[Heart failure with preserved ejection fraction in old age : Diagnostic strategies in clinical practice]

Heart failure with preserved ejection fraction (HFpEF) is characterized by diastolic dysfunction of the left ventricle in the presence of preserved systolic function (LVEF ≥ 50%). The leading symptom is exertional dyspnea, which is often the only clinical manifestation, particularly in older patients. The diagnostic algorithm follows a structured, stepwise approach. First, a basic assessment is performed including the medical history, physical examination, resting electrocardiography (ECG), measurement of natriuretic peptides and chest X‑ray. In the next step, transthoracic echocardiography is performed, enabling assessment of diastolic function as well as detection of structural cardiac abnormalities. For an objective interpretation of the findings, the HFA-PEFF score can be applied. Further advanced imaging or invasive diagnostics are reserved for cases with diagnostic uncertainty or for etiological clarification once HFpEF has been established.