HFpEF is failure of the heart to meet the body's demand but with preservation of the ejecting power of the left ventricle. It produces a syndrome known as diastolic dysfunction.
CAD is common in patients HFpEF, seen in approximately two-thirds of patients in angiographic and autopsy studies, and is a potentially reversible cause of HFpEF. Evaluate for CAD in the following scenarios:
- Symptoms suggestive of obstructive CAD – In patients with HFpEF who have symptoms that suggest the presence of obstructive CAD (eg, angina, dyspnea on exertion), which may be anginal equivalents, or who have signs of myocardial infarction or ischemia on imaging, we suggest an evaluation for CAD.
- New diagnosis of HFpEF and known CAD – In patients who present with HFpEF and known CAD without angina, we evaluate for the presence of ischemia unless the patient is not eligible for revascularization.
- Asymptomatic patients without history of CAD – In patients with HFpEF and no history of CAD, we do not routinely test for obstructive CAD.