HFPEF-project: Heart Failure Phenotyping - Exploring the Fingerprints

Inclusion criteria

• Hospitalisation for heart failure or debilitating dyspnoea (NYHA II-IV) and a diagnosis of HFpEF.
• Left ventricular ejection fraction (LVEF) >40% in the preceding 12 months or during a period of hospitalisation as determined by either cardiac ultrasound, MRI, left ventricular echocardiography, or isotope imaging.
• NTproBNP > 300 pg/ml (or BNP > 100 pg/ml) during hospitalisation or NTproBNP > 125 pg/ml in outpatients.
• Impaired myocardial relaxation (diastolic dysfunction) as determined by tissue doppler imaging (TDI: lateral mitral annulus velocity, lat E' <9cm/s or septal annulus velocity, sept E' <8 cm/s)
• Both previously undiagnosed, de-novo heart failure patients and patients admitted to hospital for acute exacerbation of known heart failure will be included in the study.

Exclusion criteria

• Age >85 years
• Significant aortic valve stenosis (AVA ≤1.0 cm2)
• Primary (structural) mitral valve disease with grade III-IV insufficiency or significant stenosis (MVA<1.5 cm2)
• Other severe valvular defect (e.g. secondary severe mitral or severe tricuspid insufficiency)
• Previous LVEF < 40% (HFrEF or HF with improved EF)
• Recent acute coronary syndrome (< 3 months) or myocardial infarction with ST elevations (STEMI) within 12 months
• Previous open heart surgery (CABG/valvular) or percutaneous valvular interventio
• Previously known specific myocardial disease (hypertrophic cardiomyopathy, non-compaction cardiomyopathy (LVNC), right ventricular arrhythmogenic cardiomyopathy (ARVC), cardiac amyloidosis, cardiac sarcoidosis, haemochromatosis)
• End-stage renal disease (eGFR <15 ml/min or dialysis treatment, previous kidney transplantation)
• Significant physical disability, mobility limitation, or dependence on another person for assistance (patient is not self-sufficient) limits participation in the study