Heart Failure with Preserved Ejection Fraction: the Major Unmet Need in Cardiology

Abstract

Heart failure with preserved ejection fraction (HFpEF) has recently been recognized as the single greatest unmet need in cardiovascular medicine. As the population ages and the comorbidity increases, the prevalence of HFpEF increases considerably. Even though there have been large numbers of studies on pathophysiology, diagnosis, and treatment of HFpEF for latest years, there are no current pharmacologic interventions that can reduce mortality. HFpEF is currently understood as a heterogeneous syndrome originated from the interplay of cardiac and extracardiac abnormalities recognized by systemic inflammation, endothelial and coronary microvascular dysfunction, cardiomyocyte dysfunction and skeletal muscle dysfunction. The difficult "jigsaw puzzle" called HFpEF has been filled with some pieces, but it is still not enough to meet clinical needs. Here, we review recent evidences and unsolved problems about HFpEF to improve our understanding of HFpEF. Finally, we hope to accelerate to completion of the problematic "jigsaw puzzle".

Impact of aortic atheroma and distensibility on diastolic function and prognosis in patients with ischemic stroke

“…In female patients, a small-sized LV chamber would be associated with abnormal LV chamber function and those conditions cause elevated LV filling pressure, which makes elevated E/e' [13]. Considering these underlying issues, solving the ventricular-vascular interaction is a significant treatment target of HFpEF [21]. Furthermore, it can be concluded that the reduction of LV afterload could be an important treatment strategy in female patients with ischemic stroke.…”

Sodium-glucose Co-transporter 2 Inhibitors: a New Path for Heart Failure Treatment

“…Since 2010, there has not been a drug that can reduce clinical events in patients with HFpEF. 26) 27) In January 2021, the US Food and Drug Administration (FDA) expanded indication to sacubitril-valsartan (ARNI) that would allow for use of the therapy in at least some patients with HFpEF, based on the results from the PARAGON-HF trial. 28) The new FDA label includes the following note: “Benefits are most clearly evident in patients with LVEF below normal.”, which supported by further analysis of PARAGON-HF.…”

Heart failure population health considerations

“…HFpEF is a heterogeneous condition, although some cardiologists divide it broadly into 3 groups: exercise-induced elevation of left ventricular filling pressures (lowest risk, difficult to diagnose), volume overload (more common, easier to recognize), or right HF (highest risk, poor prognosis). 22,33 Regardless of HFpEF's cause or presentation, clinicians and patients need to treat/monitor blood pressure and volume and address modifiable risk factors aggressively. 4,17 There are many similarities and differences among patients Antagonist (TOPCAT) trial initially showed that spironolactone did not reduce the composite end point of CV death, aborted cardiac arrest, or hospitalization for the management of HF at its conclusion and initial publication.…”

“…Physical activity lowers risk of developing HFpEF, but not HFrEF. Atrial fibrillation is marginally more prevalent in patients with HFpEF (HR, 2.34; 95% CI, 1.48-3.70) than those with HFrEF (HR, 1.32; 95% CI, 0.83-2.10).Patients with HFpEF are more likely to be women, obese, anemic, and have hypertension.1 Clinicians should approach HFpEF differently than they do HFrEF 33. Although β-blockers, ACEIs, and cardiac resynchronization are effective in HFrEF, in HFpEF these interventions do not lead to statistically significant improvements in morbidity and to date no therapies have been shown to improve mortality in HFpEF.…”