Heart failure with normal left ventricular ejection fraction

J Am Coll Cardiol. 2009 Mar 17;53(11):905-18. doi: 10.1016/j.jacc.2008.12.007.


It is estimated that approximately 50% of the heart failure population has a normal left ventricular ejection fraction, a complex broadly referred to as heart failure with normal left ventricular ejection fraction (HFNEF). While these patients have been considered in epidemiologic studies and clinical trials to represent a single pool of patients, limited more detailed studies indicate that HFNEF patients are a very heterogeneous group, with a number of key pathophysiologic mechanisms. This review summarizes and critically analyzes available data on the pathophysiology of HFNEF, placing it into context with a recently developed diagnostic algorithm. We evaluate the utility of commonly applied echocardiographic measures and biomarkers and integrate mechanistic observations into potential future therapeutic directions.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms
  • Atrial Fibrillation / physiopathology
  • Biomarkers / blood
  • Cardiac Pacing, Artificial
  • Coronary Artery Disease / physiopathology
  • Diastole / physiology
  • Dyspnea / etiology
  • Dyspnea / physiopathology
  • Echocardiography, Doppler
  • Exercise / physiology
  • Heart Failure / diagnosis
  • Heart Failure / diagnostic imaging
  • Heart Failure / physiopathology*
  • Hemodynamics
  • Humans
  • Natriuretic Peptide, Brain / blood
  • Oxygen Consumption / physiology
  • Peptide Fragments / blood
  • Stroke Volume*
  • Systole / physiology
  • Ventricular Function, Left / physiology*


  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain