Heterogenous Nature of Acute Heart Failure Syndrome and the Necessity of a Standardized Grading System for Its Clinical Presentation

Abstract

ACE inhibitors/ARBs, beta blockers, mineral corticoid receptor antagonists and digoxin have shown effectiveness in HFrEF, but not in HFpEF. Both of HFrEF and HFpEF are considered a “syndrome”, due to its heterogenous nature; (1) pathophysiology (arterial underfilling, volume accumulation, central volume shift and abnormal blood pressure control by carotid baroreceptor etc.), (2) comorbid disease (hypertension, CKD, DM, lipid disorder, etc.), (3) left ventricular geometry (normal, dilated, concentric hypertrophy, concentric remodeling, eccentric hypertrophy) and (4) clinical presentation (rapid or gradual onset, pulmonary or systemic congestion, body weight gain + or -, etc.).