Approach to diagnosis of heart failure with preserved ejection fraction

HFpEF: heart failure with preserved ejection fraction; HF: heart failure; LVEF: left ventricular ejection fraction; CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; BNP: B-type natriuretic peptide; NT-pro-BNP: N-terminal pro-BNP; RHC: right heart catheterization; PCWP: pulmonary capillary wedge pressure; BMI: body mass index.

* The signs and symptoms of HF are described in UpToDate topics on the clinical manifestations and diagnosis of HF.

¶ Though the likelihood of HFpEF may be low, other cardiac (eg, valve disease) or noncardiac (eg, obesity) conditions may be the cause of symptoms. Clinical judgment is required to determine the approach to additional evaluation for HF symptoms.

Δ BNP and NT-proBNP may not accurately reflect filling pressures in patients with CKD or obesity. The approach to choosing the ideal natriuretic peptide assay is described in related topics in UpToDate.

◊ RHC is the gold standard for the diagnosis of HFpEF. For details on RHC (eg, PCWP thresholds, exercise protocols), refer to UpToDate topics on the diagnosis of HFpEF.