Key result
HFpEF diagnostic algorithms yield widely discordant prevalence estimates ranging from ~9% to ~78%.
Why the study?
Diagnosing HFpEF remains challenging despite the development of modern diagnostic algorithms over the past ten years, and the prevalence of HFpEF in patients with concurrent arterial hypertension and T2DM needed assessment across these different algorithms.
How does the estimated prevalence and diagnostic certainty of newly diagnosed HFpEF vary across different contemporary diagnostic algorithms (ESC 2021, H2FPEF, HFA-PEFF, EACVI 2021, and ASE 2025) in patients with comorbid arterial hypertension and type 2 diabetes mellitus?
Cohort (n=90)
Open-label
No
How does the estimated prevalence and diagnostic certainty of newly diagnosed HFpEF vary across different contemporary diagnostic algorithms (ESC 2021, H2FPEF, HFA-PEFF, EACVI 2021, and ASE 2025) in patients with comorbid arterial hypertension and type 2 diabetes mellitus?
In patients with comorbid hypertension and type 2 diabetes presenting with exertional dyspnea, the estimated prevalence of HFpEF varies widely from 8.9% to 77.8% depending on the diagnostic algorithm used, with H2FPEF and HFA-PEFF yielding high rates of indeterminate results while NT-proBNP testing substantially improves diagnostic classification.
Answers are grounded in this paper and cite their sources.
Algorithm choice may yield inconsistent HFpEF diagnoses in hypertensive diabetes; leaves open need for validated, standardized criteria.
Chronic heart failure (CHF) is a common syndrome, in which heart failure with preserved left ventricular ejection fraction (HFpEF) predominates. The diagnosis of this particular phenotype of СHF currently remains challenging in medicine. Over the past ten years, scientific societies have developed and implemented modern diagnostic algorithms. Aim. To assess the prevalence of HFpEF among patients with concurrent arterial hypertension and type 2 diabetes mellitus (T2DM) using various diagnostic algorithms. Materials and methods. A study examined 90 individuals (mean age 61.61 ± 7.94 years) with arterial hypertension and T2DM who presented with dyspnea on moderate-intensity physical exertion and fatigue between 2022–2025. All participants underwent clinical and laboratory assessments, including NT-proBNP levels, 24-hour blood pressure monitoring, standard transthoracic and speckle-tracking echocardiography, as well as a diastolic stress test. HFpEF was evaluated using the European Society of Cardiology algorithm (ESC 2021), the H2FPEF score (2018), the HFA-PEFF algorithm (2019), the European Association of Cardiovascular Imaging (EACVI, 2021) consensus-based score, and the American Society of Echocardiography guidelines (2025). Results. The proportion of confirmed HFpEF diagnoses varied significantly across the scales, ranging from 8.9 % to 77.8 %. Disproved diagnoses ranged from 2.2 % to 86.7 %. A high proportion of indeterminate results was observed in specific scales, reaching up to 86.7 % and peaking at 100 % using the H2FPEF score. Conclusions. The estimated prevalence of HFpEF is highly dependent on the applied diagnostic algorithm. Evaluation of NT-proBNP levels significantly enhances diagnostic accuracy to identify HFpEF. In a cohort of patients with comorbid arterial hypertension and T2DM, the H2FPEF and HFA-PEFF algorithms demonstrate limited diagnostic certainty, yielding a high percentage of indeterminate results.
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Kolesnyk et al. (2026) conducted a cohort in Suspected heart failure with preserved ejection fraction (HFpEF) in patients with stage II arterial hypertension and type 2 diabetes mellitus (n=90). HFpEF diagnostic algorithms (ESC 2021, H2FPEF, HFA-PEFF, EACVI 2021, ASE 2025) vs. Cross-comparison of diagnostic algorithms (with and without NT-proBNP for HFA-PEFF) was evaluated on Prevalence of confirmed HFpEF diagnosis across different diagnostic algorithms. Diagnostic algorithms yielded widely varying HFpEF prevalence from 8.9% to 77.8% in hypertensive diabetic patients, with H2FPEF classifying 100% as indeterminate.
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