Strategies for management of heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) contributes substantially to hospitalizations, morbidity, and mortality worldwide.Prevalence is estimated to be roughly 2% of the population and is increasing concurrently with diabetes, atrial fibrillation, obesity, and an aging population [1].Echocardiography is usually adequate to distinguish HFpEF from heart failure with reduced or mid-range ejection fraction, which is important for treatment and prognostication [2].Effective management strategies for HFpEF are lacking.To date, no randomized trials have shown a mortality benefit, and few have shown clear evidence of reduced hospitalizations.A variety of indices can be measured to estimate myocardial performance during diastole.When abnormal, diastolic indices are supportive, but not necessary, for the diagnosis of HFpEF [3].Abnormal diastolic indices are a risk factor, but it remains unclear if treatments can reduce progression to clinical HFpEF [4,5].In this issue of the Journal, [6] report data from a cohort of symptomatic patients undergoing coronary angiography for the evaluation of possible obstructive coronary artery disease.Study participants agreed to undergo cardiac magnetic resonance imaging to evaluate diastolic indices which were linked to drug treatments for coronary artery disease, hypertension, diabetes, and dyslipidemia.They conclude that subjects meeting the study definitions for adequate treatment of these conditions had an association with superior diastolic indices.While not explicitly a study of HFpEF patients, 89% had chest pain, 66% had dyspnea, and improvement of diastolic parameters is primarily relevant to the management of HFpEF, more than other conditions.The findings are aligned with current recommended strategy for the management of HFpEF, aggressive treatment of underlying conditions that may contribute to symptoms in HFpEF [7].