Do we need exercise echocardiography to diagnose HFpEF? Not at all

Attaining a robust diagnosis of heart failure with preserved ejection fraction (HFpEF) can often be complex. A hallmark of heart failure is an increase in left ventricular (LV) filling pressure, but this may be absent at rest. Exercise may provoke increases in filling pressure, but does this suffice to make a diagnosis of HFpEF and is exercise echocardiography a reliable tool for measuring pressures in this context? Given the diversity of views and opinions, and the relevance of the topic, we and others1 felt that presenting two contrasting perspectives on the role of exercise echocardiography in guiding management for patients with suspected HFpEF was timely and necessary to stimulate further debate and guide research.