Update on diastolic heart failure or heart failure with preserved ejection fraction in the older adults

Abstract

Nearly half of all heart failure (HF) patients have diastolic HF (DHF) or clinical HF with normal or near-normal left ventricular ejection fraction (LVEF). Although the terminology has not been clearly defined, it is increasingly being referred to as HF with preserved ejection fraction (HFPEF). The prevalence of HFPEF increases with age, especially among older women. Identifying HFPEF is important because the etiology, pathogenesis, prognosis, and optimal management may differ from that for systolic HF (SHF) or HF with reduced ejection fraction. The clinical presentation of HF is similar for both SHF and HFPEF. As in SHF, HFPEF is a clinical diagnosis. Once a clinical diagnosis of HF has been made, the presence of HFPEF can be established by confirming a normal or near-normal LVEF, often by an echocardiogram. HFPEF is often associated with a history of hypertension, concentric left ventricular hypertrophy, vascular stiffness, and left ventricular diastolic dysfunction. As in SHF, HFPEF is also associated with poor outcomes. While therapies with angiotensin-converting enzyme inhibitors and beta-blockers improve outcomes in SHF, there is currently no such evidence of their benefits in older HFPEF patients. In this review recent advances in the diagnosis and management of HFPEF in older adults are discussed.

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

“…Despite having better apparent LV systolic function than men, older women are more likely to develop diastolic dysfunction and HFpEF 16, 17, 38, 60, 61. In our study, both men and women had an association between CFPWV (a global measure of aortic stiffness) and GLS.…”

“…Whereas HFpEF is almost as common as heart failure with reduced ejection fraction, HFpEF has proven relatively refractory to treatment in a number of randomized clinical trials,13, 14, 15 underscoring the importance of efforts to better understand its pathophysiology. Interestingly, HFpEF has been related to both reduced GLS and increased aortic stiffness in a number of prior studies 3, 7, 16, 17, 18, 19, 20. Furthermore, both HFpEF and aortic stiffness are prevalent in older individuals, particularly women,16, 17 suggesting possible pathophysiologic links between aortic stiffness and subclinical alterations in LV systolic function that may promote the development of HFpEF in susceptible individuals.…”

Highlights of the mechanistic and therapeutic cachexia and sarcopenia research 2010 to 2012 and their relevance for cardiology

“…This may be similar to the situation regarding the definition of diastolic heart failure or HF with preserved ejection fraction [103,104]. Guidelines and consensus papers will not be as powerful as the first successful therapies and the inclusion and exclusion criteria they used.…”

Impact of COPD on the Mortality and Treatment of Patients Hospitalized With Acute Decompensated Heart Failure

“…In addition, these patients were more likely to have a preserved EF, and there have been fewer advances in the treatment of patients with preserved EF during this time period than for those with reduced EF fi ndings. 30,31 Figure 3 -Survival following hospital discharge for acute decompensated heart failure according to history of COPD.…”