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September 8, 2026Journal of Cardiovascular Development and DiseaseOpen Access

High modified H2FPEF score linked to ~9-fold higher risk of mortality and HFH versus low scores.

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Why the study?

Does a higher modified H2FPEF score predict all-cause mortality and first heart failure hospitalization in patients with severe primary mitral regurgitation and preserved ejection fraction?

Population

388 patients from a tertiary cardiovascular referral center with consecutive index echocardiographic…

Comparison

High or intermediate modified H2FPEF score vs Low (0-1) modified H2FPEF score

Design

Cohort

Follow-up

median 4.53 years (interquartile range 2.61 to 6.60)

Key result

A high modified H2FPEF score was significantly associated with an increased risk of all-cause mortality and first heart failure hospitalization compared to a low score (HR 9.17; 95% CI 2.15-39.1).

Authors

HWHon Jen WongTKTze Siang KohZBZong Rui Bai

Discussion

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Member takes

Overview

May support risk stratification in severe primary MR with preserved EF; extends H2FPEF validation but remains hypothesis-generating.

Key Points

  • To assess the prognostic capability of an Asian-modified H2FPEF score for predicting all-cause mortality and heart failure hospitalization in severe primary mitral regurgitation with preserved ejection fraction.
  • Analyzed 388 patients with severe primary mitral regurgitation and LVEF ≥ 50% from a tertiary cardiovascular referral center, followed for a median of 4.53 years (IQR 2.61–6.60).
  • Modified the H2FPEF score using an Asian-specific obesity threshold (BMI > 25 kg/m²) and categorized patients into low (0–1), intermediate (2–5), and high (6–9) risk tiers.
  • Evaluated the primary composite endpoint of all-cause mortality and first heart failure hospitalization using multivariable Cox regression and Fine–Gray subdistribution hazard models.
  • Intermediate and high modified H2FPEF scores were independently associated with the primary composite endpoint compared to low scores (intermediate: HR 6.71, 95% CI 1.62–27.9; high: HR 9.17, 95% CI 2.15–39.1).
  • Fine–Gray regression showed no significant difference in the subdistribution hazards of first heart failure hospitalization between intermediate and high score tiers.

Study Design

Type

Cohort (n=388)

Multicenter

No

Structured PICO

Does a higher modified H2FPEF score predict all-cause mortality and first heart failure hospitalization in patients with severe primary mitral regurgitation and preserved ejection fraction?

P
Population
388 patients with severe primary mitral regurgitation and preserved ejection fraction, followed for a median of 4.53 years.
E
Exposure
High (6-9) or intermediate (2-5) modified H2FPEF score (using BMI > 25 kg/m2 cutoff for obesity)
C
Comparator
Low (0-1) modified H2FPEF score
O
Outcome
Composite of all-cause mortality and first heart failure hospitalization (HFH)composite

Main Result

Hazard Ratio: 9.17 (95% CI 2.15–39.1)

The modified H2FPEF score (using an Asian-specific BMI cutoff) effectively risk-stratifies patients with severe primary mitral regurgitation and preserved ejection fraction for mortality and heart failure hospitalization.

Cite This Study

Wong et al. (2026) conducted a cohort in Severe primary mitral regurgitation with preserved ejection fraction (n=388). High modified H2FPEF score (6-9) vs. Low modified H2FPEF score (0-1) was evaluated on Composite of all-cause mortality and first heart failure hospitalization (HFH) (HR 9.17, 95% CI 2.15-39.1). A high modified H2FPEF score was significantly associated with an increased risk of all-cause mortality and first heart failure hospitalization compared to a low score (HR 9.17; 95% CI 2.15-39.1).

synapsesocial.com/papers/6a9fd80458e84d0ff5b47205https://doi.org/10.3390/jcdd13090439
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