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.; Tschöpe, C.; de Boer, R. A.; Fraser, A. G.; Anker, S. D.; Donal, E.; Edelmann, F.; Fu, M.; Guazzi, M.; Lam, C. S. P.; Lancellotti, Patrizio; Melenovsky, V.; Morris, D. A.; Nagel, E.; Pieske-Kraigher, E.; Ponikowski, P.; Solomon, S. D.; Vasan, R. S.; Rutten, F. H.; Voors, A. A.; Ruschitzka, F.; Paulus, W. J.; Seferovic, P.; Filippatos, G.; University Hospital "Attikon", Athens

doi:10.1093/eurheartj/ehz641

Article (Scientific journals)

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.; Tschöpe, C.; de Boer, R. A. et al.

2019 • In European Heart Journal, 40 (40), p. 3297-3317

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https://hdl.handle.net/2268/248181

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10.1093/eurheartj/ehz641

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31504452

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Keywords :

Heart failure; HFpEF

Abstract :

[en] 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. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Pieske, B.; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, German Center for Cardiovascular Research (DZHK), Partner SiteBerlin, Germany, Department of Internal Medicine and Cardiology, German Heart InstituteBerlin, Germany, Berlin Institute of Health (BIH), Germany

Tschöpe, C.; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, German Center for Cardiovascular Research (DZHK), Partner SiteBerlin, Germany, Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), ChariteBerlin, Germany

de Boer, R. A.; University Medical Centre Groningen, University of Groningen, Department of CardiologyGroningen, Netherlands

Fraser, A. G.; School of Medicine, Cardiff University, Cardiff, United Kingdom

Anker, S. D.; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, German Center for Cardiovascular Research (DZHK), Partner SiteBerlin, Germany, Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), ChariteBerlin, Germany, Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany

Donal, E.; Cardiology and CIC, 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, German Center for Cardiovascular Research (DZHK), Partner SiteBerlin, Germany

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, Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy

Lam, C. S. P.; National Heart Centre, Singapore & Duke-National University of Singapore, University Medical Centre Groningen, Netherlands

More authors (15 more)

Language :

English

Title :

Publication date :

2019

Journal title :

European Heart Journal

ISSN :

0195-668X

eISSN :

1522-9645

Publisher :

NLM (Medline)

Volume :

Issue :

Pages :

3297-3317

Peer reviewed :

Peer Reviewed verified by ORBi

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