{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:54:00Z","timestamp":1787615640020,"version":"build-2736575974"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T00:00:00Z","timestamp":1766188800000},"content-version":"vor","delay-in-days":1856,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T00:00:00Z","timestamp":1605830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The aim of this study was to assess the prognostic value of the H2FPEF score in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) and preserved left ventricular ejection fraction (EF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In this multicentre study, a total of 832 patients from two German high-volume centres, who received TAVI for severe AS and preserved EF (\u226550%), were identified for calculation of the H2FPEF score. Patients were dichotomized according to low (0\u20135 points; n = 570) and high (6\u20139 points; n = 262) H2FPEF scores. Kaplan\u2013Meier and Cox regression analyses were applied to assess the prognostic impact of the H2FPEF score. We observed a decrease in stroke volume index (\u22122.04 mL\/m2\/point) and mean transvalvular gradients (\u22121.14 mmHg\/point) with increasing H2FPEF score translating into a higher prevalence of paradoxical low-flow, low-gradient AS among patients with high H2FPEF score. One year after TAVI, the rates of all-cause (low vs. high H2FPEF score: 8.0% vs. 19.4%, P &amp;lt; 0.0001) and cardiovascular (CV) mortality (1.9% vs. 9.0%, P &amp;lt; 0.0001) as well as the rate of CV mortality or rehospitalization for congestive heart failure (6.4% vs. 23.2%, P &amp;lt; 0.0001) were higher in patients with high H2FPEF score compared with those with low H2FPEF score. After multivariable analysis, a high H2FPEF score remained independently predictive of all-cause mortality [hazard ratio 1.59 (1.28\u20132.35), P = 0.018] and CV mortality or rehospitalization for congestive heart failure [hazard ratio 2.92 (1.65\u20135.15), P &amp;lt; 0.001]. Among the H2FPEF score variables, atrial fibrillation, pulmonary hypertension, and elevated left ventricular filling pressure were the strongest outcome predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The H2FPEF score serves as an independent predictor of adverse CV and heart failure outcome among TAVI patients with preserved EF. A high H2FPEF score is associated with the presence of paradoxical low-flow, low-gradient AS, the HFpEF in patients with AS. By identifying patients in advanced stages of HFpEF, the H2FPEF score might be useful as a risk prediction tool in patients with preserved EF scheduled for TAVI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.13096","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T16:18:55Z","timestamp":1605889135000},"page":"461-470","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Prognostic Value of the H2FPEF Score in Patients Undergoing Transcatheter Aortic Valve Implantation"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5752-4951","authenticated-orcid":false,"given":"Sebastian","family":"Ludwig","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Hamburg\/Kiel\/L\u00fcbeck , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costanza","family":"Pellegrini","sequence":"additional","affiliation":[{"name":"Department of Cardiology, German Heart Centre Munich , Munich ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Gossling","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Rheude","sequence":"additional","affiliation":[{"name":"Department of Cardiology, German Heart Centre Munich , Munich ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Voigtl\u00e4nder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Hamburg\/Kiel\/L\u00fcbeck , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver D.","family":"Bhadra","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Linder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kalbacher","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Hamburg\/Kiel\/L\u00fcbeck , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Koell","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Waldschmidt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Seiffert","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Hamburg\/Kiel\/L\u00fcbeck , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Reichenspurner","sequence":"additional","affiliation":[{"name":"DZHK (German Centre for Cardiovascular Research), partner site Hamburg\/Kiel\/L\u00fcbeck , Berlin ,","place":["Germany"]},{"name":"Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Blankenberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Hamburg\/Kiel\/L\u00fcbeck , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Hamburg\/Kiel\/L\u00fcbeck , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenard","family":"Conradi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Joner","sequence":"additional","affiliation":[{"name":"DZHK (German Centre for Cardiovascular Research), partner site Hamburg\/Kiel\/L\u00fcbeck , Berlin ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance , Munich ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Schofer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,20]]},"reference":[{"key":"2026012114034284300_ehf213096-bib-0001","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1056\/NEJMoa052256","article-title":"Trends in prevalence and outcome of