What the dead can teach the living: systemic nature of heart failure with preserved ejection fraction.

Abstract

Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF. Approximately 90% of new HF cases in older women are HFpEF.1 Adverse outcomes – exercise intolerance, poor quality of life, frequent hospitalizations, and reduced survival – approach those of HF with reduced EF (HFrEF). In contrast to HFrEF, the prevalence of HFpEF is increasing and its prognosis is worsening.2 Despite the strong public health importance of HFpEF, its pathogenesis is poorly understood. Our lack of understanding of HFpEF and its treatment is punctuated by the fact that 6 large, well-designed, randomized, clinical trials and several smaller ones were all neutral on their primary outcomes. The combination of high prevalence and lack of evidence-based treatments makes HFpEF a high-priority topic for research in cardiovascular disease. Article see p 550 A glaring absence among HFpEF studies has been a systematic autopsy-based study. Such studies have become more difficult as autopsy rates have declined with the availability of advanced multimodality imaging and deep-tissue biopsy techniques. Despite the increasing array of modern research techniques, postmortem methods continue to be uniquely valuable because of the ability to perform comprehensive, in-depth, detailed examinations of tissues and organs in humans. In this issue of Circulation , Mohammed and colleagues3 at the Mayo Clinic fill this critical gap with the first autopsy series of HFpEF. From a tissue registry patiently accumulated over a period of 19 years, their multidisciplinary team methodically collected and comprehensively analyzed specimens, medical records, electrocardiograms, and echocardiograms from 255 individuals, including patients with premortem diagnosis of HFpEF (n=124) and HFrEF (n=27), and from age-matched case controls who died of noncardiovascular causes (n=104). Characteristics of the HFpEF patients were relatively similar to community-based reports, including advanced age and a high prevalence of common comorbidities, including hypertension, diabetes …