Heart failure with normal ejection fraction: current diagnostic and management strategies

Heart failure with normal ejection fraction (HFNEF), previously known as diastolic heart failure (HF), is defined as a syndrome of HF with normal or near normal ejection fraction (≥ 50%) and evidence of abnormal left ventricular (LV) diastolic function. It represents about 50% of patients diagnosed with HF. HFNEF is not a benign disease as it carries a morbidity and mortality risk as high as that associated with HF and reduced ejection fraction (HFREF). HFNEF shares some risk factors, hemodynamic consequences and clinical presentations with HFREF, though they differ in the pathophysiology and cardiac morphology. Therapies such as β-blockers (BBs) and angiotensin-receptor blockers (ARBs), which are beneficial in HFREF have not shown a survival benefit in HFNEF. Therapies focus on control of hypertension, control of heart rate, revascularization in case of ischemia for long term management and use of diuretics in acute decompensated HFNEF. Exercise therapy improves performance in HFNEF.