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, Burkert; Tschöpe, Carsten; de Boer, Rudolf Aet al.
2020 • In European Journal of Heart Failure, 22 (3), p. 391-412
[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 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 (F(1) : Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F(2) : 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.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Pieske, Burkert; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin ; German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany. ; Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, ; Berlin Institute of Health (BIH), Germany.
Tschöpe, Carsten; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin ; German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany. ; Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT),
de Boer, Rudolf A ; University Medical Centre Groningen, University of Groningen, Department of
Fraser, Alan G; School of Medicine, Cardiff University, Cardiff, UK.
Anker, Stefan D; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin ; German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany. ; Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), ; Department of Cardiology and Pneumology, University Medicine Göttingen (UMG),
Donal, Erwan; Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099,
Edelmann, Frank; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin ; German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.
Fu, Michael; Section of Cardiology, Department of Medicine, Sahlgrenska University
Guazzi, Marco; Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, ; Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy.
Lam, Carolyn S P; National Heart Centre, Singapore & Duke-National University of Singapore. ; University Medical Centre Groningen, The Netherlands.
LANCELLOTTI, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie
Melenovsky, Vojtech; Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic.
Morris, Daniel A; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin
Nagel, Eike ; Institute for Experimental and Translational Cardiovascular Imaging, University ; German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt
Pieske-Kraigher, Elisabeth; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin
Ponikowski, Piotr; Medical University, Clinical Military Hospital, Wroclaw, Poland.
Solomon, Scott D; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School,
Vasan, Ramachandran S; Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine,
Rutten, Frans H ; Julius Center for Health Sciences and Primary Care, University Medical Center
Voors, Adriaan A; University Medical Centre Groningen, University of Groningen, Department of
Ruschitzka, Frank; University Heart Centre, University Hospital Zurich, Switzerland.
Paulus, Walter J; Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam
Seferovic, Petar; University of Belgrade School of Medicine, Belgrade University Medical Center,
Filippatos, Gerasimos; Department of Cardiology, National and Kapodistrian University of Athens Medical ; University of Cyprus, School of Medicine, Nicosia, Cyprus.
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