Heart Failure With Normal Ejection Fraction

A Growing Pandemic

Satnam Singh; Michael Frenneaux

Disclosures

Future Cardiol. 2012;8(3):383-392. 

In This Article

Etiology & Prevalence of HFNEF

HFNEF is a complex disease with increasing prevalence.[8] Typically HFNEF patients are elderly females often suffering from one or more of the following diseases: hypertension, diabetes, obesity and, even more frequently observed, coronary artery disease.

Due to the lack of standardization of diagnostic criteria, HFNEF still remains underdiagnosed but recent studies provide a more accurate estimate of the prevalence of HFNEF among patients with HF, which averages approximately 54%, with a range from 40 to 70%.[8] Owen et al. estimated the true prevalence of HFNEF in the community to be in the range of 1.1–5.5% of the general population.[8] HFNEF patients have increased myocardial stiffness and impaired relaxation in diastole resulting in higher left atrial pressures.[9] These high left atrial pressures predispose the patients to pulmonary venous congestion and dyspnea especially on exertion.[10] Invasive studies in chronic HF with preserved ejection function (HFPEF) and hospitalized HFPEF patients have shown a leftward and upward shift of the LV end-diastolic pressure–volume relationship.[10–12] HFPEF patients have raised LV end-diastolic pressure, end-systolic pressure, diastolic dysfunction, pulmonary capillary wedge pressure and pulmonary artery systolic pressure.[13]

Penicka et al. demonstrated that dynamic mitral regurgitation may contribute to the pathophysiology of HFNEF, and that dys-synchrony may also play a role.[12]

Ha et al.[14] and lam et al.[15] have independently demonstrated that pulmonary hypertension is common and often severe in patients with HFNEF syndrome. The prognosis of HFNEF worsens with pulmonary hypertension and right ventricular failure development.[16]

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