Overview
What HFpEF Means
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome, not an echocardiographic label.
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome, not an echocardiographic label. Diagnosis requires signs or symptoms of heart failure, a left ventricular ejection fraction (LVEF) of at least 50%, and objective evidence of cardiac structural or functional abnormality consistent with elevated left ventricular filling pressures. Examples include diastolic dysfunction, left atrial enlargement, left ventricular hypertrophy, or elevated natriuretic peptides. An ejection fraction is a proportion, not a direct measure of total cardiac performance. A patient can eject a normal percentage of a relatively small, stiff ventricle while still having inadequate filling, high upstream pressure, and poor exercise tolerance. LVEF 41–49% is classified separately as heart failure with mildly reduced ejection fraction (HFmrEF), although the 2025 Canadian Cardiovascular Society/Canadian Heart Failure Society update uses the broader term heart failure with nonreduced ejection fraction (HFnrEF) for symptomatic heart failure with LVEF greater than 40% when organizing pharmacologic treatment.