Heart Failure with Preserved Ejection Fraction (HFpEF)

Abstract

It has been estimated that Heart Failure with Preserved Ejection Fraction (HFpEF) may account for over 60% of patients hospitalized for HF. Key haemodynamic alterations in HFpEF include subtle systolic dysfunction (depicted by despite reduced average LV global longitudinal strain despite a preserved LVEF), pulmonary hypertension, right ventricular dysfunction, chronotropic incompetence. Diagnosis of HFpEF is established by typical signs and symptoms of HF, LVEF>50%, elevated natriuretic peptides and characteristic echocardiographic features of cardiac structural and functional alteration (eg increased LV mass index, LA volume index, E/E' ratio). Treatment mainly comprises of relief of congestion with diuretics, control of blood pressure and tachycardia. Exercise training has a significant role to play in symptomatic improvement. Disease modifying therapies like RAAS blockers, Mineralocorticoid Receptor Antagonists etc. have proved to be futile in HFpEF. Several emerging therapeutic modalities including device therapy are now being studied.