Heart failure with normal ejection fraction: consideration of mechanisms other than diastolic dysfunction

Area of Science:

• Cardiology
• Heart Failure Pathophysiology
• Geriatric Medicine

Background:

• Over half of heart failure (HF) patients exhibit normal ejection fraction (EF), a condition often seen in elderly females with multiple comorbidities.
• These comorbidities can lead to ventricular hypertrophy and interstitial fibrosis, traditionally implicating diastolic dysfunction as the primary cause of HF with normal EF (HFNEF).
• However, comorbidities may also affect other cardiovascular and extracardiovascular systems, contributing to HFNEF symptoms through non-diastolic mechanisms.

Purpose of the Study:

• To explore the current understanding of non-diastolic mechanisms contributing to the HFNEF syndrome.
• To propose HF with normal EF as a more descriptive alternative to diastolic HF.
• To identify potential research pathways and novel therapeutic targets for HFNEF.

Main Methods:

• Review of current scientific literature on HFNEF.
• Analysis of the impact of comorbidities on myocardial, ventricular, vascular, renal, and extracardiovascular properties.
• Discussion of non-diastolic mechanisms contributing to HFNEF symptoms.

Main Results:

• Comorbidities associated with HFNEF can influence multiple physiological systems beyond diastolic function.
• These influences suggest that HFNEF is a complex syndrome with potentially diverse underlying mechanisms.
• The term HF with normal EF is proposed to better reflect the multifaceted nature of the condition.

Conclusions:

• Non-diastolic mechanisms play a significant role in the pathophysiology of HFNEF.
• Further research into these mechanisms is crucial for developing effective therapies for HFNEF.
• Understanding these pathways may lead to targeted treatments for this prevalent patient population.