Heart failure with preserved ejection fraction: neither deformation nor timing are preserved

Abstract

This editorial refers to ‘Myocardial systolic and diastolic consequences of left ventricular mechanical dyssynchrony in heart failure with normal left ventricular ejection fraction’ by Morris et al ., on pages 556–567. Despite its frequency, heart failure with preserved ejection fraction (HFpEF) remains a riddle.1 This condition is highly heterogeneous and probably not uncommonly misdiagnosed, especially if the diagnosis is one of exclusion.2 For these and many more reasons, the pharmacological treatment of HFpEF remains difficult, with multiple negative survival studies, even though some medications have been linked to functional benefit.3 In this context, the paper of Morris et al .4 on the association of left ventricular mechanical dyssynchrony with HFpEF is interesting, and may prove to be very important. In this work, the authors studied 325 patients, 85 with HFpEF and 240 with asymptomatic diastolic dysfunction in the absence of heart failure symptoms. The diagnostic criteria were proposed by the European Society of Cardiology,5 and patients with confounding diseases were excluded. In comparison to those with asymptomatic diastolic dysfunction, patients with HFpEF were more likely to be hypertensive, have type 2 diabetes mellitus, and have a history of coronary artery disease. They had LV hypertrophy, lower tissue velocity …