Heart failure with preserved ejection fraction: refocusing on diastole

Antonio Abbate; Ross Arena; Nayef Abouzaki; Benjamin W Van Tassell; Justin Canada; Keyur Shah; Giuseppe Biondi-Zoccai; Norbert F Voelkel

doi:10.1016/j.ijcard.2014.11.106

Heart failure with preserved ejection fraction: refocusing on diastole

Int J Cardiol. 2015 Jan 20:179:430-40. doi: 10.1016/j.ijcard.2014.11.106. Epub 2014 Nov 14.

Authors

Antonio Abbate¹, Ross Arena², Nayef Abouzaki³, Benjamin W Van Tassell⁴, Justin Canada⁵, Keyur Shah³, Giuseppe Biondi-Zoccai⁶, Norbert F Voelkel⁷

Affiliations

¹ VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: aabbate@vcu.edu.
² University of Illinois Chicago, Department of Physical Therapy, Chicago, IL, USA.
³ VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
⁴ VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA; Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA, USA.
⁵ Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA.
⁶ Sapienza University of Rome, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy.
⁷ Victoria Johnson Research Laboratories, Virginia Commonwealth University, Richmond, VA, USA.

PMID: 25465302
DOI: 10.1016/j.ijcard.2014.11.106

Abstract

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of exercise intolerance and/or congestion, in the presence of a left ventricular (LV) ejection fraction within the normal limits (i.e. LVEF>50%). Determining the presence of impaired LV relaxation and/or filling (diastolic dysfunction) in HFpEF is needed to pragmatically to distinguish it from other cardiac and non-cardiac conditions where symptoms are not due to HF. There are multiple mechanisms for diastolic dysfunction ranging from structural abnormalities to functional derangements in HFpEF yet tailored therapies are lacking. Treatments proven effective in HF with systolic dysfunction have failed to show significant benefit in patients with HFpEF, which prognosis remains poor. This review will discuss the challenges inherent to the use of diagnostic criteria for HFpEF, differential diagnosis, prognostic evaluation, and treatment, highlighting the need for more research in this field.

Keywords: Cardiopulmonary; Diastole; Exercise; Heart failure; Physiology.

Publication types

Research Support, N.I.H., Extramural
Review

MeSH terms

Diagnosis, Differential
Diastole / physiology*
Heart Failure / diagnosis*
Heart Failure / physiopathology*
Humans
Risk Factors
Stroke Volume / physiology*
Ventricular Dysfunction, Left / physiopathology

Grants and funding

1R34HL118348/HL/NHLBI NIH HHS/United States