title: How to diagnose heart failure with preserved ejection fraction: the value of invasive stress testing.
abstract: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden worldwide and its prevalence is increasing. Diagnosing HFpEF is challenging and relies upon the presence of symptoms and/or signs of heart failure, preserved left ventricular systolic function, and evidence of diastolic dysfunction. Current diagnostic algorithms mainly rely on echocardiography (E/e') and biomarkers (NT-proBNP). However, only a minority of patients with HFpEF are identified, and especially HFpEF patients at an early stage of the disease are easily missed. We propose to incorporate invasive stress testing, by means of right heart catheterisation at rest and during exercise, and accurate assessment of right ventricular function, by means of cardiac magnetic resonance imaging. These additions to the current diagnostic work-up will improve diagnostic sensitivity and accurate staging of HFpEF patients.
authors.affiliation: Department of Pulmonology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre (VUmc), Amsterdam, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: Huis In 't Veld
authors.affiliation: Department of Pulmonology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre (VUmc), Amsterdam, The Netherlands.
authors.forename: F S
authors.initials: FS
authors.lastname: de Man
authors.affiliation: Department of Cardiology, ICaR-VU, VUmc, Amsterdam, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: van Rossum
authors.affiliation: Department of Cardiology, ICaR-VU, VUmc, Amsterdam, The Netherlands. ml.handoko@vumc.nl.
authors.forename: M L
authors.initials: ML
authors.lastname: Handoko
keywords: Diagnosis; Diastole; Echocardiography; Exercise test; Heart failure; Swan-Ganz catheterisation