title: [Heart failure with preserved ejection fraction: Diastolic heart failure].
abstract: Heart failure with preserved ejection fraction (HF-PEF) is part of the 'heart-failure spectrum', but differs pathophysiologically from heart failure with reduced ejection fraction (HF-REF). Metabolic abnormalities in HF-PEF cause intrinsic stiffness of the cardiac myocyte and alternation of the collagen turn-over in the extracellular matrix of the heart. HF-PEF is most often present in elderly women with a history of hypertension, diabetes mellitus or metabolic syndrome, and obesity. Signs of fluid retention are often not present on physical examination in patients with HF-PEF. The most notable echocardiographic abnormalities seen in HF-PEF are an enlarged left atrium with hypertrophy, reduced left ventricular relaxation and elevated filling pressures. Co-morbidly and advanced age are largely determinant for mortality, which in HF-PEF is somewhat lower than in HF-REF. Evidence-based drug therapy for HF-PEF is currently lacking; ongoing studies are evaluating medications other than the well-established drugs used to treat HF-REF.
authors.affiliation: Divisie Julius Centrum voor Gezondheidswetenschappen en Eerstelijnsgeneeskunde, afd. Huisartsgeneeskunde, Universitair Medisch Centrum Utrecht, the Netherlands. F.H.Rutten@umcutrecht.nl
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.forename: Maarten-Jan  M
authors.initials: MJ
authors.lastname: Cramer
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Paulus
mesh_terms: D000375:Aging / Q000502:physiology; D005260:Female; D054144:Heart Failure, Diastolic / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology*