HFpEF is characterized by which combination?

• A. Reduced EF (<40%) with LV dilation.
• B. Normal EF with systolic dysfunction.
• C. Preserved EF (≥50%) with diastolic dysfunction and/or elevated filling pressures.
• D. Hyperdynamic EF with normal filling pressures.

Answer: (C)

The main idea is that heart failure with preserved ejection fraction arises when the pumping strength is normal, but the ventricle has difficulty filling properly. The ejection fraction remains high (typically 50% or greater), yet diastolic dysfunction causes elevated filling pressures that back up into the left atrium and lungs, producing the congestion that defines heart failure symptoms.

This contrasts with heart failure due to reduced ejection fraction, where systolic contraction is impaired and the ventricle often becomes dilated. In HFpEF the chamber is usually stiff or hypertrophied from factors like long-standing hypertension or aging, leading to poor compliance. Diagnostic clues include preserved EF on echocardiography and evidence of diastolic dysfunction or elevated LV filling pressures (for example, signs like an elevated E/e′ ratio, left atrial enlargement, or pulmonary congestion).

So the description that best fits HFpEF is preserved EF with diastolic dysfunction and/or elevated filling pressures.