When to usePatient with exertional dyspnea of unclear originPreserved LVEF (≥50%)Suspected HFpEF after initial clinical evaluationBorderline echocardiographic findingsPrior to invasive hemodynamic assessmentAmbulatory HFpEF diagnostic workupParticularly useful when differentiating:HFpEF vs. pulmonary diseaseHFpEF vs. obesity/deconditioningHFpEF vs. non-cardiac dyspneaPearls/PitfallsPitfallsAtrial fibrillation strongly increases probabilityDoes not include natriuretic peptidesNot validated in: Significant valvular diseaseInfiltrative cardiomyopathyAdvanced pulmonary hypertensionObesity-related dyspnea may inflate estimated probabilityShould not replace comprehensive clinical evaluationClinical PearlsHigh calculated probability correlates with elevated filling pressuresIn obese elderly patients with AF, probability often exceeds 80%Low probability should prompt evaluation for pulmonary or deconditioning as a cause of dyspneaBest used within a structured HFpEF diagnostic pathwayConsider invasive exercise hemodynamics if probability is intermediate and clinical suspicion remains highWhy UseProvides estimated probability (%), not just risk categoriesSupports individualized diagnostic decision-makingUses widely available variables: BMIAntihypertensive treatment (≥2 drugs)Atrial fibrillationAge >60Pulmonary artery systolic pressureE/e’Helps determine: Low probability → alternative diagnosis likelyIntermediate probability → consider further testingHigh probability → HFpEF very likely-points