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Review
. 2019 Dec 19;51(12):1-9.
doi: 10.1038/s12276-019-0323-2.

Heart failure with preserved ejection fraction: present status and future directions

Somy Yoon  1 , Gwang Hyeon Eom  2
Affiliations
Review

Heart failure with preserved ejection fraction: present status and future directions

Somy Yoon et al. Exp Mol Med. .

Abstract

The clinical importance of heart failure with preserved ejection fraction (HFpEF) has recently become apparent. HFpEF refers to heart failure (HF) symptoms with normal or near-normal cardiac function on echocardiography. Common clinical features of HFpEF include diastolic dysfunction, reduced compliance, and ventricular hypokinesia. HFpEF differs from the better-known HF with reduced ejection fraction (HFrEF). Despite having a "preserved ejection fraction," patients with HFpEF have symptoms such as shortness of breath, excessive tiredness, and limited exercise capability. Furthermore, the mortality rate and cumulative survival rate are as severe in HFpEF as they are in HFrEF. While beta-blockers and renin-angiotensin-aldosterone system modulators can improve the survival rate in HFrEF, no known therapeutic agents show similar effectiveness in HFpEF. Researchers have examined molecular events in the development of HFpEF using small and middle-sized animal models. This review discusses HFpEF with regard to etiology and clinical features and introduces the use of mouse and other animal models of human HFpEF.

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Conflict of interest statement

The authors clearly declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Comorbidity associated with each type of heart failure.
HFrEF or systolic heart failure is more common in males. Well-known underlying risk factors include smoking and myocardial death due to infarction. However, HFpEF is more common in females. Comorbidities include obesity, hypertension, hyperlipidemia, and diabetes mellitus. While beta-blockers, ACEi/ARB agents, ARNI, ivabradine, and MRAs reduce mortality in HFrEF, no medications are available for HFpEF. ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin II type 1 receptor blocker; ARNI, angiotensin receptor neprilysin inhibitor; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; MRA, mineralocorticoid receptor antagonist. Arrow widths reflect the association and relevance of hazard ratios. The red blunted lines show effective inhibition of disease progression
Fig. 2
Fig. 2. Echocardiographic findings and schematic demonstrations according to the severity of diastolic dysfunction.
DD, diastolic dysfunction; PW, pulse wave; TVI, tissue velocity image
See this image and copyright information in PMC

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