From the Guidelines
Another way to write "Diastolic Heart Failure" is Heart Failure with Preserved Ejection Fraction (HFpEF). This terminology is widely used in clinical practice and medical literature to describe a condition where the heart's ability to relax and fill with blood during the diastolic phase is impaired, while the ejection fraction (the percentage of blood pumped out with each contraction) remains normal or near-normal (typically ≥50%) [ 1 ]. The term HFpEF has largely replaced "diastolic heart failure" in modern cardiology because it more precisely describes the pathophysiology - the heart can still contract and eject blood effectively, but has difficulty relaxing and filling properly.
Key Points
- HFpEF is a condition characterized by clinical symptoms and signs of HF in the setting of normal or near-normal left ventricular (LV) ejection fraction (LVEF) attributed to raised LV filling pressures at rest or on exertion [ 1 ].
- Approximately half of all HF patients suffer from HFpEF, and it is more commonly seen in individuals with cardiometabolic diseases, with incidence climbing with advancing age [ 1 ].
- Management of HFpEF has largely been focused on symptom improvement, reducing congestion with diuretics, and treating cardiovascular and non-cardiovascular comorbidities [ 1 ].
- Recent breakthrough randomized controlled trial data on the use of sodium-glucose co-transporter 2 (SGLT2) inhibitors in patients with HFpEF demonstrated reduced composite of cardiovascular death or HF hospitalizations [ 1 ].
Clinical Implications
- The distinction between HFpEF and other forms of heart failure is important for treatment approaches, as medications that work well for systolic heart failure (now called Heart Failure with Reduced Ejection Fraction or HFrEF) may not be as effective for HFpEF [ 1 ].
- HFpEF typically requires management of underlying conditions like hypertension, diabetes, and obesity [ 1 ].
From the Research
Alternative Names for Diastolic Heart Failure
- Heart failure with preserved ejection fraction (HFpEF) 2, 3, 4, 5, 6
- Heart failure with normal ejection fraction 3
- Clinical syndrome in which patients have signs and symptoms of heart failure, normal or near normal left ventricular ejection fraction (≥ 50%) and evidence of diastolic dysfunction 2
Key Characteristics
- Normal or near-normal left ventricular ejection fraction (LVEF) 2, 3, 4, 6
- Evidence of diastolic dysfunction 2
- Often associated with a history of hypertension, concentric left ventricular hypertrophy, vascular stiffness, and left ventricular diastolic dysfunction 6
Diagnosis and Management
- Diagnosis is best achieved by two-dimensional and Doppler echocardiography, which can detect abnormal myocardial relaxation, decreased compliance and increased filling pressure in the setting of normal left ventricular dimensions and preserved ejection fraction 2
- Measurement of natriuretic peptides is useful in the evaluation of patients with suspected heart failure with preserved ejection fraction in the ambulatory setting 3
- First-line pharmacologic therapy consists of sodium-glucose cotransporter type 2 inhibitors, such as dapagliflozin or empagliflozin 4
- Diuretics (typically loop diuretics, such as furosemide or torsemide) should be prescribed to patients with overt congestion to improve symptoms 4