Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment

Abstract

Half of patients with heart failure (HF) have a preserved left ventricular ejection fraction (HFpEF). Morbidity and mortality in HFpEF are similar to values observed in patients with HF and reduced EF, yet no effective treatment has been identified. While early research focused on the importance of diastolic dysfunction in the pathophysiology of HFpEF, recent studies have revealed that multiple non-diastolic abnormalities in cardiovascular function also contribute. Diagnosis of HFpEF is frequently challenging and relies upon careful clinical evaluation, echo-Doppler cardiography, and invasive haemodynamic assessment. In this review, the principal mechanisms, diagnostic approaches, and clinical trials are reviewed, along with a discussion of novel treatment strategies that are currently under investigation or hold promise for the future.

Saxagliptin and Tadalafil Differentially Alter Cyclic Guanosine Monophosphate (cGMP) Signaling and Left Ventricular Function in Aortic‐Banded Mini‐Swine

“…LV ejection fraction and stroke volume were equivalent in all groups, demonstrating preserved systolic function at rest in the presence of clinical markers of HF (ie, lung congestion, a hallmark feature of HFpEF). Similar to previous observations in our swine model and human HFpEF,1, 2, 23 LV contractility (measured as ESPVR and PRSW) was significantly increased in HF animals compared to the CON group. Tadalafil did not prevent aortic banding–induced increases in LV contractility and actually increased PRSW above levels observed in the HF group.…”

Pro‐Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction

“…It has been proposed that a heightened pro‐inflammatory state may play a role in the progression of HF, including acute decompensations 1, 2, 3, 4, 5, 6, 7, 8, 9. Impairment of nitric oxide bioavailability due to oxidative stress, leading to impaired cyclic guanosine monophosphate‐protein kinase G signaling29 is one potential mechanism underlying the link between inflammation and HF progression.…”

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…Over the past 2 decades, the syndrome of heart failure with preserved ejection fraction (HFpEF) received a lot of attention 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19. However, little therapeutic progress was made 20, 21, 22, 23, 24, 25, 26, 27.…”

“…As a whole, HFpEF has been extensively reviewed 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19. The present review focuses on 4 commonly encountered clinical phenotypes of HFpEF and their comorbid conditions (Figure).…”