Impact of Modified H2FPEF Score on Chronic Limb Threatening Ischemia in Patients With Lower Extremity Artery Disease Who Underwent Endovascular Therapy

Lower extremity artery disease (LEAD) is an arterial occlusive disease characterized by an insufficient blood supply to the lower limb arteries. The HFPEF score, comprising Heavy, Hypertensive, atrial Fibrillation, Pulmonary hypertension, Elder, and Filling pressure, has been developed to identify patients at high risk of heart failure (HF) with preserved ejection fraction. This study assessed the impact of modified HFPEF scores on chronic limb-threatening ischemia (CLTI) in patients with LEAD. This study was a prospective observational study. Because the definition of obesity differs by race, we calculated the modified HFPEF score using a body mass index >25 kg/m to define obesity in 293 patients with LEAD who underwent first endovascular therapy. The primary endpoints were newly developed and recurrent CLTI. The secondary endpoint was a composite of events, including mortality and rehospitalization due to worsening HF and/or CLTI. The modified HFPEF score increased significantly with advancing Fontaine classes. Multivariate Cox proportional hazard analysis revealed that the modified HFPEF score was an independent predictor of newly developed and recurrent CLTI and composite events. The net reclassification index and integrated discrimination improvement were significantly improved by adding the modified HFPEF score to the basic predictors. The modified HFPEF score was associated with LEAD severity and future CLTI development, suggesting that it could be a feasible marker for patients with LEAD.