Evaluation and management of heart failure with preserved ejection fraction
Abstract
Heart failure with preserved ejection fraction (HFpEF) has grown to become the dominant form of heart failure worldwide, in tandem with ageing of the general population and the increasing prevalences of obesity, diabetes mellitus and hypertension. The clinical syndrome of HFpEF is heterogeneous and must be distinguished from heart failure with reduced ejection fraction as well as other aetiologies that have different treatment strategies. The diagnosis of HFpEF is challenging and ultimately relates to the conceptual definition of heart failure as a clinical syndrome characterized by symptoms that are associated with a reduced capacity of the heart to pump blood adequately at normal filling pressures during diastole. Clinical trials to date have been largely unsuccessful in identifying effective treatments for HFpEF but evidence supports the use of diuretics, mineralocorticoid antagonists and lifestyle interventions. Pathophysiological heterogeneity in the presentation of HFpEF is substantial, and ongoing studies are underway to evaluate the optimal methods to classify patients into phenotypically homogeneous subpopulations to facilitate better individualization of treatment.
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The essence of HFpEF pathophysiology is the increase of LV filling pressure, meaning that the heart can adequately pump the blood at expense of an elevation of cardiac filling pressures that, if disproportionate during exercise or at rest, are responsible of dyspnea.
“Even if the diastolic dysfunction is the hemodynamic feature of HFpEF, the essence of its pathophysiology is the increase of LV filling pressure, meaning that the heart can adequately pump the blood at expense of an elevation of cardiac filling pressures that, if disproportionate during exercise or at rest, are responsible of dyspnea [102,103].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [102]
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Spironolactone Metabolites in TOPCAT — New Insights into Regional Variation
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Self-citationIL-1 Blockade in Patients With Heart Failure With Preserved Ejection Fraction
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Hemodynamic Responses to Rapid Saline Loading
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Physical Activity, Fitness, and Obesity in Heart Failure With Preserved Ejection Fraction
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Self-citationImpact of Atrial Fibrillation on Exercise Capacity in Heart Failure With Preserved Ejection Fraction
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The Invasive Cardiopulmonary Exercise Test
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Self-citationPulmonary Hypertension in Heart Failure With Preserved Ejection Fraction. A Community-Based Study
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Self-citationInvasive Hemodynamic Characterization of Heart Failure with Preserved Ejection Fraction
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Self-citationHeart Failure With Preserved Ejection Fraction
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Lumpers and splitters: the bumpy road to precision medicine
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Hemodynamic Effects of Weight Loss in Obesity: A Systematic Review and Meta-Analysis
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Self-citationBIOMARKER PROFILES IN HEART FAILURE PATIENTS WITH A PRESERVED AND REDUCED EJECTION FRACTION
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Risk factor-based subphenotyping of heart failure in the community
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OBESE-INFLAMMATORY PHENOTYPES IN HEART FAILURE WITH PRESERVED EJECTION FRACTION
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Self-citationTHE NEUROHORMONAL BASIS OF PULMONARY HYPERTENSION IN HEART FAILURE WITH PRESERVED EJECTION FRACTION
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Self-citationNew Insights into the Role of Left Atrial Function During Exercise in Heart Failure
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Self-citationDifferential WAIS patterns in epileptic patients with and without temporal lobe EEG abnormalities.
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2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
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2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
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Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity
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Self-citationSemaglutide in Patients with Obesity-Related Heart Failure and Type 2 Diabetes
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Self-citationHeart Failure With Preserved Ejection Fraction
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Self-citationFrom Systemic Inflammation to Myocardial Fibrosis
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Self-citationHeart Failure with Preserved Ejection Fraction: Mechanisms and Treatment Strategies
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Self-citationSarcopenia and cardiovascular diseases: A systematic review and meta‐analysis
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Heart Failure With Preserved Ejection Fraction: Heterogeneous Syndrome, Diverse Preclinical Models
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Diagnosis of Heart Failure With Preserved Ejection Fraction Among Patients With Unexplained Dyspnea
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Self-citationInflammation in Human Heart Failure: Major Mediators and Therapeutic Targets
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Self-citationImmunometabolic mechanisms of heart failure with preserved ejection fraction
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Identification of distinct phenotypic clusters in heart failure with preserved ejection fraction
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Hemodynamics for the Heart Failure Clinician: A State-of-the-Art Review
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Self-citationArtificial Intelligence-Enabled ECG for Left Ventricular Diastolic Function and Filling Pressure
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ACC/AHA/HFSA 2022 and ESC 2021 Guidelines on Heart Failure Comparison
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Sex and central obesity in heart failure with preserved ejection fraction
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Self-citationVentricular Stiffening and Chamber Contracture in Heart Failure with Higher Ejection Fraction
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Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment
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JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure
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- Authors
- Borlaug, B. A.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Borlaug, Barry A.
- ORCID
- Borlaug, Barry A.
- Venue
- Nature Reviews Cardiology
- Published
- 2020-03-30
- Volume
- 17
- Issue
- 9
- Pages
- 559-573
- ISSN
- 1759-5002 (ISSN-L)
- 1759-5010
- OpenAlex
- W3013711965
- Cited by
- 675
- References
- 180
- Citations by year
- 2026: 97 · 2025: 104 · 2024: 130 · 2023: 132 · 2022: 120 · 2021: 71 · 2020: 19 · 2012: 1
- FWCI
- 14.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nature Reviews Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL128526, U01HL125205)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- heart failure with preserved ejection fraction, HFpEF diagnosis, diuretics, mineralocorticoid receptor antagonists, lifestyle intervention, phenotypic subgroups, personalized treatment, diastolic dysfunction, aging, obesity, diabetes mellitus, hypertension
- MeSH terms
- Heart Failure, Humans, Middle Aged, Stroke Volume
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