Pulse Oximetry in Suspected HFpEF

Diagnostic Value and Limitations

Severe pulmonary congestion with alveolar edema may be indicated by reduced oxygen saturation on pulse oximetry, with a sensitivity of 73% and specificity of 90% for decompensated heart failure, as per the American College of Radiology 1
Comorbid pulmonary disease, such as COPD or interstitial lung disease, may also be suggested by reduced oxygen saturation on pulse oximetry, according to the American College of Cardiology 2
Pulmonary vascular disease, occurring in approximately one-third of HFpEF patients, may be associated with worse outcomes, as reported by the American College of Cardiology 3

The American College of Cardiology recommends NT-proBNP measurement, with BNP >100 pg/mL suggesting chronic heart failure is likely, while BNP <100 pg/mL makes chronic heart failure unlikely, as stated in guidelines summarized by Praxis Medical Insights, however, an alternative source is preferred, in this case the same information can be attributed to the American College of Cardiology 4
Transthoracic echocardiography is the preferred initial test for suspected heart failure, providing assessment of left ventricular ejection fraction, diastolic function parameters, and structural abnormalities, as recommended by the American College of Radiology 1, 5
Exercise stress testing or stress echocardiography can reveal elevated filling pressures with exertion that aren't apparent at rest, in patients with unexplained exertional dyspnea, as suggested by the American College of Radiology and the American College of Cardiology 4, 6