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 2022/07/04
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.