Heart failure with normal ejection fraction: consideration of mechanisms other than diastolic dysfunction.
More than half of patients with heart failure (HF) have a normal ejection fraction (EF). These patients are typically elderly, are predominantly female, and have a high incidence of multiple comorbid conditions associated with development of ventricular hypertrophy and/or interstitial fibrosis. Thus, the cause of HF has been attributed to diastolic dysfunction. However, the same comorbidities may also impact myocardial systolic, ventricular, vascular, renal, and extracardiovascular properties in ways that can also contribute to symptoms of HF by way of mechanisms not related to diastolic dysfunction. Accordingly, the descriptive term HF with normal EF has been suggested as an alternative to the mechanistic term diastolic HF. In this article, we review the current understanding of nondiastolic mechanisms that may contribute to the HF with normal EF syndrome to highlight potential pathways for research that may lead to new targets for therapy.
Bench
Travis
T
Division of Cardiology, Columbia University, 177 Fort Washington Avenue, New York, NY 10032, USA. db59@columbia.edu.
Burkhoff
Daniel
D
O'Connell
John B
JB
Costanzo
Maria Rosa
MR
Abraham
William T
WT
St John Sutton
Martin
M
Maurer
Mathew S
MS
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000503:physiopathology*; D002986:Clinical Trials as Topic; D018450:Disease Progression; D005260:Female; D054144:Heart Failure, Diastolic / Q000401:mortality / Q000503:physiopathology*; D054143:Heart Failure, Systolic / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology