Key result
Diastolic dysfunction, based on left ventricular concentric geometry, is argued to be a principal pathogenetic factor in heart failure with preserved ejection fraction.
The authors argue that while systolic abnormalities may exist in HFpEF, diastolic dysfunction and other factors like anemia, vascular stiffness, and renal dysfunction play the principal pathogenetic roles.
We thank Dr MacIver for his interest in our review article. As Dr MacIver, and we, described, HFPEF is associated with LV systolic dysfunction in some patients, and we also agree with Dr MacIver's comment that preserved EF does not necessarily indicate normal systolic function. owever, it is not sufficient only to reveal abnormalities in HFPEF. We, cardiologists, have to consider which abnormalities play crucial roles in the development of HFPEF. For example, 25% stenosis of the coronary artery is "abnormal", but this region is not a target of revascularization in patients with coronary artery disease. In contrast to heart failure patients with reduced EF, it is very rare that low output syndrome emerges as a principal pathophysiology in patients with HFPEF. The patients with HFPEF usually represent congestion without a significant reduction of cardiac output (wet-warm), not congestion with reduced output (wet-cold), at the hospitalization for the worsening of heart failure. A recent clinical study demonstrated that abnormality of LV diastolic function was associated with exercise intolerance in subjects with preserved EF, and that the difference in EF was not related to exercise capacity. 6]
No takes yet. Share an insight, caveat, or question.
Yamamoto et al. (2009) conducted a letter in Heart Failure With Preserved Ejection Fraction (HFPEF). Diastolic dysfunction, based on left ventricular concentric geometry, is argued to be a principal pathogenetic factor in heart failure with preserved ejection fraction.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: