HEART FAILURE WITH PRESERVED EJECTION FRACTION: THERAPEUTIC ENIGMA
Abstract:
Heart failure with preserved ejection fraction (HFPEF) is increasing in prevalence with the
aging of the population, and morbidity and mortality rates are comparable to that of heart failure with
reduced ejection fraction (HFREF). Recent literature focusing on the pathophysiology underlying this
disease suggests that multiple mechanisms are involved in the generation of the phenotype, such as
abnormal relaxation and ventricular-vascular coupling, chronotropic incompetence, volume overload
and endothelial dysfunction. Currently, no clinically proven treatments are shown to decrease morbidity
and mortality in this population; however, there may be a novel multidisciplinary and multistage
treatment strategy that can be studied to address this complex disease which incorporates
pharmacologic and non-pharmacologic therapeutics. The treatment of patients with heart failure and
preserved left ventricular (LV) function is not well established and remains mostly empirical. The lack of
large placebo-controlled trials in this field seems to be due to the fact that investigators mainly focus on
systolic dysfunction, which was for a long while perceived as the only causative mechanism of heart
failure, and also because of the ambiguity of the definition of diastolic heart failure (DHF).
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