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How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

  • Pieske B Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.
  • Tschöpe C Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.
  • de Boer RA University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands.
  • Fraser AG School of Medicine, Cardiff University, Cardiff, UK.
  • Anker SD Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.
  • Donal E Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France.
  • Edelmann F Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.
  • Fu M Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden.
  • Guazzi M Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy.
  • Lam CSP National Heart Centre, Singapore & Duke-National University of Singapore.
  • Lancellotti P Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.
  • Melenovsky V Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic.
  • Morris DA Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.
  • Nagel E Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt.
  • Pieske-Kraigher E Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.
  • Ponikowski P Medical University, Clinical Military Hospital, Wroclaw, Poland.
  • Solomon SD Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Vasan RS Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
  • Rutten FH Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
  • Voors AA University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands.
  • Ruschitzka F University Heart Centre, University Hospital Zurich, Switzerland.
  • Paulus WJ Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands.
  • Seferovic P University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia.
  • Filippatos G Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital "Attikon", Athens, Greece.
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  • 2020-03-06
Published in:
  • European journal of heart failure. - 2020
Biomarkers
Diagnosis
Echocardiography
Exercise echocardiography
HFpEF
Heart failure
Natriuretic peptides
English Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), LV filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1 : Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2 : Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
Language
  • English
Open access status
green
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/102914
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