Heart Failure with Preserved Ejection Fraction (HFpEF)

Introduction

Heart failure with preserved ejection fraction (HFpEF) is a common type of heart failure, where the heart's pumping function remains normal, but the heart muscle is stiff and doesn't fill properly with blood. This leads to symptoms of heart failure, such as shortness of breath and fatigue, despite a normal ejection fraction (EF ≥ 50%).

Causes and Risk Factors

HFpEF is more common in older adults and is often associated with other conditions, including: - Hypertension (high blood pressure) – Leading cause of HFpEF due to long-term pressure overload. - Obesity and metabolic syndrome – Excess weight can impair heart function. - Diabetes – Alters heart muscle structure and function. - Chronic kidney disease – Increases fluid overload and systemic inflammation. - Coronary artery disease – Even without heart attacks, it can contribute to HFpEF.

Symptoms

Patients with HFpEF may experience: - Shortness of breath (dyspnea), especially with exertion or when lying down. - Fatigue and reduced exercise capacity. - Swelling in the legs and ankles (edema). - A feeling of heaviness or tightness in the chest.

Diagnosis

The diagnosis of HFpEF requires a combination of: 1. Clinical assessment – Evaluation of symptoms and medical history. 2. Echocardiography – Confirms a preserved ejection fraction and assesses diastolic function. 3. Biomarkers (BNP or NT-proBNP) – Help detect heart stress. 4. Additional testing – ECG, cardiac MRI, or stress tests may be needed in selected cases.

Treatment Approaches

Unlike heart failure with reduced ejection fraction (HFrEF), HFpEF has fewer proven treatment options. Current strategies include: - Blood pressure control – ACE inhibitors, ARBs, or mineralocorticoid receptor antagonists. - Diuretics – Help manage fluid retention and reduce congestion. - SGLT2 inhibitors – Newer medications shown to improve outcomes in HFpEF patients. - Managing underlying conditions – Optimizing treatment of hypertension, diabetes, and obesity. - Lifestyle interventions – Regular exercise, dietary changes, and weight management are crucial.

Conclusion

HFpEF is a challenging condition to diagnose and treat, but careful management of risk factors and heart function can improve quality of life. Ongoing research continues to explore better treatment options for this common form of heart failure.

Source recommendations

1. European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://pubmed.ncbi.nlm.nih.gov/34447992/
3. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
4. https://pubmed.ncbi.nlm.nih.gov/22611136/
5. https://academic.oup.com/eurheartj/article/44/37/3627/7246292

2. American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Heart Failure

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/03/29/19/53/2022-AHA-ACC-HFSA-Heart-Failure-Guideline-gl-hf
3. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx
4. https://pubmed.ncbi.nlm.nih.gov/35363499/
5. https://www.sciencedirect.com/science/article/pii/S0735109721083959