Comparison of blood volume characteristics in anemic patients with low versus preserved left ventricular ejection fractions

Heart failure with preserved ejection fraction: pathophysiology and emerging therapies

Approximately half of patients with heart failure (HF) have a preserved ejection fraction (HFpEF). Morbidity and mortality are similar to HF with reduced EF (HFrEF), yet therapies with unequivocal benefit in HFrEF have not been shown to be effective in HFpEF. Recent studies have shown that the pathophysiology of HFpEF, initially believed to be due principally to diastolic dysfunction, is more complex. Appreciation of this complexity has shed new light into how HFpEF patients might respond to traditional HF treatments, while also suggesting new applications for novel therapies and strategies. In this review, we shall briefly review the pathophysiologic mechanisms in HFpEF, currently available clinical trial data, and finally explore new investigational therapies that are being developed and tested in ongoing and forthcoming trials.

Current controversies in heart failure with a preserved ejection fraction

Heart failure with a preserved ejection fraction is a fascinating and multifaceted condition that has provoked enormous debate and a wealth of mechanistic studies. Controversies exist with regard to its nomenclature. If its nomenclature is questioned, one can be certain the pathogenesis is ill understood. If the pathogenesis is disputed, the diagnosis becomes difficult and inconsistent. These diagnostic challenges result in inappropriate recruitment to clinical trials. Therefore, the trials may be underpowered and difficult to interpret. This paper examines contemporary theories of heart failure with a preserved ejection fraction, clarifies the controversies and attempts to resolve the divergences of opinion.