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Review
. 2024 Jan 8;25(2):794.
doi: 10.3390/ijms25020794.

Heart Failure with Preserved Ejection Fraction: The Pathophysiological Mechanisms behind the Clinical Phenotypes and the Therapeutic Approach

Laurențiu Stoicescu  1   2 , Dana Crişan  1   3 , Claudiu Morgovan  4 , Lucreţia Avram  1   3 , Steliana Ghibu  5
Affiliations
Review

Heart Failure with Preserved Ejection Fraction: The Pathophysiological Mechanisms behind the Clinical Phenotypes and the Therapeutic Approach

Laurențiu Stoicescu et al. Int J Mol Sci. .

Abstract

Heart failure (HF) with preserved ejection fraction (HFpEF) is an increasingly frequent form and is estimated to be the dominant form of HF. On the other hand, HFpEF is a syndrome with systemic involvement, and it is characterized by multiple cardiac and extracardiac pathophysiological alterations. The increasing prevalence is currently reaching epidemic levels, thereby making HFpEF one of the greatest challenges facing cardiovascular medicine today. Compared to HF with reduced ejection fraction (HFrEF), the medical attitude in the case of HFpEF was a relaxed one towards the disease, despite the fact that it is much more complex, with many problems related to the identification of physiopathogenetic mechanisms and optimal methods of treatment. The current medical challenge is to develop effective therapeutic strategies, because patients suffering from HFpEF have symptoms and quality of life comparable to those with reduced ejection fraction, but the specific medication for HFrEF is ineffective in this situation; for this, we must first understand the pathological mechanisms in detail and correlate them with the clinical presentation. Another important aspect of HFpEF is the diversity of patients that can be identified under the umbrella of this syndrome. Thus, before being able to test and develop effective therapies, we must succeed in grouping patients into several categories, called phenotypes, depending on the pathological pathways and clinical features. This narrative review critiques issues related to the definition, etiology, clinical features, and pathophysiology of HFpEF. We tried to describe in as much detail as possible the clinical and biological phenotypes recognized in the literature in order to better understand the current therapeutic approach and the reason for the limited effectiveness. We have also highlighted possible pathological pathways that can be targeted by the latest research in this field.

Keywords: HFpEF; heart failure; pathophysiological mechanism; phenotypes; treatment.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Conceptualization of the definition of HF 3. Prevalence and Demographics.
Figure 2
Figure 2
The main physiopathological mechanisms involved in the development of HFpEF.
Figure 3
Figure 3
Diagnostic algorithm diagram of HFpEF.
Figure 4
Figure 4
H2FPEF score used for risk assessment of HFpEF—the parameters used, the reference intervals, and the significance of each of them.
Figure 5
Figure 5
HFpEF phenotypes. Etiology and comorbidities responsible for the development of HFpEF phenotypes.
See this image and copyright information in PMC

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