Haemodynamics of Heart Failure With Preserved Ejection Fraction: A Clinical Perspective

Despite the burden of heart failure (HF) with preserved ejection fraction (HFpEF), its pathophysiological mechanisms remain controversial and are likely to be multifactorial. Indeed, it has been suggested that HFpEF may represent "a forest of a variety of trees", because of heterogeneity in pathophysiological mechanisms involved and phenotypic expression of the disease. A better understanding of HFpEF is crucial for the development of appropriate therapeutic targets. Recent studies on HFpEF have highlighted its particular haemodynamic features, and haemodynamic derangements are critical to both early and advanced stages of the disease. By definition, haemodynamic properties are determined by the result of the dynamic interchange between the heart, vasculature, and autonomic nervous system, which regulate the circulation of blood. Importantly, it has been shown that both intrinsic and extrinsic factors are implicated in the haemodynamic impairments typical of HFpEF patients. Thus, understanding of HFpEF haemodynamics requires consideration of the interplay between both cardiac and non-cardiac factors.