Box 2.

Quick guide to diagnosing HFpEF based on European Society of Cardiology Guidelines4

  • Signs and symptoms of heart failure

  • Elevated natriuretic peptide levels (BNP ≥35 pg/mL or NT-proBNP level ≥125 pg/mL)

  • A preserved ejection fraction (LVEF ≥50%)

  • Additional perturbations to cardiac structure and/or function

    • left atrial volume index >34 mL/m2

    • left ventricular mass index ≥115 g/m2 for males and ≥95 g/m2 for females

    • E to E’ ratio ≥13

    • mean E’ septal and lateral wall <9 cm/s

  • Stress testing or invasive measurement of elevated LV filling pressures can be performed. There is diagnostic doubt regarding HFpEF.

  • BNP = brain natriuretic peptide NT-proBNP; HFpEF = heart failure with preserved ejection fraction; LVEF = left ventricular ejection fraction; NT-proBNP = N terminal peptide fragment of proBNP