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Purpose of Review <p>To describe the clinical implications of normal natriuretic peptide (NP) levels in suspected heart failure with preserved ejection fraction (HFpEF).</p> Recent Findings <p>HFpEF in the ambulatory setting remains difficult to diagnose given the lack of pathognomonic echocardiographic findings, the limitations of non-invasive testing with increasing obesity, and the non-specific nature of exertional dyspnea. Recent evidence has shown that many patients with HFpEF have invasively confirmed elevation in left heart filling pressures, despite having ‘normal’ NP (&lt; 125 pg/ml) by current diagnostic criteria.</p> Summary <p>Patients with HFpEF who have normal NP levels based on current&#xa0;diagnostic thresholds have poor quality of life with clinical underrecognition&#xa0;of the severity of hemodynamic derangements related to heart failure. Use&#xa0;of very low NP rule-out levels (&lt;50 pg/ml) are clinically required to exclude&#xa0;HFpEF in this setting with low threshold to consider invasive evaluation of&#xa0;filling pressures to guide initiation of foundational therapy for HFpEF.</p>

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Heart Failure with Preserved Ejection Fraction Despite Normal Natriuretic Peptides

  • 期刊论文

  • 发表日期：

    2025年9月30日

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  • Jason K. Lee,
  • Yogesh N. V. Reddy

摘要

Purpose of Review

To describe the clinical implications of normal natriuretic peptide (NP) levels in suspected heart failure with preserved ejection fraction (HFpEF).

Recent Findings

HFpEF in the ambulatory setting remains difficult to diagnose given the lack of pathognomonic echocardiographic findings, the limitations of non-invasive testing with increasing obesity, and the non-specific nature of exertional dyspnea. Recent evidence has shown that many patients with HFpEF have invasively confirmed elevation in left heart filling pressures, despite having ‘normal’ NP (< 125 pg/ml) by current diagnostic criteria.

Summary

Patients with HFpEF who have normal NP levels based on current diagnostic thresholds have poor quality of life with clinical underrecognition of the severity of hemodynamic derangements related to heart failure. Use of very low NP rule-out levels (<50 pg/ml) are clinically required to exclude HFpEF in this setting with low threshold to consider invasive evaluation of filling pressures to guide initiation of foundational therapy for HFpEF.