HFpEF Diagnosis — RACP Adult Medicine MCQ

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ModerateCardiologyHFpEF DiagnosisRACP Adult Medicine

A 70-year-old obese woman with hypertension and AF presents with exertional dyspnoea and ankle oedema. Echo shows LVEF 58%, diastolic dysfunction (E/e' 18), elevated LAVI (48 mL/m²), LVH, and estimated PASP 45 mmHg. NT-proBNP is 450 pg/mL. What is the most likely diagnosis?

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Correct answer: D — HFpEF

Exertional dyspnoea with preserved LVEF (≥50%), elevated E/e' ratio (≥13), elevated LAVI, LVH, elevated NT-proBNP, and AF with typical risk factors (elderly, obese, hypertensive, female) is HFpEF. H2FPEF score supports the diagnosis. Treatment: diuretics (decongestion), SGLT2 inhibitors (DELIVER trial: empagliflozin reduced HF events in HFpEF), GLP-1 RA for obesity (STEP-HFpEF: semaglutide improved symptoms), and management of comorbidities. No mortality-reducing pharmacotherapy for HFpEF was proven until SGLT2i.

Reference: NHFA/CSANZ – 2023 – HFpEF; DELIVER Trial; ESC 2021