From the Guidelines
Patients with Heart Failure with preserved Ejection Fraction (HFpEF) should be monitored for several key parameters, including symptoms, vital signs, body weight, laboratory tests, and echocardiography, to effectively manage their condition and prevent morbidity, as recommended by the 2017 ACC/AHA/HFSA focused update 1. The management of HFpEF focuses on controlling symptoms, addressing comorbidities, and preventing hospitalizations. Key parameters to monitor include:
- Symptoms: dyspnea, fatigue, exercise intolerance, and edema
- Vital signs: blood pressure (target <130/80 mmHg) and heart rate
- Body weight: daily tracking to detect fluid retention early
- Laboratory tests: electrolytes (especially sodium and potassium), renal function (BUN, creatinine), natriuretic peptides (BNP or NT-proBNP), and hemoglobin levels
- Echocardiography: periodic assessment of cardiac structure and function, including left ventricular ejection fraction, diastolic function, left atrial size, and pulmonary pressures These parameters are crucial because HFpEF management involves impaired cardiac relaxation and filling despite preserved contractile function, and controlling these factors can help prevent morbidity and mortality, as supported by the 2013 ACCF/AHA guideline for the management of heart failure 1. Additionally, functional capacity can be evaluated through the 6-minute walk test or cardiopulmonary exercise testing, and medication adherence and side effects require monitoring, particularly with diuretics, SGLT2 inhibitors, and other heart failure medications, as recommended by the 2017 ACC/AHA/HFSA focused update 1 and the role of biomarkers for the prevention, assessment, and management of heart failure 1. It is also important to note that echocardiographic data adds incremental prognostic information in patients with HFpEF, including LV hypertrophy, LA volumes, E/e ratio, peak velocity of TR jet, RV function, and GLS, as stated in the recommendations for the evaluation of left ventricular diastolic function by echocardiography 1.
From the Research
Monitoring Parameters in HFpEF
To effectively manage patients with Heart Failure with preserved Ejection Fraction (HFpEF), several parameters should be monitored:
- Clinical symptoms such as dyspnea, fatigue, and exercise intolerance 2
- Vital signs, including blood pressure, heart rate, and oxygen saturation 2
- Volume status, including signs of congestion such as edema and jugular venous distension 2
- Renal function, including serum creatinine and estimated glomerular filtration rate (eGFR) 3
- Electrolyte levels, including potassium and sodium 3
- Natriuretic peptide levels, such as B-type natriuretic peptide (BNP) and N-terminal proBNP, to assess disease severity and guide therapy 4, 5, 6
- Echocardiographic parameters, including left ventricular ejection fraction (LVEF), left atrial size, and pulmonary artery systolic pressure 2
- Medication adherence and response to therapy, including diuretics, beta-blockers, and renin-angiotensin system (RAS) blockers 2, 3
Special Considerations
- Patients with HFpEF and low levels of natriuretic peptides may have different characteristics and outcomes compared to those with elevated levels 5
- The interaction between spironolactone and natriuretic peptides may affect outcomes in patients with HFpEF, with greater benefit seen in patients with lower levels of natriuretic peptides 6
- Worsening renal function related to medication may impact outcomes in patients with HFpEF, and should be carefully monitored and managed 3