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Phenotypic Spectrum of Heart Failure with Preserved Ejection Fraction #MMPMID24975905
Shah SJ; Katz DH; Deo RC
Heart Fail Clin 2014[Jul]; 10 (3): 407-18 PMID24975905show ga
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome, with several underlying etiologic and pathophysiologic factors. While prior heart failure clinical trials have used a ?one size fits all? approach, this approach has not proven successful for HFpEF. Furthermore, with the aging population and epidemics of obesity, diabetes, and hypertension, the prevalence of HFpEF will continue to grow over the foreseeable future. Coupled with the high morbidity and mortality of the HFpEF syndrome, there remains a pressing unmet need to improve the clinical care of HFpEF patients and to design better HFpEF clinical trials. Improved classification of the wide HFpEF phenotypic spectrum is therefore essential to advance the HFpEF field and begin to provide targeted treatment for these patients. Here we describe 4 potential classification schemas for HFpEF: (1) pathophysiologic classification; (2) clinical/etiologic classification; (3) classification based on type of clinical presentation; and (4) phenomics (?phenomapping?) of HFpEF. Improved phenotypic categorization of HFpEF using these schemas is now possible given the multitude of tools available to perform ?dense phenotyping? of HFpEF patients. Such categorization should lead to clinical care and clinical trials where targeted therapies based on specific mechanisms of disease can be matched to the specific patient subtypes most likely to respond to those therapies. In addition, innovative analytic strategies, such as ?phenomapping?, may allow for the use of dense multi-dimensional data to create novel phenotypic signatures, which should help identify HFpEF patients who are particularly responsive to specific treatments.