Heart Failure with Preserved Ejection Fraction – Concept, Pathophysiology, Diagnosis and Challenges for Treatment

Abstract

Heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF) occurs in 40 to 60% of the patients with HF, with a prognosis which is similar to HF with reduced ejection fraction (HFrEF). HFpEF pathophysiology is different from that of HFrEF, and has been characterized with diastolic dysfunction. Diastolic dysfunction has been defined with elevated left ventricular stiffness, prolonged iso-volumetric LV relaxation, slow LV filing and elevated LV end-diastolic pressure. Arterial hypertension occurs in majority cases with HFpEF worldwide. Patients are mostly older and obese. Diabetes mellitus and atrial fibrillation appear proportionally in a high frequency of patients with HFpEF. The HFpEF diagnosis is based on existence of symptoms and signs of heart failure, normal or approximately normal ejection and diagnosing of LV diastolic dysfunction by means of heart catheterization or Doppler echocardiography and/or elevated concentration of plasma natriuretic peptide. The present recommendations for HFpEF treatment include blood pressure control, heart chamber frequency control when atrial fibrillation exists, in some situations even coronary revascularization and an attempt for sinus rhythm reestablishment. Up to now, it is considered that no medication or a group of medications improve the survival of HFpEF patients. Due to these causes and the bad prognosis of the disorder, rigorous control is recommended of the previously mentioned precipitating factors for this disorder. This paper presents a universal review of the most important parameters which determine this disorder.

Clinical Significance of Get With the Guidelines–Heart Failure Risk Score in Patients With Chronic Heart Failure After Hospitalization

“…There are some differences in terms of pathophysiology and clinical characteristics between HFpEF and HFrEF 27. Various parameters have been previously established for risk stratification4, 5, 6, 7, 8, 28; however, each of these parameters alone is insufficient for prognostic prediction because each parameter represents only a certain aspect of the complicated pathophysiological mechanisms of HFpEF or HFrEF.…”

Effects of spironolactone in heart failure with preserved ejection fraction

“…The pathophysiology of HFpEF is complicated, which is characterized by increased myocardial fibrosis and stiffness and impaired LV relaxation. [22,23] Most patients with HFpEF have a high LV mass ratio and concentric remodeling, [24] accompanied by cardiomyocyte hypertrophy. And HFpEF patients have interstitial fibrosis and extracellular matrix changes, which result in myocardial stiffness and reduced left ventricular filling, [25–27] subsequently diastolic dysfunction occurs.…”

Effect of chronic kidney disease on the formation of diastolic heart dysfunction in heart failure patients with preserved ejection fraction

“…Диастолическая дисфункция сопровождается снижением систолического резерва миокарда, способствующим увеличению давления напол нения и более быстрой декомпенсации ЛЖ и нарушени ем его хронотропии (снижение хронотропного резерва, «хронотропная некомпетентность»). В формировании диастолической дисфункции ЛЖ ведущую роль играет избыточное повышение продольной (систолической) и поперечной жесткости кардиомиоцитов, а также нару шение процесса их активного расслабления, которые свя заны не только с прямым повреждением самих миокарди альных клеток, но и с увеличением толщины стенки ЛЖ, возникающим при его гипертрофии и / или интерстици альном фиброзе миокарда [9,10].…”