Decoding the Diagnostic Dilemmas of Heart Failure with Preserved Ejection Fraction: Applying the Universal Definition for Enhanced Diagnosis Standardization

Implementing the Universal Definition of HF for HFpEF Diagnosis

The clinical diagnosis of HFpEF is straightforward when a patient presents with typical symptoms and signs of left and/or right congestive HF with LVEF ≥50%, along with echocardiography abnormalities and elevated NP.

However, patients with HFpEF may not display this classical HF presentation. Indeed, a significant proportion of patients (∼50%) will only display symptoms during exertion, without current or previous evidence of fluid overload on clinical examination or prior hospitalization for decompensated HF (). This exercise-induced left atrial hypertension phenotype makes diagnosis challenging in clinical practice, with the Framingham criteria showing limited sensitivity.^,

[…]