Epidemiology and pathogenesis of heart failure with preserved ejection fraction

Abstract

Heart failure (HF) is a complex syndrome that affects approximately6.5 millionadults in the United States. About half of the 6.5 million adults with HF are estimated to be individuals with heart failure with preserved ejection fraction (HFpEF). It is a common cause for poor quality of life, increased health-care resource utilization, and early mortality. HF incidence has risen to epidemic proportions in the recent years. This review attempts to address the epidemiology and pathophysiology of HFpEF. The incidence of HFpEF increased from 48% to 57% from 2000 to 2007 with a slight decrease in 2010 to 52%. The temporal trends in heart failure show an overall stable incidence of HF over the last two decades with increasing incidence of HFpEF and decreasing HFrEF incidence. Many etiologies contribute to the development of HFpEF which makes the treatment very challenging. Pathophysiology of HFpEF is multifaceted stemming from several disease-specific aspects of inflammation and endothelial function, cardiomyocyte hypertrophy and fibrosis, ventricular-vascular uncoupling, pulmonary hypertension and chronotropic incompetence. Hence identifying the risk factors and etiologies is imperative to achieve optimal outcomes in this population. Newer insights into myocardial remodeling have led to an interesting finding of abnormal fibroblasts in HFpEF which are apoptosis resistant and initiate the development of an abnormal myocardial matrix resulting in initiation and progression of the disease. Upregulation of ROS has also been implicated in HFpEF. Further investigation could provide new avenues to target therapeutics specifically to stop initiation and progression of fibrosis.

The Pathogenesis and Influencing Factors of Adult Hypertension Based on Structural Equation Scanning

“…Hypertension is a disease caused by the combined action of many factors, and its influencing factors can be divided into personal characteristics (gender, age), socioeconomic background (living environment, culture, and income level), behavioral factors (smoking, drinking, insufficient exercise, and high-salt diet), and health factors (hyperglycemia, dyslipidemia, and obesity). These factors are connected to each other and have an effect on human health [ 20 ]. In the relationship between life behavior style and hypertension involved in this study, the direct effect of salt intake on hypertension is statistically significant; however, the direct effects of active exercise, smoking, and drinking on hypertension were not statistically significant.…”

Altered Heart Rate Turbulence and Variability Parameters Predict 1-Year Mortality in Heart Failure with Preserved Ejection Fraction

“…Limited therapeutic options in HFpEF are largely related to the complexity of the pathophysiology of the disease itself [ 34 , 35 , 36 , 37 ]. HFpEF, historically considered as being caused exclusively by left ventricular diastolic dysfunction [ 36 ], is a heterogeneous syndrome, caused by a complex interplay of multiple impairments in ventricular diastolic and systolic reserve, atrial function, systemic and pulmonary vascular function, nitric oxide bioavailability, chronotropic reserve, right heart function, autonomic tone, and peripheral impairments [ 1 , 4 , 34 , 35 , 36 , 37 ].…”

Myocardial Deformation Parameters Assessed By CMR Feature Tracking In Chronic Heart Failure: The Influence of An Optimal Medical Therapy On Myocardial Remodeling

“…However, no remarkable in uence on HFpEF or HFmrEF is reported, although concentric and dilated hypertrophy play a key role in their pathogenesis as well. [16] The same applies to a blockade of the sympathetic adrenergic system using beta blockers. [17,18] Because of this, it was also surprising that there was already veri able reverse remodeling in our small HFpEF cohort.…”