Clinical meaning
Heart Failure with Preserved Ejection Fraction (HFpEF, EF >=50%) represents ~50% of HF cases driven by diastolic dysfunction from myocardial stiffness and impaired relaxation. Microvascular endothelial inflammation reduces nitric oxide bioavailability, decreasing cGMP and PKG activity. This leads to unphosphorylated titin increasing passive myocardial stiffness. Concurrent cardiomyocyte hypertrophy and interstitial fibrosis further impair diastolic filling. The H2FPEF score helps diagnose HFpEF.
Diagnosis & workup
Diagnostics & workup: - Echocardiography: EF >=50%, diastolic dysfunction (E/e' >14, elevated LA volume) - BNP >35 pg/mL or NT-proBNP >125 pg/mL - H2FPEF score >=6 or HFA-PEFF algorithm - Exercise stress echocardiography if resting echo non-diagnostic - Right heart catheterization: PCWP >15 mmHg at rest (gold standard) - ECG: LVH, atrial fibrillation - BMP for renal function, glucose, electrolytes
Risk factors: - Age >65 years - Female sex (60-65% of HFpEF patients) - Hypertension (present in 60-90%) - Obesity (BMI >30, drives systemic inflammation) - Diabetes mellitus - Atrial fibrillation - Chronic kidney disease