Heart Failure With Preserved Ejection Fraction: Pathophysiology, Diagnosis, and Treatment

Eur Heart J. 2011 Mar;32(6):670-9. doi: 10.1093/eurheartj/ehq426. Epub 2010 Dec 7.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms
  • Arrhythmias, Cardiac / etiology
  • Biomarkers / metabolism
  • CCN Intercellular Signaling Proteins / metabolism
  • Cardiotonic Agents / therapeutic use
  • Clinical Trials as Topic
  • Collagen / physiology
  • Connectin
  • Elasticity
  • Exercise / physiology
  • Exercise Test
  • Extracellular Matrix / physiology
  • Heart Failure* / diagnosis
  • Heart Failure* / etiology
  • Heart Failure* / therapy
  • Humans
  • Hypertension / etiology
  • Matrix Metalloproteinases / metabolism
  • Muscle Proteins / metabolism
  • Myocytes, Cardiac / pathology
  • Physical Exertion / physiology
  • Protein Kinases / metabolism
  • Stroke Volume* / physiology
  • Tissue Inhibitor of Metalloproteinases / metabolism
  • Vascular Diseases / etiology
  • Vascular Stiffness / physiology
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / therapy
  • Ventricular Remodeling / physiology

Substances

  • Biomarkers
  • CCN Intercellular Signaling Proteins
  • Cardiotonic Agents
  • Connectin
  • Muscle Proteins
  • TTN protein, human
  • Tissue Inhibitor of Metalloproteinases
  • Collagen
  • Protein Kinases
  • Matrix Metalloproteinases