It Is Time to Look at Heart Failure With Preserved Ejection Fraction From the Right Side

Heart failure with preserved left ventricular (LV) ejection fraction (HFpEF) represents approximately half of patients with heart failure and confers similar morbidity and mortality as HF with reduced left ventricular ejection fraction (HFrEF).1 HFpEF has been characterized by abnormal LV diastolic function, abnormal LV-central vascular coupling, impaired systolic reserve and chronotropic response during exercise, abnormal skeletal muscle function, and dysfunction of the right ventricular-pulmonary vascular (RV-PV) unit. The pathophysiological heterogeneity underlying HFpEF likely explains, in part, why there are no HFpEF-specific therapies to date associated with improved survival in this population. Careful delineation of HFpEF subphenotypes on the basis of predominant pathophysiologic inputs may improve diagnostic classification, guide targeted therapy, and ultimately improve clinical outcome.