heart failure with preserved ejection fraction","volume":"355","author":"Owan","year":"2006","journal-title":"N Engl J Med"},{"key":"2026012114034284300_ehf213096-bib-0002","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1093\/eurheartj\/ehy005","article-title":"Mortality associated with heart failure with preserved vs. reduced ejection fraction in a prospective international multi-ethnic cohort study","volume":"39","author":"Lam","year":"2018","journal-title":"Eur Heart J"},{"key":"2026012114034284300_ehf213096-bib-0003","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1002\/ehf2.12418","article-title":"Clinical characteristics of hospitalized heart failure patients with preserved, mid-range, and reduced ejection fractions in Japan","volume":"6","author":"Shiga","year":"2019","journal-title":"ESC Hear Fail"},{"key":"2026012114034284300_ehf213096-bib-0004","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1002\/ehf2.12283","article-title":"Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta-analysis","volume":"5","author":"Lauritsen","year":"2018","journal-title":"ESC Hear Fail"},{"key":"2026012114034284300_ehf213096-bib-0005","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/j.jacc.2007.04.064","article-title":"Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry","volume":"50","author":"Fonarow","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"2026012114034284300_ehf213096-bib-0006","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1002\/ejhf.110","article-title":"Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion","volume":"16","author":"Van Riet","year":"2014","journal-title":"Eur J Heart Fail"},{"key":"2026012114034284300_ehf213096-bib-0007","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1007\/s00392-020-01633-w","article-title":"Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future","volume":"109","author":"Wintrich","year":"2020","journal-title":"Clin Res Cardiol"},{"key":"2026012114034284300_ehf213096-bib-0008","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1002\/ehf2.12683","article-title":"Rehospitalization burden and morbidity risk in patients with heart failure with mid-range ejection fraction","volume":"7","author":"Santas","year":"2020","journal-title":"ESC Hear Fail"},{"key":"2026012114034284300_ehf213096-bib-0009","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1161\/CIRCULATIONAHA.118.034646","article-title":"A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction","volume":"138","author":"Reddy","year":"2018","journal-title":"Circulation"},{"key":"2026012114034284300_ehf213096-bib-0010","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1161\/CIRCULATIONAHA.118.039051","article-title":"Generalizability and implications of the H2FPEF score in a cohort of patients with heart failure with preserved ejection fraction","volume":"139","author":"Segar","year":"2019","journal-title":"Circulation"},{"key":"2026012114034284300_ehf213096-bib-0011","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1093\/ajh\/hpz108","article-title":"H2FPEF score as a prognostic value in HFpEF patients","volume":"32","author":"Sueta","year":"2019","journal-title":"Am J Hypertens"},{"key":"2026012114034284300_ehf213096-bib-0012","article-title":"H2FPEF score predicts 1-year rehospitalisation of patients with heart failure with preserved ejection fraction","author":"Tao","year":"2020","journal-title":"Postgrad Med J Published Online First:"},{"key":"2026012114034284300_ehf213096-bib-0013","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1002\/ehf2.12570","article-title":"H2FPEF score for predicting future heart failure in stable outpatients with cardiovascular risk factors","volume":"7","author":"Suzuki","year":"2020","journal-title":"ESC Hear Fail"},{"key":"2026012114034284300_ehf213096-bib-0014","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/0002-9149(93)91081-R","article-title":"Prognosis of congestive heart failure in patients aged \u226562 years with unoperated severe valvular aortic stenosis","volume":"72","author":"Aronow","year":"1993","journal-title":"Am J Cardiol"},{"key":"2026012114034284300_ehf213096-bib-0015","article-title":"Severe aortic stenosis in patients 60 years of age or older: left ventricular function and 10-year survival after valve replacement","volume":"64","author":"Murphy","year":"1981","journal-title":"Circulation"},{"key":"2026012114034284300_ehf213096-bib-0016","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1161\/01.RES.38.3.172","article-title":"Adaptations of the left ventricle to chronic pressure overload","volume":"38","author":"Sasayama","year":"1976","journal-title":"Circ Res"},{"key":"2026012114034284300_ehf213096-bib-0017","doi-asserted-by":"crossref","first-page":"3351","DOI":"10.1093\/eurheartj\/ehx381","article-title":"Staging classification of aortic stenosis based on the extent of cardiac damage","volume":"38","author":"G\u00e9n\u00e9reux","year":"2017","journal-title":"Eur Heart J"},{"key":"2026012114034284300_ehf213096-bib-0018","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1093\/eurheartj\/ehx391","article-title":"2017 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"38","author":"Baumgartner","year":"2017","journal-title":"Eur Heart J"},{"key":"2026012114034284300_ehf213096-bib-0019","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1016\/j.jacc.2016.02.070","article-title":"Paradoxical