Heart failure with normal ejection fraction: current diagnostic and management strategies

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Hoda Butrous1, Ramdas G Pai

  • 1LLUMC internal medicine PGY2, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.

Expert Review of Cardiovascular Therapy
|August 27, 2013
PubMed

Insights

Heart failure with normal ejection fraction (HFNEF) affects half of heart failure patients and carries significant risks. While sharing traits with reduced ejection fraction heart failure, HFNEF requires distinct management strategies focusing on symptom control and exercise.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Heart failure with normal ejection fraction (HFNEF), previously diastolic heart failure, affects approximately 50% of heart failure patients.
  • HFNEF presents with preserved ejection fraction (≥ 50%) and abnormal left ventricular diastolic function.
  • This condition carries a morbidity and mortality risk comparable to heart failure with reduced ejection fraction (HFREF).

Purpose of the Study:

  • To define heart failure with normal ejection fraction (HFNEF).
  • To compare HFNEF with heart failure with reduced ejection fraction (HFREF).
  • To outline current therapeutic approaches for HFNEF.

Main Methods:

  • The study defines HFNEF based on clinical presentation, ejection fraction, and diastolic function.
  • It compares risk factors, hemodynamics, and clinical features between HFNEF and HFREF.
  • It reviews current therapeutic strategies for HFNEF.

Main Results:

  • HFNEF is characterized by normal ejection fraction and impaired diastolic function.
  • HFNEF shares some clinical aspects with HFREF but differs in pathophysiology and cardiac morphology.
  • Standard HFREF therapies like beta-blockers and ARBs have not demonstrated survival benefits in HFNEF.

Conclusions:

  • HFNEF is a significant clinical syndrome with high morbidity and mortality.
  • Effective management of HFNEF involves controlling hypertension and heart rate.
  • Revascularization for ischemia, diuretics for acute decompensation, and exercise therapy are key components of HFNEF management.

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