Clinical meaning
Heart failure with preserved ejection fraction (HFpEF, EF ≥50%) involves impaired ventricular relaxation and increased myocardial stiffness. The stiff ventricle cannot fill adequately during diastole, leading to elevated filling pressures, pulmonary congestion, and exercise intolerance despite normal systolic function.
Diagnosis & workup
Diagnostics & workup: - Order echocardiogram (EF ≥50% with diastolic dysfunction) - Order BNP/NT-proBNP (may be only mildly elevated) - Order exercise stress echocardiography - Order HFpEF diagnostic score (H2FPEF or HFA-PEFF) - Order hemodynamic assessment if diagnosis uncertain
Risk factors: - Hypertension (most common cause) - Obesity and metabolic syndrome - Female sex - Advanced age - Diabetes mellitus - Atrial fibrillation - Chronic kidney disease - Obstructive sleep apnea