Evolving insights into the pathophysiology of heart failure with preserved ejection fraction

The syndrome of heart failure with preserved ejection fraction (HFpEF) is particularly prevalent and burdensome in older individuals. The pharmacologic treatment of HFpEF has largely relied on using interventions that have proven useful in patients with systolic heart failure. However, recent clinical trials have shown that these interventions have only limited efficacy in patients with HFpEF. Thus, there is a dire need for novel strategies in the management of HFpEF. Developing these strategies, in turn, requires a thorough understanding of the pathophysiologic mechanisms that underlie this syndrome. Patients with HFpEF have abnormalities in diastolic function. However, most of these abnormalities can also be observed in other individuals who do not have heart failure, which calls into question the notion that diastolic abnormalities are sufficient to explain the syndrome of HFpEF. This article provides an overview of some of the nondiastolic factors that have recently been considered as potential contributors to the pathophysiology of HFpEF, such as alterations in systolic function, left ventricular volumes, and arterial properties. © 2009 Current Medicine Group, LLC.