Highlights the knowledge gap in the natural history and clinical progression of HFpEF from pre-clinical diastolic dysfunction, calling for further prospective studies.
Persistent uncertainty in HFpEF progression from pre-clinical stages; leaves open evidence-based staging and intervention timing.
Over the last two decades, important advances have been made in explaining some pathophysiological aspects of heart failure with preserved ejection fraction (HFpEF) with repercussions for the successful clinical management of the syndrome. Despite these gains, our knowledge for the natural history of clinical progression from the pre-clinical diastolic dysfunction (PDD) until the final clinical stages is significantly limited. The subclinical progression of PDD to the clinical phenotype of HFpEF and the further clinical progression to some more complex clinical models with multi-organ involvement, similar to heart failure with reduced ejection fraction (HFrEF), continue to be poorly understood. Prospective studies are needed to elucidate the natural history of clinical progression in patients with HFpEF and to identify the exact left ventricular remodeling mechanism that underlies this progression.
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Louridas et al. (2016) studied this question.
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