Hear more from our expert, Dr. Jen Ho about the diagnosis, characteristics, pathogenesis and treatment of Heart Failure with Preserved Ejection Fraction (HFpEF).

Interview Videos:

Key Points on HFpEF (“Garden Variety”) vs. HFpEF Masqueraders:

  • Definition: Clinical syndrome of volume overload and elevated left filling pressures at rest OR exercise in a patientย EF of 50% or higher
  • No single diagnostic test
  • Masqueraders of HFpEF:
    • Primary cardiomyopathy: restrictive or hypertrophic cardiomyopathy
    • High output HF in the setting of anemia, hyperthyroidism, and cirrhosis
    • Primary cardiac abnormalities: valvular, coronary, or pericardial disease

Key Points on Echo, BNP and Advanced Testing:

  • No echo finding alone diagnoses HFpEF, but supportive results include:
    • 1. LA dilation
    • 2. LV diastolic dysfunction
    • 3. LV hypertrophy
  • Echo can be normal in some patients with HFpEF
  • Other causes of pro-BNP elevation: CKD, atrial fibrillation, and female sex
  • Advanced hemodynamic testing may reveal diastolic dysfunction with exercise in difficult cases
  • Cardiac MRI may help to exclude “HFpEF masqueraders”

Key Points on Pathogenesis and Risk Factors:

  • Pathogenesis is incompletely understood but related to obesity and metabolic disease
  • Both the incidence and prevalence of HFpEF is increasing likely due to the obesity epidemic and the downstream consequences of it
  • HFpEF has a strong association with obesity and metabolic dysfunction
  • Risk factors for HFpEF include increasing age, hypertension, and heart disease
  • Prevalence is greater among females

Key Points on Treatment:

  1. Manage risk factors !
  2. SGLT-2 inhibitors
  3. MRAs
  4. ARNIs
  5. Loop diuretics for congestion
  • Avoid beta blockers unless there is another indication as they may decrease functional status
  • Picking a diuretic dose is largely trial and error

Relevant Podcast with complete show notes & transcript:

HFpEF: 5 Pearls Segment

  • Guest discussant: Dr. Jen Ho
  • Original Interview by Dr. Rati Vani and Dr. Shreya P. Trivedi
  • Video by Dr. Waleed Rehman and Dr. Alice Kennedy

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