A diagnosis relies on thorough interpretation of the entire echocardiogram, including left ventricular mass, left atrial volume and assessment of diastolic function. Unlike impaired ejection fraction, which reliably defines heart failure with reduced ejection fraction (HFrEF), the diagnosis of HFpEF can be challenging as there is no single abnormal echocardiographic parameter that defines its presence. It can potentially become a major burden to healthcare systems worldwide, which are already overstretched. HFpEF is a rapidly growing problem due to an ageing population as well as increased incidence of risk factors such as hypertension, diabetes and obesity (Figure 1). 1 HFpEF is not a single condition but a result of many different pathologies, adding challenges to management. Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have clinical features of heart failure in the presence of normal or near-normal left ventricular ejection fraction, usually defined as ejection fraction at 50% or above.
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