Targeting heart failure with preserved ejection fraction: current status and future prospects

Abstract

Heart failure with preserved ejection fraction (HFpEF) portrays a significant burden in terms of prevalence, morbidity, mortality, and health care costs. There is a lack of consensus on the basic pathophysiology, definition, and therapeutic targets for therapy for this syndrome. To date, there are no approved therapies available for reducing mortality or hospitalization for these patients. Several clinical trials have recently started to try and bridge this major gap. There is an urgent need to focus on drug and device development for HFpEF as well as to understand HFpEF pathophysiology.

Keywords: HFpEF therapies; diastolic dysfunction.

Figure 1

Multiple factors that contribute to the pathophysiology of HFpEF. Abbreviations: LV, left ventricular; ECM, extracellular matrix; HFpEF, Heart failure with preserved ejection fraction; CV, cardiovascular.

Figure 2

Effect of changes in arterial elastance (E_a) in SBP and SV. Notes: (A) Normal pressure–volume curve showing the relation between E_a and E_es. (B) Pressure–volume curve in a patient with HFpEF showing a significant drop in SBP with mild increase in SV after decrease in E_a (red line). (C) Pressure–volume curve in a patient with HFrEF with increase in SV and minimal change in SBP after decrease in E_a with vasodilator therapy. Abbreviations: SBP, systolic blood pressure; SV, stroke volume; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.