Epidemiology and clinical course of heart failure with preserved ejection fraction

Abstract

Heart failure with preserved ejection fraction (HFPEF) is increasingly recognized as a major public health problem worldwide. Significant advances have been made in our understanding of the epidemiology of HFPEF over the past two decades, with the publication of numerous population-based epidemiological studies, large heart failure registries, and randomized clinical trials. These recent studies have provided detailed characterization of larger numbers of patients with HFPEF than ever before. This review summarizes the state of current knowledge with regards to the disease burden, patient characteristics, clinical course, and outcomes of HFPEF. Despite the wealth of available data, substantive gaps in knowledge were identified. These gaps represent opportunities for further research in HFPEF, a syndrome that is clearly a rising societal burden and that is associated with substantial morbidity and mortality.

Figure 1

Burden of heart failure. The actual annual incidence of heart failure reported in the USA (squares and dotted line) exceeded the projected annual incidence (triangles and solid line) calculated based on a stable incidence of 10 per 1000 person-years in persons aged ≥65 years. Reproduced from reference with permission from Elsevier.

Figure 2

A patient diagnosed for a heart failure with preserved ejection fraction. (A) Apical four-chamber view: left ventricular concentric hypertrophy with a small end-systolic volume. (B) Deformation imaging performed from this apical view to assess the longitudinal systolic function: the global longitudinal strain is depressed (−12.3%; normal −20%) despite the fact that the left ventricular ejection fraction is 55 ± 5%. (C) Parasternal short-axis view. (D) Radial strain assessment from this parasternal view: the radial strain is increased (60%, normal value 40%) to compensate for the decrease of the longitudinal one. (E) Apical four-chamber view: the left atrium is enlarged with a left atrial value greater than 38 mL/M². (F) Pulse tissue Doppler demonstrating the e′ is blunted (6 cm/s) as s′ is (other demonstration of the decrease in the left ventricular longitudinal function). (G) Mitral inflow: delayed relaxation pattern with E/e′ >13. (H) Tricuspid regurgitation with an estimated systolic pulmonary arterial pressure of ∼55 mmHg.