HFpEF is characterized by which combination?

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

Answer: (C)

HFpEF is defined by a preserved ejection fraction with diastolic dysfunction and/or elevated filling pressures. This means the heart pumps out a normal percentage of blood with each beat, but the ventricle is stiff and doesn’t fill well during diastole, leading to higher pressures in the heart and symptoms of heart failure. That combination—normal or near-normal EF plus diastolic dysfunction and raised filling pressures—is exactly what the correct choice describes.

The other scenarios don’t fit: reduced or dilated systolic function points to heart failure with reduced EF, and a hyperdynamic EF with normal filling pressures doesn’t explain the elevated filling pressures and diastolic filling problems seen in HFpEF.