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Review
. 2015 Sep 15;3(3):521-7.
doi: 10.3889/oamjms.2015.087. Epub 2015 Jul 28.

Heart Failure with Preserved Ejection Fraction - Concept, Pathophysiology, Diagnosis and Challenges for Treatment

Lidija Veterovska Miljkovik  1 , Vera Spiroska  2
Affiliations
Review

Heart Failure with Preserved Ejection Fraction - Concept, Pathophysiology, Diagnosis and Challenges for Treatment

Lidija Veterovska Miljkovik et al. Open Access Maced J Med Sci. .

Abstract

Heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF) occurs in 40 to 60% of the patients with HF, with a prognosis which is similar to HF with reduced ejection fraction (HFrEF). HFpEF pathophysiology is different from that of HFrEF, and has been characterized with diastolic dysfunction. Diastolic dysfunction has been defined with elevated left ventricular stiffness, prolonged iso-volumetric LV relaxation, slow LV filing and elevated LV end-diastolic pressure. Arterial hypertension occurs in majority cases with HFpEF worldwide. Patients are mostly older and obese. Diabetes mellitus and atrial fibrillation appear proportionally in a high frequency of patients with HFpEF. The HFpEF diagnosis is based on existence of symptoms and signs of heart failure, normal or approximately normal ejection and diagnosing of LV diastolic dysfunction by means of heart catheterization or Doppler echocardiography and/or elevated concentration of plasma natriuretic peptide. The present recommendations for HFpEF treatment include blood pressure control, heart chamber frequency control when atrial fibrillation exists, in some situations even coronary revascularization and an attempt for sinus rhythm reestablishment. Up to now, it is considered that no medication or a group of medications improve the survival of HFpEF patients. Due to these causes and the bad prognosis of the disorder, rigorous control is recommended of the previously mentioned precipitating factors for this disorder. This paper presents a universal review of the most important parameters which determine this disorder.

Keywords: diastole; echocardiography; hearth failure; old people; preserved ejection fraction.

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Figures

Figure 1
Figure 1
Results from the investigation of the cardiac mortality depending the grade of diastolic dysfunction. NYHA-functional class for heart failure; MAP medium atrial pressure; DD diastolic dysfunction [2, 7].
Figure 2
Figure 2
End-systolic relation pressure-volume is equal in normal heart and diastolic heart failure, but the end-diastolic relation pressure-volume is different [11].
Figure 3
Figure 3
Grades of diastolic dysfunction by means of pulsed wave mitral Doppler and tissue Doppler mitral annular measurement [17].
Figure 4
Figure 4
Dopler of pulmonary vein [17].
Figure 5
Figure 5
Systolic and diastolic heart failure-two phenotypes with different pathophysiology that are together linked [11].
See this image and copyright information in PMC

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