Heart Failure With Preserved Ejection Fraction

Heart Failure With Preserved Ejection Fraction is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Definition

  • HFpEF, also called diastolic HF, refers to the clinical syndrome of HF in the presence of preserved systolic function (LVEF >50%).
  • Diastolic dysfunction refers to an abnormality in the mechanical function of the heart during the relaxation phase of the cardiac cycle, resulting in elevated filling pressures and impairment of ventricular filling.

Epidemiology

  • Almost half of patients admitted to the hospital with HF have a normal or near-normal EF.1
  • HFpEF is most prevalent in older women, most of whom have hypertension and/or diabetes mellitus. Many of these patients also have CAD and/or AF.

Etiology

  • The vast majority of patients with HFpEF have hypertension and LV hypertrophy.
  • Myocardial disorders associated with HFpEF include RCM, obstructive and nonobstructive HCM, infiltrative cardiomyopathies, and constrictive pericarditis.

Pathophysiology

  • Reduced ventricular compliance and elastance play a major role in the pathophysiology of HFpEF.
  • Factors contributing to the clinical HFpEF syndrome include abnormal sodium handling by the kidneys, atrial dysfunction, autonomic dysfunction, increased arterial stiffness, pulmonary hypertension, sarcopenia, obesity, deconditioning, and other comorbidities.

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General Principles

Definition

  • HFpEF, also called diastolic HF, refers to the clinical syndrome of HF in the presence of preserved systolic function (LVEF >50%).
  • Diastolic dysfunction refers to an abnormality in the mechanical function of the heart during the relaxation phase of the cardiac cycle, resulting in elevated filling pressures and impairment of ventricular filling.

Epidemiology

  • Almost half of patients admitted to the hospital with HF have a normal or near-normal EF.1
  • HFpEF is most prevalent in older women, most of whom have hypertension and/or diabetes mellitus. Many of these patients also have CAD and/or AF.

Etiology

  • The vast majority of patients with HFpEF have hypertension and LV hypertrophy.
  • Myocardial disorders associated with HFpEF include RCM, obstructive and nonobstructive HCM, infiltrative cardiomyopathies, and constrictive pericarditis.

Pathophysiology

  • Reduced ventricular compliance and elastance play a major role in the pathophysiology of HFpEF.
  • Factors contributing to the clinical HFpEF syndrome include abnormal sodium handling by the kidneys, atrial dysfunction, autonomic dysfunction, increased arterial stiffness, pulmonary hypertension, sarcopenia, obesity, deconditioning, and other comorbidities.

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