Diagnosis of Heart Failure With Preserved Ejection Fraction Relies on Detection of Increased Diastolic Filling Pressure, But How?

In this issue of the Journal of the American Heart Association (JAHA), Ki Hong Choi et al publish an important study in a Korean population to show the diagnostic and prognostic value of left ventricular end-diastolic pressure (LVEDP) in patients with suspected heart failure with preserved ejection fraction (HFpEF).¹ Of 404 patients with suspected HFpEF, LVEDP was ≥16 mm Hg in 80%, consistent with HFpEF, and this group of patients was found to have higher heart failure assoication-pretest assessment, echocardiography, functional testing, and final etiology (HFA-PEFF) scores than the 20% of patients with noncardiac dyspnea who had LVEDP <16 mm Hg. Although the HFA-PEFF score was associated with a significantly higher 10-year risk of death-or heart failure-related events, the score was in the intermediate range for a significant proportion (56%) of the study patients. Even in this group, increased LVEDP was associated with a significantly higher risk than in patients with LVEDP <16 mm Hg. Therefore, the authors correctly concluded that invasively measured LVEDP can provide additional discriminative value to diagnose HFpEF or to predict a worse outcome, especially in patients with intermediate HFA-PEFF scores.