Question 1

What if the E/e' is not available on my echocardiogram?

Accepted Answer

E/e' (ratio of early mitral inflow velocity to early mitral annular velocity) requires Doppler tissue imaging. If unavailable, substitute the presence of diastolic dysfunction per conventional criteria (e.g., enlarged left atrium, abnormal mitral inflow pattern). The score's performance is slightly reduced without this component.

Question 2

Does treatment differ for patients with high H₂FPEF?

Accepted Answer

Patients with a high-score (high probability) HFpEF benefit from a structured approach including sodium-glucose cotransporter-2 inhibitors (SGLT2i, e.g., dapagliflozin, empagliflozin), diuretics for volume overload, blood pressure control, and management of comorbidities. SGLT2i is endorsed by major guidelines irrespective of ejection fraction.

Question 3

How does H₂FPEF compare to HFA-PEFF?

Accepted Answer

H₂FPEF is simpler (bedside-gettable) and more suited to the outpatient evaluation of unexplained dyspnoea. HFA-PEFF is a multi-step algorithm that includes detailed echocardiographic and biomarker thresholds; it is more sensitive but requires more resources. The two tools can be complementary: H₂FPEF for initial triage, HFA-PEFF for confirmatory workup.