The LEDA Score

BACKGROUND: Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging because clinical findings may not reflect hemodynamic disease expression. OBJECTIVES: The aim of the study was to evaluate the diagnostic performance of LEDA (Left ventricular concentricity, E/e', left ventricle-to-left atrium Diastasis volume ratio, left Atrial reservoir function), an integrated echocardiographic score, for identifying HFpEF and elevated left-sided filling pressure (LSFP). METHODS: FPEF (Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure score) and HFA-PEFF (Heart Failure Association Pre-test assessment, Echocardiography & natriuretic peptide, Functional testing, Final etiology diagnostic algorithm); 2025 American Society of Echocardiography diastolic criteria were analyzed as an echocardiographic filling-pressure framework rather than as a standalone HFpEF diagnostic score. RESULTS: FPEF, HFA-PEFF, and American Society of Echocardiography criteria, with area under the curve of 0.85, 0.74, 0.74, and 0.61, respectively (P ≤ 0.010). At LEDA ≥3, the positive likelihood ratio was 7.4, compared with 3.0, 1.8, and 1.6, respectively. For invasive LSFP endpoints, LEDA achieved area under the curve up to 0.90, specificity up to 95.5%, and positive likelihood ratio up to 16.3. CONCLUSIONS: In this selected cohort undergoing an invasive hemodynamic assessment for diagnostic uncertainty, LEDA showed stronger diagnostic performance than contemporary HFpEF diagnostic algorithms and an echocardiographic filling-pressure framework. External validation is required before application to broader outpatient populations.