults without heart failure, higher H₂FPEF score is associated with subclinical abnormalities that resemble those observed in HFpEF. These findings broaden the external validity of the H₂FPEF score and suggest that this instrument might help identify patients positioned to benefit from preventive interventions.