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Review
. 2024 Feb 28;13(5):1375.
doi: 10.3390/jcm13051375.

Heart Failure with Preserved Ejection Fraction: How to Deal with This Chameleon

Fabiana Lucà  1 , Fabrizio Oliva  2 , Maurizio Giuseppe Abrignani  3 , Stefania Angela Di Fusco  4 , Mauro Gori  5 , Simona Giubilato  6 , Roberto Ceravolo  7 , Pier Luigi Temporelli  8 , Stefano Cornara  9 , Carmelo Massimiliano Rao  1 , Giorgio Caretta  10 , Andrea Pozzi  11 , Giulio Binaghi  12 , Alessandro Maloberti  2 , Concetta Di Nora  13 , Irene Di Matteo  2 , Anna Pilleri  12 , Sandro Gelsomino  14 , Carmine Riccio  15 , Massimo Grimaldi  16 , Furio Colivicchi  4 , Michele Massimo Gulizia  17
Affiliations
Review

Heart Failure with Preserved Ejection Fraction: How to Deal with This Chameleon

Fabiana Lucà et al. J Clin Med. .

Abstract

Heart failure with preserved ejection fraction (HFpEF) is characterized by a notable heterogeneity in both phenotypic and pathophysiological features, with a growing incidence due to the increase in median age and comorbidities such as obesity, arterial hypertension, and cardiometabolic disease. In recent decades, the development of new pharmacological and non-pharmacological options has significantly impacted outcomes, improving clinical status and reducing mortality. Moreover, a more personalized and accurate therapeutic management has been demonstrated to enhance the quality of life, diminish hospitalizations, and improve overall survival. Therefore, assessing the peculiarities of patients with HFpEF is crucial in order to obtain a better understanding of this disorder. Importantly, comorbidities have been shown to influence symptoms and prognosis, and, consequently, they should be carefully addressed. In this sense, it is mandatory to join forces with a multidisciplinary team in order to achieve high-quality care. However, HFpEF remains largely under-recognized and under-treated in clinical practice, and the diagnostic and therapeutic management of these patients remains challenging. The aim of this paper is to articulate a pragmatic approach for patients with HFpEF focusing on the etiology, diagnosis, and treatment of HFpEF.

Keywords: heart failure with preserved ejection fraction (HFpEF); mineralocorticoid receptor antagonists (MRAs); sodium-glucose cotransporter-2 (SGLT2) inhibitors sacubitril/valsartan chronic.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The pathophysiological mechanism linking diabetes to HFpEF.
Figure 2
Figure 2
The pathophysiological mechanism linking arterial hypertension to HFpEF.
Figure 3
Figure 3
Pulmonary hypertension in HFpEF. DM: diabetes mellitus; HFpEF: heart failure with preserved ejection fraction.
Figure 4
Figure 4
Relationship between OSAS and HFpEF. OSAS: obstructive sleep apnea syndrome; HFpEF: heart failure with preserved ejection fraction; PAP: continuous positive airway pressure; BPAP: bilevel positive airway pressure; and ASV: adaptive servo ventilation.
Figure 5
Figure 5
Patient education and self-support.
See this image and copyright information in PMC

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