Heart Failure with Preserved Ejection Fraction—a Concise Review

Abstract

Purpose of Review Heart failure with preserved ejection fraction (HFpEF) is a relatively new disease entity used in medical terminology; however, both the number of patients and its clinical significance are growing. HFpEF used to be seen as a mild condition; however, the symptoms and quality of life of the patients are comparable to those with reduced ejection fraction. The disease is much more complex than previously thought. In this article, information surrounding the etiology, diagnosis, prognosis, and possible therapeutic options of HFpEF are reviewed and summarized. Recent Findings It has recently been proposed that heart failure (HF) is rather a heterogeneous syndrome with a spectrum of overlapping and distinct characteristics. HFpEF itself can be distilled into different phenotypes based on the underlying biology. The etiological factors of HFpEF are unclear; however, systemic low-grade inflammation and microvascular damage as a consequence of comorbidities associated with endothelial dysfunction, oxidative stress, myocardial remodeling, and fibrosis are considered to play a crucial role in the pathogenesis of a disease. The H 2 FPEF score and the HFpEF nomogram are recently validated highly sensitive tools employed for risk assessment of subclinical heart failure. Summary Despite numerous studies, there is still no evidence-based pharmacotherapy for HFpEF and the mortality and morbidity associated with HFpEF remain high. A better understanding of the etiological factors, the impact of comorbidities, the phenotypes of the disease, and implementation of machine learning algorithms may play a key role in the development of future therapeutic strategies.

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

“…The latest data show that the prevalence of HFmrEF in hospitalized patients ranged from 13 to 26% (9)(10)(11), while the prevalence in outpatients varied from 9 to 21% (12)(13)(14)(15)(16)(17). Nevertheless, previous studies mostly focused on HFrEF and HFpEF, with less attention paid to HFmrEF until now (18,19). Consequently, less is known regarding the clinical characteristics of patients with HFmrEF, and with limited evidence on which to base recommendation for therapy (20).…”

Echocardiographic evaluation of left ventricular end diastolic pressure in patients with diastolic heart failure

“…The current definition of heart failure classifies diastolic dysfunction as a clinically symptomatic stage, when in fact, the patient may present with asymptomatic structural or functional cardiac abnormalities (systolic or diastolic left ventricular dysfunction) before the onset of clinical symptoms, an early event of heart failure. [ 1 ] It is important to identify these early events because they are associated with poor prognosis, and early intervention can significantly reduce patient fatality. [ 2 ] Elevated left ventricular end-diastolic pressure (LVEDP) is the main index of left ventricular diastolic dysfunction.…”

Epidemiology and pathogenesis of heart failure with preserved ejection fraction

“…Cardiovascular outcomes such as cardiovascular death, heart failure hospitalization and aborted cardiac arrest were worse in phenogroup 3 as compared to 1. All cause mortality was worse in phenogroups 2 and 3 as compared to phenogroup 1 (Adamczak et al, 2020;Cohen et al, 2020;Samson et al, 2016;Shah et al, 2017Shah et al, , 2015 The H2FPEF score appears to have good discriminatory power to distinguish HfpEf from other causes of dyspnea with a c statistic of 0.886 (Paulus, 2018;Reddy et al, 2018). The other score HFA-PEFF put forth uses functional, morphological and biomarker characteristics of HFpEF to aid diagnosis.…”