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Updated: Oct 3, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Do the Current Guidelines for Heart Failure Diagnosis and Treatment Fit with Clinical Complexity?
Paolo Severino1, Andrea D'Amato1, Silvia Prosperi1
1Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy.
Insights
Heart failure (HF) is a multisystemic disease impacting multiple organs, not just the heart. New therapeutic strategies must address this broader impact for improved patient outcomes.
Area of Science:
- Cardiology
- Multisystemic Diseases
Background:
- Heart failure (HF) is a syndrome of cardiac dysfunction leading to inadequate output or increased filling pressures.
- HF progresses to a multisystemic disease, affecting multiple organs and significantly impacting prognosis.
- Current European Society of Cardiology guidelines (2021) still emphasize left ventricular ejection fraction (LVEF) for HF management despite known limitations.
Purpose of the Study:
- To advocate for a revised understanding and definition of heart failure.
- To highlight the critical role of multiorgan involvement in HF pathophysiology and prognosis.
- To emphasize the need for multiorgan protective therapies alongside traditional cardioprotective treatments.
Main Methods:
- Conceptual review and analysis of current heart failure definitions and management strategies.
- Comparison of heart failure's multisystemic progression to cancer metastasis.
- Evaluation of the prognostic significance of multiorgan involvement in heart failure.
Main Results:
- Left ventricular ejection fraction (LVEF) remains a central but limited parameter in HF evaluation.
- Multiorgan involvement in HF significantly influences patient survival, morbidity, and hospitalization rates.
- Multiorgan protective therapies are as crucial as cardioprotective therapies for managing HF.
Conclusions:
- A paradigm shift in the conceptualization of heart failure is necessary.
- The definition and therapeutic approach to HF must evolve beyond a purely cardiac perspective.
- Integrating multiorgan protection into HF management is essential for improving outcomes.
Abstract:
Heart failure (HF) is a clinical syndrome defined by specific symptoms and signs due to structural and/or functional heart abnormalities, which lead to inadequate cardiac output and/or increased intraventricular filling pressure. Importantly, HF becomes progressively a multisystemic disease. However, in August 2021, the European Society of Cardiology published the new Guidelines for the diagnosis and treatment of acute and chronic HF, according to which the left ventricular ejection fraction (LVEF) continues to represent the pivotal parameter for HF patients' evaluation, risk stratification and therapeutic management despite its limitations are well known. Indeed, HF has a complex pathophysiology because it first involves the heart, progressively becoming a multisystemic disease, leading to multiorgan failure and death. In these terms, HF is comparable to cancer. As for cancer, surviving, morbidity and hospitalisation are related not only to the primary neoplastic mass but mainly to the metastatic involvement. In HF, multiorgan involvement has a great impact on prognosis, and multiorgan protective therapies are equally important as conventional cardioprotective therapies. In the light of these considerations, a revision of the HF concept is needed, starting from its definition up to its therapy, to overcome the old and simplistic HF perspective.
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