Clinical predictors and prognostic implications of HFpEF following STEMI based on HFA-PEFF score: a multicenter cohort analysis

초록

Background: ST-segment elevation myocardial infarction (STEMI) is usually associated with impaired systolic function, but heart failure with preserved ejection fraction (HFpEF) may also occur and remains under-recognized in this setting. We aimed to investigate the prevalence, clinical predictors, and outcomes of HFpEF in STEMI patients with preserved left ventricular ejection fraction (LVEF). Methods: We retrospectively analyzed 421 STEMI patients who underwent successful percutaneous coronary intervention (PCI). Among them, 280 patients with LVEF >= 50% on 1-month follow-up echocardiography were included. Patients were classified as HFpEF or non-HFpEF according to the Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final etiology (HFA-PEFF) score, with scores >= 5 defining HFpEF. The primary endpoint was a composite of cardiovascular (CV) death or hospitalization for heart failure (HF). Results: Eighty-eight patients (31.4%) were classified as HFpEF. Compared with the non-HFpEF group, these patients were older (mean age 70 years), more frequently female (46.6% vs. 16.1%), and less likely to be current smokers (31.8% vs. 51.0%). During a median follow-up of 3 years, 2 patients (0.7%) died from CV causes and 29 (10.4%) were hospitalized for HF. The incidence of HF hospitalization was significantly higher in the HFpEF group (17.0% vs. 7.3%). In multivariable Cox regression, HFpEF was independently associated with the composite outcome [hazard ratio (HR) 2.45; 95% confidence interval (CI): 1.10-5.44]. Conclusions: In STEMI patients with preserved LVEF, a substantial proportion developed HFpEF, which was associated with increased risks of HF hospitalization and mortality. The HFA-PEFF score provides incremental prognostic value in this population and may help identify high-risk patients for closer monitoring and tailored management.

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