Association between postprocedural echocardiographic and laboratory data and clinical outcomes in patients with preserved ejection fraction after catheter ablation for atrial fibrillation

Background: The HFA-PEFF score comprising echocardiographic and laboratory data is designed to diagnose heart failure with preserved ejection fraction and holds prognostic value in patients who underwent catheter ablation for atrial fibrillation (AF). However, the incorporation of many variables into this score limits its practical use.

Objective: We aimed to develop and to validate a simplified score (AF-HFA-PEFF score) focusing on AF-related parameters to predict cardiovascular events and AF recurrence.

Methods: We retrospectively enrolled 354 patients with preserved ejection fraction who underwent AF ablation. Using Cox regression hazard ratios from the HFA-PEFF score variables, we generated a risk score from a random 50% of patients and validated it with the other half.

Results: Univariate analysis revealed that postprocedural E/e', tricuspid regurgitation peak gradient, left atrial volume index, and brain natriuretic peptide levels were associated with 3-year cardiovascular events or AF recurrence. We developed the AF-HFA-PEFF score incorporating these factors. In the derivation group, C statistics for cardiovascular events were 0.72 for the AF-HFA-PEFF score and 0.74 for the original HFA-PEFF score and 0.71 and 0.69 for AF recurrence, respectively. Validation demonstrated that patients with an AF-HFA-PEFF score <4 had a 3-year cardiovascular event risk of 1.4% vs 9.4% for scores ≥4 (P < .001). For AF recurrence, these figures were 9.7% and 65.6%, respectively (P < .001).

Conclusion: The AF-HFA-PEFF score is simpler than the HFA-PEFF score and is equally associated with 3-year cardiovascular events and AF recurrence.