Medscape InDiscussion: Heart Failure S1 Episode 5: HFpEF Mimickers, GDMT and Treatment-Tailoring Strategies
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Apr 6, 2023 
Jennifer Ho, an associate professor and advanced heart failure specialist researching HFpEF. She breaks down how HFpEF is diagnosed using history, biomarkers, and imaging. She highlights common mimickers like infiltrative and valvular disease. She outlines guideline-directed therapies and practical strategies for tailoring treatment and lifestyle care.
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HFpEF Is A Clinical Diagnosis Not Just An Echo Finding
- Heart failure with preserved ejection fraction (HFpEF) is primarily a clinical diagnosis guided by history and physical exam.
- Echo and natriuretic peptides can be normal in exertional HFpEF, so use scores like H2F-PEF to rule out or in and reserve advanced testing for intermediate cases.
Look For Red Flags That Signal HFpEF Mimickers
- Actively screen for HFpEF mimickers like cardiac amyloidosis, CAD, valvular disease, sarcoid, hypertrophic cardiomyopathy, and pericardial disease.
- Look for red flags: disproportionate LVH, biatrial enlargement, conduction block, RV involvement, or suggestive systemic/family history to prompt further testing.
HFpEF Patients Often Have Severely Reduced Exercise Capacity
- Despite new therapies, residual risk in HFpEF remains high and functional capacity is often severely reduced.
- Average peak VO2 ~15 mL/kg/min across studies, highlighting major activity limitations and the value of QoL-focused therapies.
