Heart Failure with Preserved Ejection Fraction as a Cause of Unexplained Dyspnea

Figuring out the cause of unexplained dyspnea is challenging when pulmonary function is normal, systemic causes are excluded, and left ventricular ejection fraction (LVEF) by echocardiography is normal. When such patients are seen in primary care practice but aren't acutely symptomatic, heart failure with preserved ejection fraction (HFpEF) remains in the differential diagnosis.

In this retrospective multicenter study that involved 736 patients with unexplained dyspnea and LVEF >50%, researchers assessed the accuracy of two decision tools developed to identify HFpEF. One tool — the H₂FPEF — requires only four clinical variables plus two echocardiographic variables (i.e., pulmonary artery systolic pressure and the E/e′ ratio, a measure of lef…