The ventilatory abnormalities and prognostic values of H₂FPEF score in dyspnoeic patients with preserved left ventricle systolic function

Aims: Heart failure with preserved ejection fraction (HFpEF) is one of the major diagnoses in dyspnoeic subjects, and H₂FPEF score enables robust differentiation of HFpEF. Given ventilatory abnormalities prevail in subjects with HFpEF, the associations between H₂FPEF score and pulmonary function remain to be elucidated. Methods and results: Subjects who presented with exertional dyspnoea and had left ventricular ejection fraction of >50% were eligible for this study. Total lung capacity, forced expiratory volume in the 1 s, and forced vital capacity (FVC) were obtained by pulmonary function tests. Pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e'), and left ventricular mass (LVM) were measured by echocardiogram. Among a total of 5849 participants (65.6 ± 6.4 years, 54% men), 2453 (41.9%) had low H₂FPEF score (0 ~ 1) and 160 (2.7%) had high H₂FPEF score,^6~9 respectively. Subjects with high H₂FPEF score were older and had higher proportion of restrictive and obstructive defect, more morbidities, poorer renal function, lower haemoglobin, higher LVM, E/e' ratio, and PASP. During a mean follow-up duration of 30.0 ± 20.5 months, the H₂FPEF score was significantly associated with mortality [hazard ratio and 95% confidence intervals, 1.063(1.010–1.18)], independent of sex, haemoglobin, renal function, LVM, and comorbidities. Conclusions: Either obstructive or restrictive ventilation defects prevail in subjects with high H₂FPEF score, indicating chronic obstructive pulmonary disease (COPD) is commonly associated with HFpEF. In addition, H₂FPEF score was correlated with long-term survival in dyspnoeic subjects with or without concomitant diseases of HFpEF and COPD.