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Clinical manifestations and diagnosis of heart failure with preserved ejection fraction

Author
Barry A Borlaug, MD
Section Editor
Wilson S Colucci, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have symptoms and signs of HF, normal or near normal left ventricular ejection fraction (LVEF >50 percent), and evidence of cardiac dysfunction as assessed by physical examination (eg, jugular venous distention), echocardiography (abnormal pattern of LV diastolic filling, left atrial enlargement), or cardiac catheterization (elevated filling pressures at rest or during stress) [1-4]. In addition to normal EF, patients with HFpEF generally display normal left ventricular volumes. In contrast, HF with a reduced EF (HFrEF) is characterized by increased left ventricular volumes and reduced EF. Among all patients with HF, as many as half have a normal or near normal LVEF [3-10]. Previously, HFpEF was termed “diastolic HF” and HFrEF was described as “systolic HF.”  

A number of conditions can cause the clinical syndrome of HF with normal EF (table 1), but because they have their own unique pathophysiologies, clinical trajectories, and treatments, they should be distinguished from HFpEF. For example, patients with significant valvular heart disease, pericardial disease, hypertrophic or restrictive cardiomyopathy, and high output HF technically have HF with a preserved EF but should not be considered to have HFpEF.

The etiology, clinical manifestations, and diagnosis of patients with HFpEF will be reviewed here. Issues related to treatment, prognosis, and pathophysiology are discussed separately. (See "Treatment and prognosis of heart failure with preserved ejection fraction" and "Pathophysiology of heart failure with preserved ejection fraction" and "Cellular mechanisms of diastolic dysfunction".)

PREVALENCE AND DEMOGRAPHICS

The prevalence of heart failure with preserved ejection fraction (HFpEF) increases with age [3,4,7,11].

A Mayo Clinic study examined all consecutive patients hospitalized with decompensated HF from 1987 through 2001 [12]. The proportion of patients with the diagnosis of HFpEF increased over time and was significantly higher among community patients than among referral patients (55 versus 45 percent). Over the next decade (2000 through 2010), the proportion of HF patients with HFpEF continued to increase while the incidence of HFpEF and HF with reduced EF declined [13].

                      

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Literature review current through: Nov 2016. | This topic last updated: Wed Feb 17 00:00:00 GMT+00:00 2016.
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