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2015 ; 3
(3
): 521-7
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Heart Failure with Preserved Ejection Fraction - Concept, Pathophysiology,
Diagnosis and Challenges for Treatment
#MMPMID27275281
Miljkovik LV
; Spiroska V
Open Access Maced J Med Sci
2015[Sep]; 3
(3
): 521-7
PMID27275281
show ga
Heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF)
occurs in 40 to 60% of the patients with HF, with a prognosis which is similar to
HF with reduced ejection fraction (HFrEF). HFpEF pathophysiology is different
from that of HFrEF, and has been characterized with diastolic dysfunction.
Diastolic dysfunction has been defined with elevated left ventricular stiffness,
prolonged iso-volumetric LV relaxation, slow LV filing and elevated LV
end-diastolic pressure. Arterial hypertension occurs in majority cases with HFpEF
worldwide. Patients are mostly older and obese. Diabetes mellitus and atrial
fibrillation appear proportionally in a high frequency of patients with HFpEF.
The HFpEF diagnosis is based on existence of symptoms and signs of heart failure,
normal or approximately normal ejection and diagnosing of LV diastolic
dysfunction by means of heart catheterization or Doppler echocardiography and/or
elevated concentration of plasma natriuretic peptide. The present recommendations
for HFpEF treatment include blood pressure control, heart chamber frequency
control when atrial fibrillation exists, in some situations even coronary
revascularization and an attempt for sinus rhythm reestablishment. Up to now, it
is considered that no medication or a group of medications improve the survival
of HFpEF patients. Due to these causes and the bad prognosis of the disorder,
rigorous control is recommended of the previously mentioned precipitating factors
for this disorder. This paper presents a universal review of the most important
parameters which determine this disorder.
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