For a >65‑year‑old patient with heart failure with preserved ejection fraction, mild concentric left‑ventricular hypertrophy, chronic diastolic dysfunction, low stroke‑volume index, hypertension and likely comorbidities (diabetes, hyperlipidaemia, chronic kidney disease, coronary artery disease), what additional information should be included in a concise two‑page summary for an upcoming visit to an academic cardiovascular centre, and what major considerations and key questions should be raised with the specialists?

Two-Page Summary for Academic Cardiovascular Center Visit

Patient Profile Summary

Create a concise header section including:

• Age >65, male
• Primary diagnosis: HFpEF with LVEF ≥50% 1
• Key structural findings: Mild concentric LVH, chronic diastolic dysfunction, low stroke-volume index 1
• Comorbidities: Hypertension, diabetes, hyperlipidemia, chronic kidney disease, coronary artery disease 2, 3
• Current NYHA functional class and symptom trajectory 1

Critical Diagnostic Information to Include

Echocardiographic parameters with specific values:

• LVEF percentage and measurement method 1
• E/e' ratio (target >14 suggests significant diastolic dysfunction) 1
• Left atrial volume index (LAVI) with specific measurements 1
• Septal and posterior wall thickness measurements 4
• Tricuspid regurgitation peak velocity for pulmonary hypertension assessment 1
• Right ventricular function assessment, as RV dysfunction increases mortality up to 10-fold in HFpEF 5

Natriuretic peptide levels:

• BNP and/or NT-proBNP values with dates (diagnostic threshold: BNP >35 pg/mL, NT-proBNP >125 pg/mL for chronic HFpEF) 1
• Serial values if available to show trajectory 1

Functional capacity documentation:

• 6-minute walk distance or cardiopulmonary exercise test results if performed 1
• Specific exercise limitations and symptoms during exertion 1

Essential Laboratory Data

Include specific values for:

• Estimated glomerular filtration rate (eGFR) and creatinine trends 1
• Hemoglobin A1c and glucose control 3
• Lipid panel 3
• Serum sodium (hyponatremia is prognostically important) 1
• Hemoglobin (anemia is a common comorbidity) 1, 3

Current Medication Regimen

List all cardiovascular medications with doses:

• Diuretics (type and dose) 1
• SGLT2 inhibitors status (dapagliflozin or empagliflozin are disease-modifying for HFpEF) 1
• Antihypertensive agents (ARBs, ACE inhibitors, beta-blockers) 6, 4
• Mineralocorticoid receptor antagonists 1
• Rate control agents if atrial fibrillation present 1

Major Considerations and Key Questions for Specialists

Diagnostic clarification:

• Request cardiac MRI if not yet performed to exclude infiltrative diseases (amyloidosis, sarcoidosis) or hypertrophic cardiomyopathy, particularly given concentric LVH pattern 6, 4
• Consideration for technetium pyrophosphate (99mTc-PYP) scan if transthyretin cardiac amyloidosis suspected 1
• Need for invasive hemodynamic assessment if diagnosis remains uncertain despite comprehensive non-invasive testing 1

Optimization of guideline-directed medical therapy:

• If not already prescribed, initiate SGLT2 inhibitor (empagliflozin or dapagliflozin) as this is the only Class I recommendation for disease-modifying therapy in HFpEF 1
• Blood pressure target achievement (<130/80 mmHg) with ARBs as first-line for LVH regression 6, 4
• Appropriateness of mineralocorticoid receptor antagonist (spironolactone) for symptom management 1

Comorbidity management:

• Optimal diabetes control strategy given HFpEF (SGLT2 inhibitors provide dual benefit) 1, 3
• Chronic kidney disease progression risk and medication adjustments 1
• Sleep apnea screening and treatment if not yet addressed 4, 3
• Obesity management strategies including potential for weight loss interventions 3

Advanced therapeutic considerations:

• Eligibility for clinical trials targeting HFpEF mechanisms 7
• Role of cardiac rehabilitation program (improves exercise tolerance and diastolic function without necessarily reducing LVH) 8
• If atrial fibrillation develops or is present, rhythm versus rate control strategy and anticoagulation optimization 1

Prognostic assessment:

• Risk stratification for sudden cardiac death (ICD consideration if LVEF declines) 1
• Evaluation for pulmonary hypertension severity and right ventricular dysfunction, which dramatically impacts prognosis 5
• Assessment of need for advanced HF specialist follow-up versus community management 1

Specific questions to ask:

• "Given my low stroke-volume index with preserved EF, am I a candidate for invasive hemodynamic exercise testing to confirm HFpEF diagnosis?" 1
• "Should I have cardiac MRI to exclude infiltrative cardiomyopathy or HCM given my concentric LVH pattern?" 6, 4
• "Am I a candidate for SGLT2 inhibitor therapy, and if already on one, is the dose optimized?" 1
• "What is my risk of progression to reduced ejection fraction, and what monitoring schedule is recommended?" 1
• "Are there clinical trials available for my specific HFpEF phenotype?" 7

Medications to Avoid

Document any exposure to contraindicated agents:

• NSAIDs (worsen fluid retention and kidney function) 6
• Non-dihydropyridine calcium channel blockers if HFrEF develops 1
• Thiazolidinediones (PPAR-γ agonists cause fluid retention) 1
• DPP-4 inhibitors (associated with HF hospitalizations) 1