title: Heart Failure with Preserved Ejection Fraction: Persistent Diagnosis, Therapeutic Enigma.
abstract: Heart failure with preserved ejection fraction (HFPEF) is increasing in prevalence with the aging of the population, and morbidity and mortality rates are comparable to that of heart failure with reduced ejection fraction (HFREF). The diagnosis can be difficult to make, especially in older adults, stemming from the presence of multiple comorbid illnesses with confounding symptoms. New diagnostic tools have resulted in guidelines proposed to define and diagnose HFPEF. Recent literature focusing on the pathophysiology underlying this disease suggests multiple mechanisms are involved in the generation of the phenotype, such as abnormal relaxation and ventricular-vascular coupling, chronotropic incompetence, volume overload, and redistribution and /or endothelial dysfunction. Currently, no clinically proven treatments are shown to decrease morbidity and mortality in this population; however, there may be a novel multidisciplinary and multistage treatment strategy that can be studied to address this complex disease which incorporates pharmacologic and non-pharmacologic therapeutics.
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Taslima
authors.initials: T
authors.lastname: Bhuiyan
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
references.citation: N Engl J Med. 1994 Sep 29;331(13):821-7
references.pmid: 8078528
references.citation: Semin Respir Crit Care Med. 2010 Oct;31(5):521-7
references.pmid: 20941653
references.citation: J Am Coll Cardiol. 2007 Jan 16;49(2):198-207
references.pmid: 17222731
references.citation: Eur Heart J. 2005 Feb;26(3):215-25
references.pmid: 15642700
references.citation: Circulation. 2003 Jan 7;107(1):139-46
references.pmid: 12515756
references.citation: J Am Coll Cardiol. 2004 Oct 19;44(8):1543-9
references.pmid: 15489083
references.citation: Am J Cardiol. 2009 Mar 15;103(6):845-51
references.pmid: 19268743
references.citation: Biophys J. 1995 Mar;68(3):1027-44
references.pmid: 7756523
references.citation: JAMA. 2010 Nov 3;304(17):1950-1
references.pmid: 21045104
references.citation: J Am Coll Cardiol. 1995 Dec;26(7):1565-74
references.pmid: 7594087
references.citation: Arch Intern Med. 2008 Apr 14;168(7):713-20
references.pmid: 18413553
references.citation: Prog Cardiovasc Dis. 2005 Mar-Apr;47(5):320-32
references.pmid: 16003647
references.citation: Heart Fail Clin. 2009 Apr;5(2):217-28
references.pmid: 19249690
references.citation: Circulation. 2006 Apr 25;113(16):1966-73
references.pmid: 16618817
references.citation: Am J Physiol Heart Circ Physiol. 2005 Mar;288(3):H1203-8
references.pmid: 15498827
references.citation: JAMA. 2008 Jul 23;300(4):431-3
references.pmid: 18647986
references.citation: Circulation. 2003 Jan 21;107(2):346-54
references.pmid: 12538439
references.citation: Circulation. 2005 Feb 15;111(6):774-81
references.pmid: 15699264
references.citation: Geriatr Gerontol Int. 2010 Jul;10 Suppl 1:S127-36
references.pmid: 20590828
references.citation: Circulation. 2009 Jan 20;119(2):269-80
references.pmid: 19118257
references.citation: Circulation. 2006 May 2;113(17):2089-96
references.pmid: 16636176
references.citation: Prog Cardiovasc Dis. 2005 Jan-Feb;47(4):276-84
references.pmid: 15991155
references.citation: Eur J Heart Fail. 2011 Jan;13(1):18-28
references.pmid: 20685685
references.citation: Circ Heart Fail. 2010 Nov;3(6):659-67
references.pmid: 20852060
references.citation: Ann Intern Med. 2002 Oct 15;137(8):631-9
references.pmid: 12379062
references.citation: Eur Heart J. 2006 Oct;27(19):2338-45
references.pmid: 16963472
references.citation: Trends Cardiovasc Med. 2008 Nov;18(8):280-92
references.pmid: 19345315
