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Updated: May 10, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Heart failure with preserved ejection fraction in children: hormonal imbalance between aldosterone and brain
Satoshi Masutani1, Hirofumi Saiki, Clara Kurishima
1Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University.
Insights
Heart failure with preserved ejection fraction (HFpEF) occurs in children, often after congenital heart surgery. A higher aldosterone/BNP ratio may predict pediatric HFpEF, which has a lower mortality rate than systolic HF.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Heart failure with preserved ejection fraction (HFpEF) is well-documented in adults, but information on its occurrence in children (EF >50%) is lacking.
- Pediatric HFpEF is a significant clinical entity that warrants further investigation.
Purpose of the Study:
- To investigate the characteristics of pediatric patients diagnosed with HFpEF.
- To compare the hormonal profiles and outcomes of pediatric HFpEF with those of pediatric systolic heart failure (SHF).
Main Methods:
- A retrospective review of 3,907 pediatric cardiovascular disease patients over a 10-year period.
- Identification and analysis of 18 pediatric HFpEF cases.
- Comparison of serum aldosterone and plasma brain natriuretic peptide (BNP) levels between HFpEF and SHF groups.
Main Results:
- Pediatric HFpEF was identified in 0.5% of patients, predominantly young children (1.1±0.9 years) post-congenital heart surgery.
- HFpEF patients exhibited concentric hypertrophy, diastolic dysfunction, elevated blood pressure, higher serum aldosterone, and lower plasma BNP compared to SHF patients.
- A higher aldosterone/BNP ratio significantly predicted pediatric HFpEF (AUC=0.89), with a ratio ≥10.3 being optimal.
- HF mortality was lower in pediatric HFpEF than SHF, with symptom improvement in 61% during follow-up.
Conclusions:
- Heart failure with preserved ejection fraction (HFpEF) is present in the pediatric population.
- Despite epidemiological differences, a shared pathophysiology may link childhood and adult HFpEF.
- Further research is needed to explore the causal relationship between specific hormonal profiles and pediatric HFpEF.
Background:
There is no information on heart failure (HF) with preserved ejection fraction (HFpEF, EF >50%) in children.
Methods And Results:
Through a retrospective review of 3,907 pediatric patients with cardiovascular disease, we examined the characteristics of pediatric HFpEF over a 10-year period. We identified 18 patients with HFpEF (0.5%). They were predominantly young children (1.1±0.9 years, no sex preponderance), who had undergone surgery for congenital heart disease. They also had concentric hypertrophy and diastolic dysfunction with elevated blood pressure. Notably, HFpEF patients had more pronounced elevation of serum aldosterone but less pronounced elevation of plasma brain natriuretic peptide (BNP) than 22 systolic HF patients (SHF, EF ≤50%) (aldosterone: 1,375±1,200 vs. 511±563pg/ml, P<0.05, and BNP: 101±141 vs. 749±818pg/ml, P<0.005). Consequently, the aldosterone/BNP ratio was significantly higher in HFpEF (38±63) than in SHF (1.7±1.9, P<0.05), and an aldosterone/BNP ratio of 10.3 or higher best predicted HFpEF (area under the curve=0.89). The HF mortality rate was significantly lower in the HFpEF than in the SHF cases, and HF symptoms showed amelioration in 61% of patients during the follow-up period of 4.2±2.6 years.
Conclusions:
HFpEF does exist in children. A common pathophysiology underlies childhood and adult HFpEF despite considerable epidemiological and etiological differences. Future controlled studies are warranted to assess the cause-effect relationship between unique hormonal profiles and HFpEF.
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