Mechanisms, diagnosis, and treatment of heart failure with preserved ejection fraction and diastolic dysfunction

ABSTRACT

Introduction: Heart failure with preserved ejection fraction (HFpEF) continues to be a major challenge for clinicians. Many crucial aspects of the syndrome remain unclear, including the exact pathophysiology, early diagnosis, and treatment. Patients with HFpEF are often asymptomatic late into the disease process, and treatment with medications commonly used in heart failure with reduced ejection fraction (HFrEF) has not been proven to be beneficial. In addition, the confusion of similar terms with HFpEF, such as diastolic heart failure, and diastolic dysfunction (DD), has led to a misunderstanding of the true scope of HFpEF.

Areas covered: In this review, authors highlight the differences in terminology and critically review the current knowledge on the underlying mechanisms, diagnosis, and latest treatment strategies of HFpEF.

Expert commentary: While significant advances have been made in the understanding of HFpEF, the definitive diagnosis of HFpEF continues to be difficult. The development of improved and standardized methods for detecting DD has shown promise in identifying early HFpEF. However, even with early detection, there are few treatment options shown to provide mortality benefit warranting further investigation.

KEYWORDS:

• HFpEF
• HFrEF
• Diastolic dysfunction
• Inflammation
• Biomarkers

Declaration of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by NIH grants R01HL112597, R01HL116042, and R01HL120659 to DK Agrawal from the NHLBI. The content of this review is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.