[Heart failure with preserved ejection fraction (HFpEF). What's up?].
REVUE MEDICALE DE LIEGE 2022;
77:593-602. [PMID:
36226396]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Heart failure with preserved left ventricular ejection fraction (HFpEF) is a serious condition with a constantly increasing prevalence which is in correlation with the increase of this disease's risk factors incidence (obesity, arterial hypertension, diabetes, etc.) and the aging of the population. The first challenge is the diagnosis of HFpEF. Two score-based algorithms have been proposed by the European (ESC HFA-PEFF score) and the American (ACC/AHA H2FpEF score) Cardiology Societies to help the clinician in the differential diagnosis of exertional dyspnea; these scores include the association of various signs of elevated ventricular filling pressures at rest and/or during exercise. According to the ESC recommendations, the management of HFpEF is currently based on symptomatic treatment with diuretics, treatment of co-morbidities and treatment of the underlying etiology if it is identified at the end of the diagnostic approach. The prognosis of this disease is pejorative because no treatment had demonstrated its effectiveness for all HFpEF phenotypes in controlled studies until now. The management algorithm could change soon due to the publication of the EMPEROR-Preserved study, which demonstrated the efficacy of empagliflozin, an SGLT2 inhibitor, concerning a significant reduction of the mortality rate and cardiac hospitalization, regardless of left ventricular ejection fraction. That said, there are many ongoing studies in the field, and treatment prospects will likely be more targeted on the HFpEF phenotype in a near future, due to the heterogeneous nature of this clinical entity.
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