The aging heart in focus: The advanced understanding of heart failure with preserved ejection fraction

Area of Science:

• Cardiology
• Systemic Syndromes
• Geriatric Medicine

Background:

• Heart failure with preserved ejection fraction (HFpEF) is the most prevalent form of heart failure, affecting 50% of patients.
• Its incidence is rising in aging populations, presenting as a heterogeneous systemic syndrome influenced by factors like metabolic syndrome and hypertension.
• HFpEF involves multi-organ dysfunction, including the heart, lungs, muscles, and vasculature, with cellular abnormalities in cardiomyocytes, endothelial cells, fibroblasts, adipocytes, and immune cells.

Purpose of the Study:

• To provide a comprehensive review of the etiology, pathobiology, and molecular mechanisms of HFpEF.
• To discuss the utility and limitations of preclinical animal models in HFpEF research.
• To summarize recent therapeutic trials in both animal models and human patients, focusing on agents like SGLT2 inhibitors.

Main Methods:

• Literature review of recent advances in HFpEF research.
• Analysis of studies on systemic pathology and clinically relevant animal models.
• Examination of data from clinical trials investigating novel therapeutic interventions.

Main Results:

• Recent progress in animal models and systemic pathology has enhanced the understanding of HFpEF.
• Clinical trials with sodium-glucose cotransporter 2 inhibitors show promise for HFpEF treatment.
• The complex nature of HFpEF necessitates a multi-faceted approach involving cellular and organ-level investigations.

Conclusions:

• Improved understanding of HFpEF's complex etiology and pathobiology is crucial for developing effective treatments.
• Advances in preclinical models and targeted therapies offer new hope for improving clinical outcomes in HFpEF patients.
• Continued research into molecular mechanisms and therapeutic strategies is essential to combat the growing burden of HFpEF.