Predictive Value Of H₂FPEF Score In The Prognosis Of Patients With Ejection Fraction Preserved Heart Failure After First Acute Myocardial Infarction

Background:With the establishment of chest pain centres and green channel,the increase in early myocardial reperfusion and pharmacological treatment has contributed significantly to the reduction in mortality in acute myocardial infarction.Heart failure with preserved ejection fraction（HFpEF）after acute myocardial infarction（AMI）remains the main type of heart failure after acute myocardial infarction.And there is still a lack of effective methods to diagnose and assess prognosis in this population.The H₂FPEF score was proposed in Circulation in 2018,which relies solely on the clinical presentation of patients and cardiac ultrasound to screen and diagnose patients with HFpEF.This score has been used in studies to evaluate the prognosis of patients with HFpEF.The prognostic relevance of this score for patients with ejection fraction preserved heart failure after first acute myocardial infarction is currently the subject of further study.Purpose:To investigate the value of the H₂FPEF score in predicting the prognosis of patients with HFpEF after first AMI,so as to identify high-risk groups early,intervene promptly and help to formulate optimal treatment strategies.Methods:This is a retrospective,single-center,observational study that selected patients who were hospitalized in the Department of Cardiovascular Medicine at the First Hospital of Jilin University from January 2020 to December 2020,who were first diagnosed with AMI and underwent coronary angiography,and who had HFpEF during their hospitalization.And finally 441 patients were included,their clinical data,cardiac ultrasonography and relevant laboratory test results were recorded and outcomes were followed up.The patients were divided into 3 groups according to their H₂FPEF scores,the low group（0-2 points）,the medium group（3-4 points）and the high group（5-9 points）.Univariate analysis was performed on the data related to the 3 groups.According to the presence or absence of adverse outcomes,the patients were divided into 2 groups.The clinical data,echocardiography and related laboratory tests were compared and analyzed between the 2 groups.The risk factors affecting adverse outcomes were predicted by logistic regression analysis,and the predictive ability of the H₂FPEF score for adverse outcomes was evaluated using ROC curves.Results:（1）Age,admission systolic and diastolic blood pressure were higher in patients in the high subgroup of the H₂FPEF score than in the medium and low subgroups and were significantly different（P<0.05）.BMI was significantly higher in patients in the high and medium subgroups than in the low subgroup and was statistically different（P<0.05）.The incidence of hypertension,atrial fibrillation,multi-vessel coronary artery disease and non-ST-segment elevation myocardial infarction was higher in patients in the high subgroup than in the low and middle subgroups,and there was a significant difference（P<0.05）.The incidence of diabetes mellitus was higher in patients in the middle subgroup than in the other two groups,and there was a statistical difference between the two groups（P<0.05）.The incidence of smoking was higher in the low group than in the other two groups,and there was a statistical difference（P<0.05）.In terms of medication use,the utilization rate ofβ-blockers,ACEI/ARB and CCB drugs in the high group was significantly higher than that in the other two groups,and there was a statistical significance（P<0.05）.The incidence of LAD,IVST and LVED,LVMI,and pulmonary hypertension were higher in the high group than in the low and middle groups,and were statistically significant（P<0.05）.The LVPW was higher in the middle and high groups than in the low group,and was statistically significant（P<0.05）.In laboratory tests,the peak c Tn I was higher in the high group than in the middle and low groups,and was statistically different from that in the middle group（P<0.05）.The D-dimer,Scr and UA were higher in the high group than in the middle group and low subgroups and there was statistically significant difference（P<0.05）.The TG of patients in the middle subgroup was higher than those in the high and low subgroups,and there was a statistical difference between them（P<0.05）.During a follow-up period of 24 to 36 months,all-cause mortality occurred in 32 patients and adverse cardiovascular outcomes,including angina,recurrent myocardial infarction,hospitalization for heart failure,and cardiac death,occurred in 152 patients.All-cause death was significantly higher in the high and medium subgroups than in the low subgroup,and the difference was statistically significant with the low subgroup（P=0.01）.The incidence of adverse cardiovascular outcomes was higher in the high subgroup than in the other two groups,and the difference was statistically significant with the low subgroup（P<0.001）.（2）The H₂FPEF score was higher in patients with adverse outcomes than in those without adverse outcomes,and the difference was statistically significant（P<0.05）.There was a statistical difference between the two groups in age,hypertension,atrial fibrillation,and the incidence of pulmonary hypertension（P<0.05）,but no statistical difference in diabetes,smoking,alcohol consumption,etc.In the killip classification,the incidence of grade II-IV was higher in the adverse outcome group than in the no adverse outcome group,and the difference was statistically significant（P<0.05）.There were statistical differences between the two groups in BMI,D-dimer,BNP,Hb,AST,albumin,bilirubin,TC,LAD and LVED（P<0.05）.The logistic multifactorial regression results showed that H₂FPEF score,BNP and LVED were risk factors for adverse outcome,while bilirubin was its protective factor.The ROC curve evaluated the predictive value of H₂FPEF score for adverse outcome.The area under the curve（AUC）was 0.657（95%CI:0.606-0.709）and the optimal cut-off value was 4.5.The sensitivity was 37%and the specificity was 83.3%.Conclusion:（1）H₂FPEF score,BNP and LVED are risk factors for adverse outcomes in patients with HFpEF after AMI,while bilirubin is a protective factor.（2）In patients with HFpEF after first AMI,the higher the H₂FPEF score,the higher the probability of adverse outcome.The optimal critical value of H₂FPEF score to predict the occurrence of adverse outcome is 4.5.（3）The H₂FPEF score is a simple and feasible method for the diagnosis of HFpEF,and can also be used to predict the prognosis of patients with HFpEF after AMI.