Diagnostic Workup for Suspected HFpEF

Accurately diagnosing heart failure with preserved ejection fraction (HFpEF) remains one of the greatest challenges in cardiovascular medicine. Panelists emphasized that symptoms such as dyspnea, fatigue, and exercise intolerance often overlap with those of other conditions, including pulmonary disease and obesity-related cardiometabolic dysfunction. They noted that this diagnostic ambiguity frequently leads to underdiagnosis or delayed treatment initiation. The group agreed that clinical suspicion should be heightened in patients with multiple risk factors and that early recognition is crucial to prevent irreversible myocardial remodeling and symptom progression.

Panelists discussed the value of structured diagnostic algorithms such as the H2FpEF and Heart Failure Association PEFF scores, which combine clinical characteristics, echocardiographic findings, and biomarker levels to estimate the likelihood of HFpEF. Natriuretic peptide testing, tissue Doppler imaging, and assessment of left atrial size and filling pressures were cited as key diagnostic tools. The conversation also explored how emerging modalities, such as strain echocardiography and cardiac MRI, can provide further insight into diastolic dysfunction and myocardial fibrosis, offering a more nuanced understanding of disease stage and severity.

The panel concluded that an accurate diagnostic workup depends not only on technology but also on multidisciplinary coordination. Collaboration between cardiology, primary care, nephrology, and endocrinology helps integrate data and guide individualized treatment planning. Panelists highlighted that confirming the diagnosis is particularly important before introducing mineralocorticoid receptor antagonists or sodium-glucose transporter 2 inhibitors, as patient selection strongly influences therapeutic safety and effectiveness. Ultimately, they agreed that refining diagnostic pathways—supported by education, standardized protocols, and improved access to imaging—will accelerate appropriate treatment initiation and improve outcomes for patients with suspected HFpEF.