Invasive exercise hemodynamics

Resting PCWP &lt;15 mmHg

Peak exercise PCWP &lt;25 mmHg and PCWP/CO &lt;2

Peak exercise PCWP ≥25 mmHg or PCWP/CO &gt;2

HFpEF ruled out

Type 1 HFpEF: Exercise-induced LA hypertension (EILAH)

Resting PCWP ≥15 mmHg

Any of these criteria* • Rest or exercise RAP/PCWP &gt;0.8 • Rest PVR &gt;3 WU • Rest DPG &gt;7 mmHg • Ex. PVR &gt;1.8 WU • TAPSE &lt;14 mm • RV FAC &lt;30% • RV FWS &lt;20% • &gt;2+ TR • Hepatic congestion

Type 2 HFpEF: Resting LA hypertension ± volume overload (RELAH)

Type 3 HFpEF: Pulmonary vascular disease Right heart failure (e.g., latent PVD, CpcPH)

HFPEF PHENOTYPES