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HFpEF — RACP Adult Medicine MCQ

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ModerateCardiologyHFpEFRACP Adult Medicine

A 68-year-old woman presents with worsening exertional dyspnoea. She is found to have a serum NT-proBNP of 4500 pg/mL and echocardiography shows an LVEF of 62% with grade III diastolic dysfunction and elevated left atrial pressure. What is the diagnosis?

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Correct answer: D — Heart failure with preserved ejection fraction

HFpEF is defined as symptoms and signs of heart failure with LVEF ≥50%, elevated natriuretic peptides, and structural/functional abnormalities (e.g. LVH, LAE, diastolic dysfunction). LVEF 62% with grade III diastolic dysfunction and elevated NT-proBNP meets criteria. HFpEF accounts for ~50% of heart failure and is associated with obesity, hypertension, AF, diabetes, and ageing. SGLT2 inhibitors (empagliflozin – EMPEROR-Preserved; dapagliflozin – DELIVER) are now recommended for HFpEF.

Reference: NHF – 2023 – Heart Failure Guidelines; ESC – 2023 – Heart Failure Guidelines Update