Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Barcelona, Spain.
Servicio de Cardiología, Hospital Clínico Universitario de Valencia-España, Valencia, Spain.
Heart Fail Rev. 2024 Jan;29(1):179-189. doi: 10.1007/s10741-023-10360-z. Epub 2023 Oct 20.
Heart failure (HF) with preserved ejection fraction (HFpEF) is a common condition in clinical practice, affecting more than half of patients with HF. HFpEF is associated with morbidity and mortality and with considerable healthcare resource utilization and costs. Therefore, early diagnosis is crucial to facilitate prompt management, particularly initiation of sodium-glucose co-transporter 2 inhibitors. Although European guidelines define HFpEF as the presence of symptoms with or without signs of HF, left ventricular EF ≥ 50%, and objective evidence of cardiac structural and/or functional abnormalities, together with elevated natriuretic peptide levels, the diagnosis of HFpEF remains challenging. First, there is no clear consensus on how HFpEF should be defined. Furthermore, diagnostic tools, such as natriuretic peptide levels and resting echocardiogram findings, are significantly limited in the diagnosis of HFpEF. As a result, some patients are overdiagnosed (i.e., elderly people with comorbidities that mimic HF), although in other cases, HFpEF is overlooked. In this manuscript, we perform a systematic narrative review of the diagnostic approach to patients with HFpEF. We also propose a comprehensible algorithm that can be easily applied in daily clinical practice and could prove useful for confirming or ruling out a diagnosis of HFpEF.
射血分数保留的心衰（HFpEF）是临床实践中的一种常见病症，影响超过一半的心衰患者。HFpEF 与发病率和死亡率以及大量医疗保健资源的利用和成本有关。因此，早期诊断对于促进及时管理至关重要，特别是钠-葡萄糖共转运蛋白 2 抑制剂的起始治疗。尽管欧洲指南将 HFpEF 定义为存在有或无心力衰竭症状、左心室射血分数≥50%、以及心脏结构和/或功能异常的客观证据，并伴有升高的利钠肽水平，但 HFpEF 的诊断仍然具有挑战性。首先，如何定义 HFpEF 尚无明确共识。此外，诊断工具，如利钠肽水平和静息超声心动图检查结果，在 HFpEF 的诊断中存在明显的局限性。因此，一些患者被过度诊断（即，有类似于心力衰竭的合并症的老年人），而在其他情况下，HFpEF 则被忽视。在本文中，我们对 HFpEF 患者的诊断方法进行了系统的叙述性综述。我们还提出了一个易于在日常临床实践中应用的综合算法，该算法对于确认或排除 HFpEF 的诊断可能很有用。
