Evolution of a Geriatric Syndrome: Pathophysiology and Treatment of Heart Failure With Preserved Ejection Fraction

Bharathi Upadhya, MD; Barbara Pisani, MD; Dalane W. Kitzman, MD


J Am Geriatr Soc. 2017;65(11):2431-2440. 

In This Article

Cardiac Comorbidities

Twenty-five percent to 68% of individuals with HFpEF have coronary artery disease (CAD), which is associated with greater deterioration in LV function and greater mortality, including CV death.[49,50] An autopsy study recently showed that epicardial CAD was frequent and extensive in individuals with HFpEF.[24] An important observation in this study was that individuals with HFpEF had low coronary microvascular density. The prevalence of AF has been increasing because of the aging of the general population and greater longevity. AF in individuals with HFpEF is associated with impaired LV systolic and diastolic functional reserves, large LA with poor LA function, more severe neurohumoral activation, and impaired exercise tolerance.[51,52] Hypertension is the most prevalent risk factor for HF and precedes the diagnosis of HF in 75% to 85% of persons who develop HF. Along with afterload excess, LV hypertrophy, fibrosis, and arterial stiffness, hypertension induces inflammation, oxidative stress, and endothelial dysfunction in individuals with HFpEF.[53]