Heart failure with preserved ejection fraction (HFpEF): phenotypes, diagnostic algorithms, and new therapeutic options

Abstract

Heart failure (HF) is currently one of the most important public health problems. Heart failure with preserved ejection fraction (HFpEF) is a highly heterogeneous disease characterized by normal or near-normal left ventricular ejection fraction, diastolic dysfunction and elevated left ventricular filling pressures. The prognosis of HFpEF is similar to that of HF with reduced ejection fraction (HFrEF), but its management requires a personalised approach. The aim of this review article to summarize the current knowledge on HFpEF, including different phenotypes, diagnostic challenges, and novel therapeutic options. The heterogeneity of HFpEF and the importance of the individual phenotypes cannot be overemphasized, as this greatly influences the choice of treatment options and facilitates the development of personalized treatment strategies. Diagnosis of HFpEF is difficult and requires a combination of clinical symptoms, specific echocardiographic parameters and biomarkers. The H2FPEF score and the HFA-PEFF algorithm can help to estimate the probability of HFpEF. SGLT2 inhibitors have made a major breakthrough in the treatment of HFpEF, and their use is recommended as a class I recommendation in current guidelines. In addition, mineralocorticoid receptor antagonists, GLP-1 receptor agonists and appropriate treatment of the comorbidities also play an important role in the management of HFpEF.

Keywords

• heart failure
• hfpef
• diagnosis
• phenotypes
• sglt2 inhibitors