Heart Failure with Preserved Ejection Fraction (HFpEF)

Introduction

Heart failure (HF) is a condition where the heart is unable to pump blood effectively, leading to symptoms such as shortness of breath and fatigue. One specific type of heart failure is Heart Failure with Preserved Ejection Fraction (HFpEF).

What is Preserved Ejection Fraction?

The ejection fraction (EF) refers to the percentage of blood the left ventricle pumps out with each heartbeat. In HFpEF, the heart's EF remains normal (above 50%), but the heart muscle is stiff and does not fill properly. This leads to congestion and symptoms like fluid retention.

Causes & Risk Factors

HFpEF is often caused by comorbidities, including: - Hypertension (high blood pressure) – leads to increased heart stiffness. - Diabetes – causes damage to blood vessels and heart tissue. - Obesity – increases cardiac workload. - Chronic kidney disease – affects fluid balance and blood pressure regulation. - Coronary artery disease – reduces oxygen supply to the heart. - Aging – results in natural stiffening of the heart muscle.

Symptoms

• Shortness of breath (especially on exertion or lying down)
• Fatigue and weakness
• Swelling in the legs and abdomen
• Rapid weight gain due to fluid retention
• Irregular heartbeat (atrial fibrillation is common)

Diagnosis

Doctors use various tests, including: - Echocardiography – confirms a preserved ejection fraction (>50%). - Blood tests (NT-proBNP, BNP) – markers of heart stress. - ECG (Electrocardiogram) – detects arrhythmias or underlying conditions. - Cardiac MRI – provides detailed imaging if needed.

Treatment Approaches

There is no single medication that directly treats HFpEF, but treatments aim to manage symptoms and underlying conditions:

1. Lifestyle Modifications

• Salt and fluid restriction to prevent fluid overload.
• Weight management, especially in obesity-related HFpEF.

• Regular low-intensity exercise to improve cardiovascular function.

  2. Medication Therapy

• Diuretics – to relieve fluid buildup.

• SGLT2 inhibitors (Empagliflozin, Dapagliflozin) – proven to benefit HFpEF.
• Aldosterone antagonists (Spironolactone) – may improve symptoms.
• Blood pressure control (ACE inhibitors, ARBs, or ARNIs).

• Beta-blockers – manage heart rate and blood pressure.

  3. Treatment of Comorbidities

• Diabetes: Strict glycemic control.

• Hypertension: Blood pressure management is essential.
• Atrial fibrillation: Rhythm control strategies.

Prognosis

While HFpEF has a high morbidity rate, proper lifestyle changes, comorbidity management, and medication adherence can improve quality of life and reduce hospitalizations.

Conclusion

HFpEF is a complex condition requiring a multidisciplinary approach for optimal management. If you have risk factors, timely screening and lifestyle modifications can help prevent progression.

Source recommendations

1. American Heart Association Guidelines on Heart Failure Management

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://professional.heart.org/en/guidelines-and-statements
3. https://www.heart.org/en/health-topics/heart-failure
4. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx
5. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure

2. European Society of Cardiology (ESC) Guidelines on Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
4. https://academic.oup.com/eurheartj/article/44/37/3627/7246292
5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines