Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

JACC Basic Transl Sci. 2021 Aug 4;6(9-10):772-795. doi: 10.1016/j.jacbts.2021.06.002. eCollection 2021 Sep-Oct.


Characterized by a rapidly increasing prevalence, elevated mortality and rehospitalization rates, and inadequacy of pharmaceutical therapies, heart failure with preserved ejection fraction (HFpEF) has motivated the widespread development of device-based solutions. HFpEF is a multifactorial disease of various etiologies and phenotypes, distinguished by diminished ventricular compliance, diastolic dysfunction, and symptoms of heart failure despite a normal ejection performance; these symptoms include pulmonary hypertension, limited cardiac reserve, autonomic imbalance, and exercise intolerance. Several types of atrial shunts, left ventricular expanders, stimulation-based therapies, and mechanical circulatory support devices are currently under development aiming to target one or more of these symptoms by addressing the associated mechanical or hemodynamic hallmarks. Although the majority of these solutions have shown promising results in clinical or preclinical studies, no device-based therapy has yet been approved for the treatment of patients with HFpEF. The purpose of this review is to discuss the rationale behind each of these devices and the findings from the initial testing phases, as well as the limitations and challenges associated with their clinical translation.

Keywords: BAT, baroreceptor activation therapy; CCM, cardiac contractility modulation; CRT, cardiac resynchronization therapy; HF, heart failure; HFmEF, heart failure with mid-range ejection fraction; HFpEF; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; IASD, Interatrial Shunt Device; LAAD, left atrial assist device; LAP, left atrial pressure; LV, left ventricular; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; NYHA, New York Heart Association; PCWP, pulmonary capillary wedge pressure; QoL, quality of life; TAA, transapical approach; atrial shunt devices; electrostimulation; heart failure devices; heart failure with preserved ejection fraction; left ventricular expanders; mechanical circulatory support; neuromodulation.

Publication types

  • Review