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. 2019 Oct 21;40(40):3297-3317.
doi: 10.1093/eurheartj/ehz641.

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)

Burkert Pieske  1   2   3   4 , Carsten Tschöpe  1   2   5 , Rudolf A de Boer  6 , Alan G Fraser  7 , Stefan D Anker  1   2   5   8 , Erwan Donal  9 , Frank Edelmann  1   2 , Michael Fu  10 , Marco Guazzi  11   12 , Carolyn S P Lam  13   14 , Patrizio Lancellotti  15 , Vojtech Melenovsky  16 , Daniel A Morris  1 , Eike Nagel  17   18 , Elisabeth Pieske-Kraigher  1 , Piotr Ponikowski  19 , Scott D Solomon  20 , Ramachandran S Vasan  21 , Frans H Rutten  22 , Adriaan A Voors  6 , Frank Ruschitzka  23 , Walter J Paulus  24 , Petar Seferovic  25 , Gerasimos Filippatos  26   27
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Free article

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)

Burkert Pieske et al. Eur Heart J. .
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Abstract

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 HF 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 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'), left ventricular (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.

Keywords: HFpEF; Heart failure; biomarkers; diagnosis; echocardiography; exercise echocardiography; natriuretic peptides.

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