references.citation: Circulation. 2000 May 2;101(17):2118-21
references.pmid: 10790356
references.citation: Heart. 2004 May;90(5):511-7
references.pmid: 15084546
references.citation: J Card Fail. 2007 Mar;13(2):133-6
references.pmid: 17395054
references.citation: Pharmacol Rep. 2009 Jan-Feb;61(1):139-45
references.pmid: 19307702
references.citation: Circulation. 2010 May 18;121(19):2137-45
references.pmid: 20479164
references.citation: Am Heart J. 2000 Mar;139(3):412-22
references.pmid: 10689255
references.citation: Nurs Times. 1998 Jan 21-27;94(3):47
references.pmid: 9510767
references.citation: Am J Cardiol. 2008 Apr 15;101(8):1151-6
references.pmid: 18394450
references.citation: Eur Heart J. 2009 Feb;30(3):382-3; author reply 383
references.pmid: 19109350
references.citation: Nat Clin Pract Cardiovasc Med. 2008 Nov;5(11):715-24
references.pmid: 18813212
references.citation: J Am Coll Cardiol. 2004 Jun 16;43(12):2207-15
references.pmid: 15193681
references.citation: Arch Intern Med. 2005 Sep 12;165(16):1842-7
references.pmid: 16157827
references.citation: Circulation. 2001 Aug 14;104(7):779-82
references.pmid: 11502702
references.citation: N Engl J Med. 2010 Feb 18;362(7):590-9
references.pmid: 20089957
references.citation: J Card Fail. 2005 Apr;11(3):177-87
references.pmid: 15812744
references.citation: Circulation. 2008 Jan 1;117(1):43-51
references.pmid: 18071071
references.citation: Congest Heart Fail. 2006 May-Jun;12(3):166-8
references.pmid: 16760703
references.citation: Am J Med. 2009 Nov;122(11):1029-36
references.pmid: 19854331
references.citation: J Card Fail. 2010 Jun;16(6):e1-194
references.pmid: 20610207
references.citation: N Engl J Med. 1997 Feb 20;336(8):525-33
references.pmid: 9036306
references.citation: Am J Cardiol. 2001 Feb 15;87(4):413-9
references.pmid: 11179524
references.citation: Curr Vasc Pharmacol. 2007 Jan;5(1):15-25
references.pmid: 17266610
references.citation: Circ Res. 2009 Mar 27;104(6):780-6
references.pmid: 19179657
references.citation: Arch Gerontol Geriatr. 2011 May-Jun;52(3):e93-102
references.pmid: 21176977
references.citation: Curr Heart Fail Rep. 2009 Mar;6(1):57-64
references.pmid: 19265594
references.citation: N Engl J Med. 2008 Dec 4;359(23):2456-67
references.pmid: 19001508
references.citation: Circulation. 1998 Aug 11;98(6):567-79
references.pmid: 9714115
references.citation: Am J Hypertens. 2004 Apr;17(4):370-4
references.pmid: 15062893
references.citation: JAMA. 2002 Nov 6;288(17):2144-50
references.pmid: 12413374
references.citation: Arch Intern Med. 2009 May 11;169(9):851-7
references.pmid: 19433696
references.citation: Lancet. 2003 Sep 6;362(9386):777-81
references.pmid: 13678871
references.citation: Heart. 2007 Feb;93(2):155-8
references.pmid: 16387829
references.citation: J Am Geriatr Soc. 1982 Nov;30(11):700-5
references.pmid: 7130576
references.citation: Curr Cardiol Rep. 2010 May;12(3):216-22
references.pmid: 20424964
references.citation: JAMA. 2010 May 5;303(17):1716-22
references.pmid: 20442387
references.citation: Circ Heart Fail. 2010 Sep;3(5):588-95
references.pmid: 20543134
references.citation: J Am Soc Echocardiogr. 2005 Feb;18(2):99-106
references.pmid: 15682045
references.citation: Circulation. 2009 Jun 23;119(24):3070-7
references.pmid: 19506115
references.citation: Circulation. 2003 Jan 28;107(3):490-7
references.pmid: 12551876
references.citation: Circ Heart Fail. 2008 Jul;1(2):91-7
references.pmid: 19300532
references.citation: Int J Cardiol. 2011 Mar 3;147(2):312-3
references.pmid: 21215475
references.citation: N Engl J Med. 2001 Jan 4;344(1):17-22
references.pmid: 11136955
references.citation: N Engl J Med. 2006 Jul 20;355(3):251-9
references.pmid: 16855265
references.citation: Hypertension. 2010 Jun;55(6):1418-24
references.pmid: 20404218