#HFpEF was a hot topic this morning at @CanHFSociety #HFupdate20! Dr. @KSharmaMD of @HopkinsMedicine spoke on the process of making a correct HFpEF diagnosis - something which most internists and even cardiologists struggle with according to data which was shared. 1/6 
In the "real world" @KSharmaMD makes her diagnosis by identifying patients with a clinical heart failure syndrome, LVEF > 50% and objective evidence of cardiac disease (⬆️BNP, LVH, diastolic dysfunction, PCWP or LVEDP > 15). Dr. Sharma also alerted us to be mindful of the 2/6
presence of "exercise-induced HFpEF" - a phenotype with normal or mildly abnormal filling pressures at rest (i.e. LVEDP, PCWP, mPAP), but severe elevation of such pressures with activity. Her gold standard is a level three stress test, which is a 3/6
right heart catheterization while performing exercise for those unaware of this type of testing. A recumbent bicycle in the cath lab is a good method of exercise-induced stress. Those with "exercise-induced HFpEF" will demonstrate a sharp increase in LVEDP, PCWP and mPAP 4/6
with such activity. But what if you do not perform level three stress testing at your center? Dr. Lisa Mielniczuk of the University of Ottawa discussed how stress echocardiography can potentially replace invasive hemodynamic testing in such situations. However, @KSharmaMD 5/6
mentioned the difficulty of acquiring optimal echocardiographic windows in this patient population, and suggested that if this was the case a referral to a center with level three stress testing would be recommended. Invasive hemodynamics are the gold standard. 6/6
