Diagnosis of Heart Failure with Preserved Ejection Fraction

Heart failure (HF) remains a major public health problem and significant burden for patients and health care providers in most parts of the world.¹ HF is commonly classified as "diastolic" (preserved ejection fraction) or "systolic" (reduced ejection fraction), and currently heart failure with preserved or normal ejection fraction (HFNEF) accounts for more than 50% of all HF patients.²•³ Although the revised American College of Cardiology/American Heart Association guidelines for the diagnosis and management of HF adopted the tenn "heart failure with preserved" or normal "ejection fraction" rather than "diastolic HF,'¹⁴ the later term is still preferred by several investigators and certainly prevails in current diagnostic billing codes. Both tenns are used interchangeably in our own institution.

Recent clinical studies have provided sufficient data to develop standardized diagnostic criteria to define HFNEF.¹•⁵•⁷ HFNEF is a clinical syndrome characterized by symptoms and/or signs of fluid retention with preserved left ventricular (LV) ejection fraction and evidence of abnormal diastolic function. The purpose of this article is to provide perspective on the clinical and diagnostic (nonechocardiographic) aspects of HFNEF.