Heart Failure With Preserved Ejection Fraction

It is now well established that among patients with the clinical syndrome of heart failure (HF), approximately half have preserved systolic function, known most commonly as heart failure with preserved ejection fraction (HFpEF). Although originally considered to be predominantly a syndrome that pathophysiologically involves abnormalities in diastolic function (relaxation and/or stiffness), ongoing investigation suggests that, although diastolic abnormalities may be present in many patients, other aspects of pathophysiology likely also contribute to symptoms.Many recent articles have continued to explore aspects of this fascinating clinical syndrome. This review will summarize advances in understanding of the HFpEF syndrome, focusing on epidemiology, pathophysiology, and therapeutics.Lewis and colleagues1 examined data on >8000 patients enrolled in the Prevention of Events With Angiotensin Converting Enzyme Inhibition (PEACE) trial, a randomized trial of the angiotensin-converting enzyme inhibitor trandolapril for prevention of adverse events in patients with stable coronary artery disease and normal systolic function, to assess predictors of incident HF over a median of 4.8 years of follow-up after randomization. Several factors were associated with an increased risk of incident HF hospitalization or HF death, including older age, hypertension, and diabetes mellitus, whereas randomization to trandolapril reduced risk. A risk score was developed that showed good discrimination for incident HF with a C statistic of 0.80. Although this study did not report a reevaluation of left ventricular (LV) function at the time of the incident HF event, the data suggest that among patients with stable coronary artery disease and preserved ejection fraction (EF), clinical factors can risk-stratify patients in regard to the possibility of future HF for potential preventive strategies.Of great interest are possible differences in risk factors and underlying disease states in patients with HFpEF compared with those with HF and reduced EF. The Framingham Study investigators examined clinical characteristics and risk …