2024 Guidelines of the Taiwan Society of Cardiology for the Diagnosis and Treatment of Heart Failure with Preserved Ejection Fraction

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a multi-organ systemic syndrome that involves cardiac and extra-cardiac pathophysiological abnormalities. Its growing prevalence causes a major public concern worldwide. HFpEF is usually associated with multiple comorbidities, and non-cardiovascular death is common in patients with HFpEF. In Asia, patients with HFpEF has a younger age, higher prevalence of diabetes and chronic kidney disease than Western countries. A 2-step diagnostic algorithm is recommended in this guideline. In the first step, the diagnosis of HFpEF can be made if patients have symptoms and/or signs of heart failure, left ventricular ejection fraction ≥ 50%, increased natriuretic peptide, and objective evidence of left atrial or left ventricular abnormalities or raised left ventricular filling pressure. If diagnosis is still uncertain, invasive or noninvasive stress test can be performed in the second step. Comorbidities need to be controlled in HFpEF. Weight reduction for obesity and supervised exercise training are recommended for HFpEF. For pharmacological therapy, diuretic is used to relieve congestion and sodium-glucose cotransporter 2 inhibitor, empagliflozin or dapagliflozin, is recommended to improve prognosis of HFpEF. The research on HFpEF is advancing at a rapid pace. It is expected that newer modalities for diagnosis and management of HFpEF could appear in the near future.

Keywords: Guideline; Heart failure with preserved ejection fraction; Taiwan.

Figure 1

A 2-step diagnostic algorithm of HFpEF. AF, atrial fibrillation; BNP, B-type natriuretic peptide; CXR, chest X-ray; ECG, electrocardiography; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; LVEDP, left ventricular end diastolic pressure; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal proB-type natriuretic peptide; PCWP, pulmonary capillary wedge pressure; TR, tricuspid regurgitation.

Figure 2

Current major non-pharmacological and pharmacological therapies for HFpEF. HFpEF, heart failure with preserved ejection fraction; SGLT2i, sodium-glucose cotransporter 2 inhibitor.