Application of the HFA-PEFF algorithm to characterize and score cardiac abnormalities in women with preeclampsia

OBJECTIVE: Preeclampsia imposes significant cardiovascular stress and frequently diastolic dysfunction. New recommendations advise multimodal assessments of cardiac function. The Heart Failure Association - Pretest assessment, Echocardiography and Functional testing, and Final etiology (HFA-PEFF) scoring system integrates echocardiographic indices and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and provides a structured way to characterize cardiac function. This study applied the HFA-PEFF algorithm to assess cardiac function in preeclampsia and its association with maternal and fetal outcomes. METHODS: This prospective observational study was conducted between 2019 and 2022. Ninety women with preeclampsia and 46 normotensive controls were assessed using echocardiography and NT-proBNP levels according to the HFA-PEFF scoring system. Patients were categorized into high (≥5 points), intermediate (2-4 points), or low (0-1 points) score groups. Maternal and fetal outcomes were recorded. RESULTS: Women with preeclampsia were more frequent in the high (27 vs. 0%) and intermediate (56 vs. 28%) score groups and less frequent in the low-score group (18 vs. 72%, P < 0.001) compared to controls. The median HFA-PEFF score was 3 points [interquartile range (IQR) 2-5] in women with preeclampsia and 1 point (IQR 0-2) in controls ( P < 0.001). The HFA-PEFF score groups did not relate to core outcomes overall but small-for-gestational age neonates and higher soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFLT/PlGF) ratios were more common in the HFA-PEFF high-score group ( P = 0.011, P = 0.036). CONCLUSION: The HFA-PEFF algorithm effectively detected cardiac dysfunction - reflected in structural changes, functional impairment, and elevated heart failure biomarkers - in women with preeclampsia. NT-proBNP may serve as potential screening tool for HFA-PEFF score.