low-gradient aortic stenosis: the HFpEF of aortic stenosis","volume":"67","author":"Chin","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2026012114034284300_ehf213096-bib-0020","volume-title":"Early hemodynamic changes and long-term outcome of patients with severe low gradient aortic stenosis after transcatheter aortic valve replacement","author":"Schewel","year":"2019"},{"key":"2026012114034284300_ehf213096-bib-0021","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jcmg.2017.01.002","article-title":"Cardiac imaging for assessing low-gradient severe aortic stenosis","volume":"10","author":"Clavel","year":"2017","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026012114034284300_ehf213096-bib-0022","doi-asserted-by":"crossref","first-page":"286","DOI":"10.4244\/EIJ-D-16-00801","article-title":"Long-term outcomes after TAVI in patients with different types of aortic stenosis: the conundrum of low flow, low gradient and low ejection fraction","volume":"13","author":"Puls","year":"2017","journal-title":"EuroIntervention"},{"key":"2026012114034284300_ehf213096-bib-0023","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s00392-015-0889-1","article-title":"Invasive hemodynamic assessments during transcatheter aortic valve implantation: comparison of patient outcomes in higher vs. lower transvalvular gradients with respect to left ventricular ejection fraction","volume":"105","author":"Schewel","year":"2016","journal-title":"Clin Res Cardiol"},{"key":"2026012114034284300_ehf213096-bib-0024","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1136\/bmj.2.5402.177","article-title":"Human experimentation: code of ethics of W.M.A","volume":"2","author":"World Medical Association","year":"1964","journal-title":"BMJ"},{"key":"2026012114034284300_ehf213096-bib-0025","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/0197-2456(96)00075-X","article-title":"A note on quantifying follow-up in studies of failure time","volume":"17","author":"Schemper","year":"1996","journal-title":"Control Clin Trials"},{"key":"2026012114034284300_ehf213096-bib-0026","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.amjcard.2019.10.014","article-title":"Predictors of in-hospital mortality after transcatheter aortic valve implantation","volume":"125","author":"Krittanawong","year":"2020","journal-title":"Am J Cardiol"},{"key":"2026012114034284300_ehf213096-bib-0027","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jacc.2013.02.092","article-title":"A novel paradigm for heart failure with preserved ejection fraction","volume":"62","author":"Paulus","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2026012114034284300_ehf213096-bib-0028","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.jchf.2017.05.010","article-title":"Atrial fibrillation in heart failure: a common and deadly combination","volume":"5","author":"Lam","year":"2017","journal-title":"JACC Hear Fail"},{"key":"2026012114034284300_ehf213096-bib-0029","doi-asserted-by":"crossref","first-page":"2856","DOI":"10.1161\/CIRCULATIONAHA.106.668681","article-title":"Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival","volume":"115","author":"Hachicha","year":"2007","journal-title":"Circulation"},{"key":"2026012114034284300_ehf213096-bib-0030","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1002\/ehf2.12431","article-title":"Identifying a low-flow phenotype in heart failure with preserved ejection fraction: a secondary analysis of the RELAX trial","volume":"6","author":"Patel","year":"2019","journal-title":"ESC Hear Fail"},{"key":"2026012114034284300_ehf213096-bib-0031","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1016\/j.amjcard.2015.06.027","article-title":"Meta-analysis of the prognostic impact of stroke volume, gradient, and ejection fraction after transcatheter aortic valve implantation","volume":"116","author":"Eleid","year":"2015","journal-title":"Am J Cardiol"},{"key":"2026012114034284300_ehf213096-bib-0032","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.amjcard.2019.10.016","article-title":"Impact of baseline left ventricular diastolic dysfunction in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation","volume":"125","author":"Koifman","year":"2020","journal-title":"Am J Cardiol"},{"key":"2026012114034284300_ehf213096-bib-0033","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1093\/ehjci\/jex067","article-title":"Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study","volume":"18","author":"Lancellotti","year":"2017","journal-title":"Eur Hear J - Cardiovasc Imaging"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ehf2.13096","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ehf2.13096","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/8\/1\/461\/65798688\/eschf_8_1_461.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/8\/1\/461\/65798688\/eschf_8_1_461.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T19:04:03Z","timestamp":1769022243000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/8\/1\/461\/8369287"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,20]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,11,20]]},"published-print":{"date-parts":[[2021,2,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.13096","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,2]]},"published":{"date-parts":[[2020,11,20]]},"assertion":[{"value":"2020-06-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}