Which echo findings support a diagnosis of heart failure with preserved ejection fraction (HFpEF)?

Which echo findings support a diagnosis of heart failure with preserved ejection fraction (HFpEF)?

• A. Elevated E/e′, left atrial enlargement, preserved EF, and small left ventricular cavity.
• B. Significant left ventricular dilation with reduced EF.
• C. Normal filling pressures.
• D. Severe mitral stenosis.

Answer: (A)

Heart failure with preserved ejection fraction stems from diastolic dysfunction where the heart can still squeeze normally but has trouble relaxing and filling. On echo, this shows up as a preserved ejection fraction (typically ≥50%), but signs of high left ventricular filling pressures. A practical marker is the E/e′ ratio: elevated values indicate higher filling pressures, which contribute to symptoms of congestion. Chronic pressure overload also pushes the left atrium to enlarge over time, another common echo finding in HFpEF. The left ventricle itself is often not dilated; instead it may be relatively small or show concentric remodeling due to hypertrophy, which helps explain preserved systolic function. This pattern distinguishes HFpEF from scenarios like significant LV dilation with reduced EF (which points to heart failure with reduced ejection fraction), or normal filling pressures (less consistent with HFpEF). Severe mitral stenosis is a valvular disease with its own pressure changes, not a primary HFpEF pattern, even though it can raise filling pressures.

Heart failure with preserved ejection fraction stems from diastolic dysfunction where the heart can still squeeze normally but has trouble relaxing and filling. On echo, this shows up as a preserved ejection fraction (typically ≥50%), but signs of high left ventricular filling pressures. A practical marker is the E/e′ ratio: elevated values indicate higher filling pressures, which contribute to symptoms of congestion. Chronic pressure overload also pushes the left atrium to enlarge over time, another common echo finding in HFpEF. The left ventricle itself is often not dilated; instead it may be relatively small or show concentric remodeling due to hypertrophy, which helps explain preserved systolic function.

This pattern distinguishes HFpEF from scenarios like significant LV dilation with reduced EF (which points to heart failure with reduced ejection fraction), or normal filling pressures (less consistent with HFpEF). Severe mitral stenosis is a valvular disease with its own pressure changes, not a primary HFpEF pattern, even though it can raise filling pressures.