Diastolic Dysfunction in Acute and Critical Illness: Acute Pathophysiology to Chronic Heart Failure

Area of Science:

• Cardiology
• Internal Medicine
• Pathophysiology

Background:

• Heart failure with preserved ejection fraction (HFpEF) is a multi-organ syndrome driven by systemic inflammation and comorbidities.
• Acute diastolic dysfunction is common in critical illnesses like sepsis, but its long-term impact on developing chronic HFpEF is understudied.
• Survivors of critical illness have an increased risk of major adverse cardiovascular events.

Purpose of the Study:

• To review the pathophysiology of HFpEF across the continuum from chronic stable disease to acute decompensation.
• To identify the long-term sequelae of critical illness on cardiovascular health.
• To highlight recent therapeutic advancements for chronic HFpEF.

Main Methods:

• Literature review of pathophysiology, clinical significance, and therapeutic options for HFpEF.
• Analysis of the transition from acute illness to chronic HFpEF.
• Synthesis of findings from recent landmark clinical trials.

Main Results:

• HFpEF pathophysiology is linked to comorbidity-induced systemic inflammation.
• The progression from acute diastolic dysfunction to chronic HFpEF requires further investigation.
• New therapies like SGLT2 inhibitors, MRAs, and GLP-1 RAs show promise for chronic HFpEF.

Conclusions:

• Understanding HFpEF across its continuum is crucial for effective management.
• Further research is needed to elucidate the transition from critical illness to chronic HFpEF.
• Emerging therapies offer new hope for patients with chronic HFpEF.