Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment.
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.
The Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN 55906, USA. borlaug.barry@mayo.edu
Barry A
BA
Borlaug
Walter J
WJ
Paulus
D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000209:etiology; D015415:Biomarkers / Q000378:metabolism; D055511:CCN Intercellular Signaling Proteins / Q000378:metabolism; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003094:Collagen / Q000502:physiology; D064211:Connectin; D004548:Elasticity; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005109:Extracellular Matrix / Q000502:physiology; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000209:etiology; D020782:Matrix Metalloproteinases / Q000378:metabolism; D009124:Muscle Proteins / Q000378:metabolism; D032383:Myocytes, Cardiac / Q000473:pathology; D005082:Physical Exertion / Q000502:physiology; D011494:Protein Kinases / Q000378:metabolism; D013318:Stroke Volume / Q000502:physiology; D019714:Tissue Inhibitor of Metalloproteinases / Q000378:metabolism; D014652:Vascular Diseases / Q000209:etiology; D059289:Vascular Stiffness / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D020257:Ventricular Remodeling / Q000502:physiology
D015415:Biomarkers; D055511:CCN Intercellular Signaling Proteins; D002316:Cardiotonic Agents; D064211:Connectin; D009124:Muscle Proteins; C577285:TTN protein, human; D019714:Tissue Inhibitor of Metalloproteinases; D003094:Collagen; D011494:Protein Kinases; D020782:Matrix Metalloproteinases