{"id":9372,"date":"2025-12-12T17:05:34","date_gmt":"2025-12-12T14:05:34","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9372"},"modified":"2025-12-13T01:17:33","modified_gmt":"2025-12-12T22:17:33","slug":"hfpef-common-disease-uncommon-diagnosis","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/hfpef-common-disease-uncommon-diagnosis\/","title":{"rendered":"HFpEF: Common Disease, Uncommon Diagnosis"},"content":{"rendered":"
HFpEF: Common Disease, Uncommon Diagnosis<\/div>\n
<\/div>\n
Source: Medscape Medical News<\/div>\n
Date: December 09, 2025<\/div>\n
<\/div>\n
Keynotes:<\/div>\n
\u20071.\u2060 \u2060HFpEF: A Rising Clinical Challenge<\/div>\n
\u2022 HFpEF causes HF symptoms despite LVEF \u2265 50% due to elevated LV filling pressures.<\/span><\/div>\n
\u2022 HFpEF is commonly underdiagnosed because its symptoms resemble those of many noncardiac illnesses.<\/span><\/div>\n
\u2022 Prevalence is rising, especially in older adults, women, and obesity.<\/span><\/div>\n
<\/div>\n
\u20072.\u2060 \u2060Why Diagnosis Is Often Missed or Delayed<\/div>\n
\u2022 One-third of HFpEF patients have normal filling pressures at rest; abnormalities appear only during exercise.<\/span><\/div>\n
\u2022 Patients with obesity waited 22 months on average to receive the correct diagnosis.<\/span><\/div>\n
\u2022 Many dismiss exertional dyspnea as aging \u2192 11-month average delay before even visiting a primary provider.<\/span><\/div>\n
<\/div>\n
\u20073.\u2060 \u2060\u2022 <\/span>Among HFpEF subtypes, the obesity-related form is relatively easier to recognize due to its well-defined clinical features.<\/div>\n
<\/div>\n
\u20074.\u2060 \u2060Invasive hemodynamic testing remains essential in patients who have normal filling pressures at rest but persistent clinical suspicion. It can uncover:<\/div>\n
\u2022 Elevated filling pressures that appear only during exercise<\/span><\/div>\n
\u2022 Patterns that help differentiate left-heart HFpEF from pulmonary vascular involvement<\/span><\/div>\n
Its main limitations include procedural complexity and limited availability.<\/div>\n
\u2022 Research aims to replace invasive testing with noninvasive surrogates (imaging, biomarkers).<\/span><\/div>\n
<\/div>\n
\u20075.\u2060 \u2060HFA-PEFF (ESC 2019)<\/div>\n
\u2022 Comprehensive algorithm combining:<\/span><\/div>\n
\u2022\u2060\u00a0 \u2060Clinical findings (signs & symptoms)<\/div>\n
\u2022\u2060\u00a0 \u2060Echocardiography<\/div>\n
\u2022\u2060\u00a0 \u2060Biomarkers<\/div>\n
\u2022\u2060\u00a0 \u2060And, in selected cases, complex invasive hemodynamic testing, such as right heart catheterization performed:<\/div>\n
\u2013 at rest then<\/div>\n
\u2013 after a fluid challenge (e.g., 500 mL saline)<\/div>\n
\u2022 More accurate rule-in \/ rule-out for HFpEF than simpler scores.<\/span><\/div>\n
\u2022 Usually applied in specialized centers rather than routine clinics.<\/span><\/div>\n
<\/div>\n
\u20076.\u2060 \u2060AI-Based Tools: Promising but Not Yet Ready<\/div>\n
\u2022 ECG-AI models classify HF types using ECG plus echo-derived EF.<\/span><\/div>\n
\u2022 Echo-AI models using a single 4-chamber image estimate HFpEF probability.<\/span><\/div>\n
\u2022 Early promise, but insufficient accuracy for routine clinical use.<\/span><\/div>\n
<\/div>\n
\u20077.\u2060 \u2060Refinements in Diagnostic Testing<\/div>\n
\u2022 Fluid challenge (500 mL over 5 min): PCWP >18 mmHg \u2192 supports HFpEF.<\/span><\/div>\n
\u2022 Stress echocardiography detects abnormal diastolic filling but needs high expertise.<\/span><\/div>\n
\u2022 Progress aims to reduce reliance on exercise RHC in the future.<\/span><\/div>\n
<\/div>\n
\u20078.\u2060 \u2060Biomarkers: Why NT-proBNP Falls Short in HFpEF<\/div>\n
<\/div>\n
A) Biological limitation<\/div>\n
\u2022 HFpEF has less myocardial stretch \u2192 lower natriuretic peptide release.<\/span><\/div>\n
\u2022 Many HFpEF patients\u2014especially with obesity\u2014have normal BNP\/NT-proBNP despite true hemodynamic burden.<\/span><\/div>\n
\u2022 Resting biomarkers fail to capture exercise-only congestion.<\/span><\/div>\n
<\/div>\n
Sensitivity at standard cut-offs (125 pg\/mL)<\/div>\n
\u2022 Non-obese: sensitivity ~80\u201388% (misses 12\u201320%).<\/span><\/div>\n
\u2022 Obesity (BMI \u226535): sensitivity ~55\u201367% (misses up to 45%).<\/span><\/div>\n
\u2022 In several series: <50% sensitivity in obese patients.<\/span><\/div>\n
<\/div>\n
C) Lowering the cut-off (<50 pg\/mL)<\/div>\n
\u2022 Improves sensitivity:<\/span><\/div>\n
\u2022 97% (non-obese)<\/span><\/div>\n
\u2022 ~86% (obese)<\/span><\/div>\n
\u2022 But markedly lowers specificity \u2192 more false positives.<\/span><\/div>\n
<\/div>\n
D) Clinical impact<\/div>\n
\u2022 Normal NT-proBNP does NOT exclude HFpEF, especially in:<\/span><\/div>\n
\u2022 Obesity<\/span><\/div>\n
\u2022 Early disease<\/span><\/div>\n
\u2022 Exertional symptoms<\/span><\/div>\n
\u2022 Biomarkers must be combined with clinical scores, imaging, and functional hemodynamics.<\/span><\/div>\n
<\/div>\n
\u20079.\u2060 \u2060Emerging Biomarkers and Future Directions (Simplified)<\/div>\n
\u2022 Because NT-proBNP often fails to detect HFpEF, especially in obesity and early disease, researchers are searching for better blood markers that can reflect diastolic pressure and congestion more accurately.<\/span><\/div>\n
\u2022 Promising candidates include soluble ST2, inflammatory markers, and fibrosis markers.<\/span><\/div>\n
\u2022 No biomarker is reliable enough yet to diagnose HFpEF across all patient groups.<\/span><\/div>\n
<\/div>\n
10.\u2060 \u2060Improving Referral Pathways<\/div>\n
\u2022 More internists now refer directly to HF specialists or simultaneous cardiology + pulmonology evaluation.<\/span><\/div>\n
\u2022 Early testing (NT-proBNP + echo) in dyspnea with obesity or age-related risk helps reduce diagnostic delay.<\/span><\/div>\n
<\/div>\n
11.\u2060 \u2060The Bottom Line<\/div>\n
<\/div>\n
HFpEF diagnosis continues to lag because resting biomarkers underperform, congestion often appears only with exertion, and obesity masks peptide levels. Accurate diagnosis requires integrating natriuretic peptides with structured algorithms, imaging, and\u2014in selected cases\u2014invasive hemodynamic assessment.<\/div>\n
<\/div>\n
Link: https:\/\/www.medscape.com\/viewarticle\/cracking-hfpef-are-diagnostic-methods-evolving-2025a1000yi5?<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

HFpEF: Common Disease, Uncommon Diagnosis Source: Medscape Medical News Date: December 09, 2025 Keynotes: \u20071.\u2060 \u2060HFpEF: A Rising Clinical Challenge \u2022 HFpEF causes HF symptoms despite LVEF \u2265 50% due to elevated LV filling pressures. \u2022 HFpEF is commonly underdiagnosed because its symptoms resemble those of many noncardiac illnesses. \u2022 Prevalence is rising, especially in […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9372","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9372","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=9372"}],"version-history":[{"count":2,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9372\/revisions"}],"predecessor-version":[{"id":9377,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9372\/revisions\/9377"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9372"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9372"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9372"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}