Candidate screening for heart failure with preserved ejection fraction clinic by Fib-4 index from subclinical subjects

Open AccessPublished:September 20, 2022DOI:
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      Background and aims

      Recognition of heart failure with preserved ejection fraction (HFpEF) at an early stage in mass screening is desirable, but difficult to achieve. We examined whether the Fibrosis (Fib)-4 index, a simple index of liver stiffness/fibrosis, could be used as a screening tool to select candidates requiring expert diagnostics.


      Individuals who participated in annual health checks between 2006 and 2007 in Arita-cho, Saga, Japan, with no history of cardiovascular disease and ejection fraction (EF) ≥ 50% were enrolled; (total 710; 258 men; median age, 59 years)


      Participants were divided into five groups according to HFpEF risk: 215 (30%), 100 (14%), 171 (24%), 163 (23%), and 61 (9%) with Heart Failure Association (HFA)-PEFF scores of 0, 1, 2, 3, and 4–6 points, respectively. The highest HFpEF risk group (HFA-PEFF score, 4–6 points) showed poor prognosis for the clinical events of all-cause mortality and hospitalization for HF (log-rank test, P = 0.002). The Fib-4 index was correlated with HFpEF risk stratification (rs = 0.526), and increment in the Fib-4 index was independently linked to high HFpEF risk by multiple logistic regression analysis (adjusted odds ratio, 1.311; 95% confidence interval [CI], 1.078–1.595; P = 0.007). Fib-4 index stratified clinical prognosis (log-rank test, P < 0.001) was an independent predictor of all-cause mortality and hospitalization for heart failure (HF) (hazard ratio, 1.305; 95% Confidence Interval, 1.139–1.495; P < 0.001).


      The Fib-4 index can be used to select appropriate candidates for a detailed examination of HFpEF in a subclinical population.

      Graphical abstract

      Key words


      ALT (alanine aminotransferase), aORs (adjusted odd ratios), ASE (American Society of Echocardiography), AST (aspartate aminotransferase), BNP (B-type natriuretic peptide), CI (confidence interval), CVP (central venous pressure), eGFR (estimated glomerular filtration rate), GLS (global longitudinal strain), HDL (high-density lipoprotein), HFpEF (heart failure with preserved ejection fraction), HFrEF (heart failure with reduced ejection fraction), IVST (interventricular septal thickness), LA (left atrium), LDL (low-density lipoprotein), LV (left ventricular), LVDd (left ventricular end-diastolic), LVDs (left ventricular end-systolic diameter), LVEF (left ventricular ejection fraction), LVMI (left ventricular mass index), MACE (major adverse cardiovascular events), NAFLD (nonalcoholic fatty liver disease), PWT (posterior wall thickness), RWT (relative wall thickness), TR (tricuspid regurgitation)