(CCSP066) EVALUATING THE UTILITY OF H2FPEF SCORES IN OLDER PATIENTS WITH SUSPECTED PULMONARY HYPERTENSION AND CARDIOVASCULAR RISK FACTORS

Background: Current clinical and hemodynamic diagnostic approaches do not fully discriminate pulmonary arterial hypertension (PAH) from pulmonary hypertension associated with left heart disease (PH-LHD) in older patients particularly when cardiovascular risk factors (CVRF) are present. We are conducting a prospective study to evaluate systematic addition of exercise in older patients (>45 years) with at least 1 CVRF, referred for right-heart catheterization (RHC) to diagnose suspected PH. H2FPEF is an alternate strategy based on a clinical score used to predict likelihood of PH-LHD, but tested primarily among patients with dyspnea of unknown origin.

METHODS AND RESULTS: This analysis evaluates the performance of H2FPEF score to discriminate hemodynamic PH-LHD from PAH in our patient population. H2FPEF is an integer score (0-9) based on the presence of: age >60years, BMI >30kg/m2, hypertension, atrial fibrillation, doppler echocardiography estimated Pulmonary Artery Systolic Pressure (>35mmHg) and E/e’>9. Resting hemodynamic classifications were based on 2022 ESC/ERS guidelines. Cycle ergometry was performed in a semi-upright position as we have previously published.

We recruited 31 patients with data available to calculate H2FPEF score (50% female; 72±9 years); the median score was 6 [IQR 4-7]. The figure demonstrates resting hemodynamic classifications distributed by H2FPEF score. In patients with scores ≤4 (lower likelihood of PH-LHD), none were classified as PH-LHD. For patients with scores 5-7, 60% were classified as PAH and 27% as PH-LHD. In patients with H2FPEF scores 8-9 (higher likelihood of PH-LHD), 29% were classified as PAH and 71% as PH-LHD. As such, the proportion of patients classified as PH-LHD was higher as H2FPEF score increases, but scores ≥7 did not rule out PAH. We observed that exercise reclassifies a large proportion as PH-LHD. Specifically exercise reclassified 5 of 7 patients with normal resting hemodynamics: 1 as Exercise-PAH and 4 as Exercise-PH-LHD. Among patients with resting PAH, only 5 retained Exercise-PAH classification, while 11 reclassified as Exercise-PH-LHD. The table shows the corresponding H2FPEF scores. H2FPEF scores were similar between patients reclassified as Exercise-PH-LHD and patients who retained the Exercise-PAH classification.

Conclusion: This study demonstrated that H2FPEF scores are high in a cohort of older patients with CVRF referred for RHC to evaluate suspected PH. The majority of patients with either normal hemodynamics or PAH were reclassified as PH-LHD with exercise. However, there is significant overlap in the distribution of scores such that the H2FPEF score did not differentiate between patients with exercise confirmation of PAH from those who had PH-LHD.