RT Book, Section A1 Ferreira, João Pedro A1 Sharma, Kavita A1 Butler, Javed A2 Fuster, Valentin A2 Narula, Jagat A2 Vaishnava, Prashant A2 Leon, Martin B. A2 Callans, David J. A2 Rumsfeld, John A2 Poppas, Athena SR Print(0) ID 1191377021 T1 Diagnosis and Management of Heart Failure with Preserved Ejection Fraction T2 Fuster and Hurst's The Heart, 15e YR 2022 FD 2022 PB McGraw-Hill Education PP New York, NY SN 9781264257560 LK accesscardiology.mhmedical.com/content.aspx?aid=1191377021 RD 2023/02/07 AB Chapter SummaryThis chapter provides an in-depth description of heart failure with preserved ejection fraction (HFpEF), from pathophysiology to treatment. Patients with HFpEF have a multifaceted constellation of comorbidities and clinical presentations. Numerous pathogenic mechanisms, including diastolic dysfunction, impaired systolic reserve, abnormal ventricular-arterial coupling, inflammation, endothelial dysfunction, chronotropic incompetence, altered myocardial energetics, impaired peripheral skeletal muscle metabolism and perfusion, pulmonary hypertension, atrial fibrillation, coronary artery disease, obesity, and renal insufficiency, contribute to the disease burden of HFpEF (see Fuster and Hurst's Central Illustration). The prognosis of patients with HFpEF remains poor. Many treatments (including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, sacubitril/valsartan, and sodium glucose cotransporter-2 inhibitors) have been tested in HFpEF. Candesartan, spironolactone, and sacubitril/valsartan all demonstrated a modest effect to reduce heart failure hospitalizations in patients with HFpEF, at least up to left ventricular ejection fractions in the 50% to 55% range. Empagliflozin showed a more pronounced effect to reduce the composite of heart failure hospitalizations or cardiovascular death across the spectrum of ejection fraction of HFpEF patients.