Leveraging Exercise Stress Echocardiography for Heart Failure With Preserved Ejection Fraction

Inclusion Criteria: * Clinically indicated exercise stress echo for the evaluation of exertional dyspnea or chest pain * Age ≥50 years Exclusion Criteria: * Known history of HFpEF * LVEF \<50% on baseline echo study * History of hypertrophic cardiomyopathy, amyloidosis, or pulmonary arterial hypertension, severe right ventricular dysfunction and severe valvular disease based on chart review or baseline echo study * History of organ transplant (heart, kidney, liver, lungs) * Severe pulmonary disease requiring ambulatory oxygen therapy * End-stage renal disease requiring long-term renal replacement therapy * Decompensated liver disease * Conditions that prevent accurate assessment of E/e' ratio (mitral prosthetic valve, severe mitral annular calcification) * Plan to use echo contrast agent during stress study (i.e. contrast agent needed for baseline study) * Patients from outside Duke health system with no plan for long-term care at Duke