HFpEF is primarily characterized by which of the following?

• A. Impaired ventricular filling (diastolic dysfunction) with preserved EF.
• B. Reduced EF due to systolic failure.
• C. Systolic failure with dilated ventricle.
• D. Right-sided HF.

Answer: (A)

Heart failure with preserved ejection fraction is defined by diastolic dysfunction—the heart’s ability to relax and fill is impaired—while the pumping function (ejection fraction) remains normal. The stiff ventricle doesn’t fill efficiently during diastole, so filling pressures rise and heart-failure symptoms appear despite a normal-looking EF. This combination of impaired filling with preserved systolic function is what sets HFpEF apart.

The other scenarios describe problems with pumping strength rather than filling. Reduced ejection fraction and systolic failure usually involve a dilated, weaker ventricle with a low EF. Right-sided heart failure focuses on venous congestion from trouble on the right side, which is not the defining feature of HFpEF.