A clinical algorithm to differentiate heart failure with a normal ejection fraction by pathophysiologic mechanism

Area of Science:

• Cardiology
• Heart Failure Pathophysiology
• Diastolic Dysfunction

Background:

• Increasing incidence and prevalence of heart failure, particularly in aging populations.
• Over half of heart failure patients exhibit a normal ejection fraction, indicating diverse underlying mechanisms.
• The pathophysiology of heart failure with normal ejection fraction is not fully understood, though left ventricular diastolic dysfunction is a primary suspect.

Purpose of the Study:

• To explore alternative pathophysiologic mechanisms contributing to heart failure with normal ejection fraction.
• To propose a novel algorithm for identifying the primary cause of heart failure with normal ejection fraction.
• To aid in guiding management and targeted therapies for this patient group.

Main Methods:

• Analysis of pressure-volume relations to delineate various end-systolic and end-diastolic pressure-volume configurations.
• Development of a diagnostic algorithm incorporating blood pressure, left ventricular hypertrophy (via ECG/echocardiography), and left ventricular size.
• Utilizing established measures from pressure-volume analysis.

Main Results:

• Identified potential alternative pathophysiologic mechanisms beyond typical diastolic dysfunction.
• Proposed a practical algorithm for classifying heart failure with normal ejection fraction.
• The algorithm integrates simple clinical factors for mechanistic identification.

Conclusions:

• Heart failure with normal ejection fraction encompasses multiple pathophysiologic pathways.
• The proposed algorithm offers a systematic approach to identifying the primary mechanism.
• This approach may facilitate personalized treatment strategies for heart failure with normal ejection fraction.