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Published on: May 22, 2026
Heart failure with a normal left ventricular ejection fraction: diastolic heart failure
1Wake Forest University, School of Medicine, Winston-Salem, NC 27157-1045, USA. wlittle@wfubmc.edu
Summary
Heart failure with preserved ejection fraction (HFpEF) affects many, particularly elderly women with hypertension. Diastolic dysfunction plays a key role in HFpEF, highlighting the need for targeted treatment strategies.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Trials
Background:
- Reduced left ventricular ejection fraction (LVEF) is a primary criterion for heart failure diagnosis and clinical trials.
- A significant and growing number of heart failure patients exhibit a normal ejection fraction (HFpEF).
- HFpEF patients are often elderly women with systolic hypertension and prone to sudden pulmonary congestion.
Purpose of the Study:
- To highlight the clinical significance of heart failure with normal ejection fraction (HFpEF).
- To emphasize the role of diastolic dysfunction in symptomatic heart failure.
- To discuss current understanding and management considerations for HFpEF.
Main Methods:
- Echocardiography for LVEF measurement.
- Clinical assessment of heart failure symptoms.
- Review of existing clinical trial criteria and patient demographics.
Main Results:
- Reduced LVEF (<0.30-0.35) has historically defined heart failure entry criteria.
- A substantial proportion of heart failure patients present with normal LVEF (>0.50).
- These HFpEF patients often have systolic hypertension and risk of flash pulmonary edema.
Conclusions:
- The recognition of HFpEF necessitates a focus on diastolic dysfunction as a cause of heart failure.
- Optimal treatment for HFpEF is not yet fully established.
- Management strategies should include controlling systolic hypertension and preventing fluid overload.
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