Comparative value of HFpEF scores for risk stratification in patients with unexplained dyspnoea

BACKGROUND AND AIMS: In patients with unexplained dyspnea, heart failure with preserved ejection fraction (HFpEF) is a frequent cause. Diagnostic scores estimate HFpEF probability, but their prognostic role and clinical applicability in this population remain uncertain. This study evaluated the association of HFpEF scores with structural remodeling, functional limitation, and clinical outcomes. METHODS: This multicenter cohort study included 2,535 patients with unexplained dyspnea who underwent combined cardiopulmonary exercise testing and echocardiography. HFpEF probability was assessed using H₂FPEF, HFA-PEFF, and HFpEF-ABA scores, with patients stratified into risk categories. RESULTS: Higher scores correlated with adverse ventricular and atrial remodeling, impaired exercise capacity, and higher pulmonary pressures, both at rest and during exercise. Intermediate and high-risk categories for HFA-PEFF, H₂FPEF, and HFpEF-ABA scores showed significantly elevated hazard ratios versus the low-risk group: HFA-PEFF (HR 2.62 95%CI 1.56-4.40, p