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Diagnostic algorithm for HFpEF: how much is the recent consensus applicable in clinical practice?

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Abstract

Heart failure with preserved ejection fraction (HFpEF) represents an important cardiovascular entity with increasing prevalence and relatively high mortality. The agreement about diagnostic algorithm for HFpEF is still missing. Echocardiographic approach remains the cornerstone in HFpEF diagnosis. Echocardiographic diastolic stress test provides numerous useful parameters that correlated well with indexes obtained by cardiac catheterization. Recently published consensus recommended new scoring system that included functional and structural echocardiographic parameters, as well as biomarkers. The new score for evaluation of HFpEF introduces a new set of parameters and proposed novel cutoff values for some of them. There are several important points that need to be resolved before full acceptance and clinical usage. First, some cutoff values are new and represent the result of expert consensus, without previous validation. Second, many patients with hypertension, obesity, and diabetes would be referred for further investigations as the result of this scoring, which is difficult to achieve in clinical circumstances. Third, the consensus equalized non-invasive and invasive diastolic stress tests in diagnosing of HFpEF, which is not a small issue. Namely, even though cardiac catheterization provides the final confirmation of elevated left ventricular filling pressures, it is still an invasive method, associated with procedural risk and other limitations. The aim of this review was to summarize the current knowledge diagnosis of HFpEF, as well as the recent consensus about diagnostic algorithm in patients with suspected HFpEF with its advantages and disadvantages.

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Authors and Affiliations

  1. Department of Cardiology, University Hospital “Dr. Dragisa Misovic - Dedinje”, Heroja Milana Tepica 1, Belgrade, 11000, Serbia

    Marijana Tadic

  2. University of Milan-Bicocca, Milan, Italy

    Cesare Cuspidi, Guido Grassi & Giuseppe Mancia

  3. Clinical Research Unit, Istituto Auxologico Italiano, Viale della Resistenza 23, 20036, Meda, Italy

    Cesare Cuspidi

  4. Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, 90502, USA

    Francesca Calicchio

  5. Policlinico di Monza, Monza, Italy

    Giuseppe Mancia

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  1. Marijana Tadic
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  2. Cesare Cuspidi
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  3. Francesca Calicchio
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Correspondence to Marijana Tadic.

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Tadic, M., Cuspidi, C., Calicchio, F. et al. Diagnostic algorithm for HFpEF: how much is the recent consensus applicable in clinical practice?. Heart Fail Rev 26, 1485–1493 (2021). https://doi.org/10.1007/s10741-020-09966-4

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