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If an underlying cardiomyopathy is suspected or the aetiology is unclear, further imaging with cardiac magnetic resonance (CMR) imaging is recommended. We refer to the 2023 ESC Guidelines for the management of cardiomyopathies regarding specific recommendations and approaches for investigations into specific cardiomyopathies.124 An approach with laboratory and imaging tests chosen according to the five subtypes [hypertrophic cardiomyopathy (HCM), DCM, restrictive cardiomyopathy, ARVC, and non-dilated LV cardiomyopathy] has been recommended.124

In patients with unexplained dyspnoea, CPET may be used to identify the cause of unexplained dyspnoea and/or exercise intolerance. When a specific aetiology is suspected, further investigations may be required, such as 18F-fluorodeoxyglucosepositron emission tomography (18F-FDG-PET) for suspected



 





 



	

 

 

 

	




		  

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Figure 6 Major risk factors of heart failure with preserved ejection fraction. CKD, chronic kidney disease; HFpEF, heart failure with preserved ejection fraction. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026