Heart failure with preserved ejection fraction: A review

Abstract

Heart failure is the final stage of evolution of a large number of cardiovascular diseases and represents a health problem worldwide, due to increased prevalence of cardiovascular diseases. The patients with heart failure with preserved ejection fraction (HFpEF) represent about a half of the patients with heart failure and the prevalence of HFpEF is on the rise. HFpEF is mainly a disease of the elderly patients, who have numerous cardiovascular diseases – hypertension, myocardial ischaemia, atrial fibrillation, valvular disease, and also non-cardiovascular comorbidities, such as obesity, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and obstructive sleep apnoea. HFpEF is more prevalent in women than in men, but women have a better prognosis than men. The pathophysiological changes that appear in HFpEF are: ventricular stiffening, cardiomyocite hypertrophy and hypercontractility, myocardial fibrosis and inflammation, which lead to abnormal diastolic function with delayed relaxation and inappropriate filling, in the presence of a normal systolic function of the left ventricle. The diagnosis of HFpEF is based on clinical, echocardiographic and biological criteria. In contrast to HFrEF, there is no effective treatment for HFpEF. The treatment of HFpEF includes diuretics for clinical improvement and treatment of comorbidities. The prognosis of patients with HFpEF is similar with those with HFrEF. Currently, the main objectives of the treatment in patients with HFpEF are to improve clinical status and decrease hospitalizations. Further studies are needed to establish an effective treatment to increase survival in these patients. Therefore, HFpEF continues to be a challenge for clinicians regarding the optimal therapy.