Diastolic Stress Testing — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiologyDiastolic Stress TestingRACP Adult Medicine

A 65-year-old man with suspected HFpEF has borderline Echo findings (E/e' 12, LAVI 32 mL/m², LVEF 55%). Resting NT-proBNP is 100 pg/mL (borderline). He is highly symptomatic with exertional dyspnoea. What is the most appropriate next diagnostic step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — HFpEF

Borderline findings at rest with symptoms suggest the need for exercise testing. Diastolic stress testing (exercise echocardiography measuring E/e' with exertion, or invasive haemodynamic exercise testing showing PCWP >25 mmHg with exercise) can unmask HFpEF that is normal at rest. H2FPEF score helps integrate clinical and echocardiographic data. If score is intermediate (2-5), exercise testing is recommended. [Note: option set limits — clinical answer is diastolic stress test]

Reference: ESC – 2021 – HF; H2FPEF Score; NHFA/CSANZ 2023