Table 2

Heart Failure Association PEFF algorithm: stepwise approach in diagnosing heart failure with preserved ejection fraction (P–F)

PInitial work-up (step 1 (P): Pretest assessment)

  • Symptoms and/or signs of HF

  • Comorbidities/risk factors

  • ECG

  • Standard echocardiography

  • Natriuretic peptides

  • Ergometry/6MWT or CPET

EDiagnostic work-up (step 2 (E): Echocardiographic and natriuretic peptide score)

  • Comprehensive echocardiography

  • Natriuretic peptides, if not measured in step 1

F1Advanced work-up (step 3 (F1): Functional testing in case of uncertainty)

  • Diastolic stress test: exercise stress echocardiography

  • Invasive haemodynamic measurements

F2Aetiological work-up (step 4 (F2): Final aetiology)

  • Cardiovascular MRI

  • Cardiac or non-cardiac biopsies

  • Scintigraphy/CT/PET

  • Genetic testing

  • Specific laboratory tests

  • CPET, cardiopulmonary exercise testing; HF, heart failure; 6MWT, 6 min walk test; PET, positron emission tomography.