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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 with normal or near normal left ventricular EF (LVEF >50 percent) [1-5]. Most patients with HFpEF also display normal left ventricular volumes and evidence of diastolic dysfunction (eg, abnormal pattern of LV filling and elevated filling pressures) [2,6-8]. By contrast, HF with a reduced EF (HFrEF) is characterized by increased LV volumes and reduced EF. Previously, HFpEF was termed "diastolic HF" and HFrEF was described as "systolic HF."

HFpEF should be distinguished from other causes of HF with an LVEF >50 percent such as valvular heart disease, pericardial disease, and high output HF (table 1).

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 [3,4,9,10].

Among all patients with HF in the United States, half or more have a normal or near normal LVEF [8,11]. 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]. Additional data from the ARIC study show that HFpEF is by far the dominant form of HF among older adults in the United States, representing 65 to 77 percent of prevalent cases [11]. This study also showed that the majority of adults in the community have either risk factors for HF (Stage A, 52 percent) or structural remodeling (Stage B HF, 30 percent) and are thus at increased risk for developing symptomatic HF (Stage C 13 percent).

                      
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Literature review current through: Sep 2017. | This topic last updated: Sep 19, 2017.
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