Table 1

Diagnostic criteria for HFpEF

ESC guidelines 20162 AHA guidelines 20133
History and examinationSymptoms and signs of HFSymptoms and signs of HF
Ejection fraction≥50%≥50%
Natriuretic peptidesBNP>35 pg/mL and/or
NT-proBNP>125 pg/mL
Elevated levels are supportive
ImagingCardiac structural alterationsAbnormal LV diastolic function
 LAVI>34 mL/m2
 LVMI≥115 g/m2 (Males) ≥95 g/m2 (Females)
And/or cardiac functional alterations
 E/e’ mean septal-lateral≥13
 Mean e’ septal/lateral wall<9 cm/s
Additional indirect measures
 Reduced global longitudinal strain
 Elevated PASP (from TR velocity)
ECGAF, LVH, repolarisation abnormalitiesNo specifications
ExclusionsExclude other known causes of HFExclude other known causes of HF
Further testing in case of uncertaintyDiastolic stress test
 E/e’, PASP, strain, SV and CO
or invasive assessment of LV pressures
 Rest PCWP≥15 mm Hg or LVEDP≥16 mm Hg±change with exercise*
  • *Defined as increase in PCWP to ≥25 mm Hg with exercise by Obokata et al.8

  • AF, atrial fibrillation; BNP, b-type natriuretic peptide; CO, cardiac output; HF, heart failure; HFpEF, HF with preserved ejection fraction; LAVI, left atrial volume index; LV, left ventricular; LVEDP, left ventricular end diastolic pressure; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index; NT-proBNP, N-terminal pro B-type natriuretic peptide; PASP, pulmonary artery systolic pressure; PCWP, pulmonary capillary wedge pressure; SV, stroke volume; TR, tricuspid regurgitation.