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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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“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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Metadata
- 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
- 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 › Physiology (medical) › 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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