Heart Failure with Preserved Ejection Fraction

Heart failure (HF) is a worldwide growing epidemic, which affects 2-3% of the adults. Notably, HF manifestations can exist in patients with preserved left ventricular ejection fraction (HFPEF) which constitutes up to 50% of all HF patients. HFPEF is a heterogeneous entity with a number of key pathophysiologic mechanisms including impaired diastolic relaxation, abnormal filling, myocardial restriction and stiffness, longitudinal axis ventricular dysfunction, or right ventricular dysfunction. It is characterized by impaired peak oxygen consumption, elevated N terminal pro Btype natriuretic peptide (NT pro-BNP) which represents the main physiologic and neurohormonal changes. HFPEF is more common in older age and in women, especially in patients with history of hypertension, atrial fibrillation (AF), coronary artery disease (CAD) and diabetes. Yet, it is mainly a diagnosis of exclusion, with heterogeneous differential diagnosis, high rate of hospitalization, and comparable mortality to HF with systolic dysfunction (SHF).