Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.

Tibor Kempf, Tarek Bekfani, Gerd Hasenfuss, Johann Bauersachs, Rolf Wachter, Birgit Assmus, Stephan von Haehling, Michael Böhm, Frank Edelmann, Elke Dworatzek, Djawid Hashemi, Kristian Hellenkamp, Philipp Raake, Katharina A Schütt, Paul Christian Schulze

Journal: Clinical research in cardiology : official journal of the German Cardiac Society 2024;113(9):1287-1305

PMID: 38602566

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Abstract

The aetiology of heart failure with preserved ejection fraction (HFpEF) is heterogenous and overlaps with that of several comorbidities like atrial fibrillation, diabetes mellitus, chronic kidney disease, valvular heart disease, iron deficiency, or sarcopenia. The diagnosis of HFpEF involves evaluating cardiac dysfunction through imaging techniques and assessing increased left ventricular filling pressure, which can be measured directly or estimated through various proxies including natriuretic peptides. To better narrow down the differential diagnosis of HFpEF, European and American heart failure guidelines advocate the use of different algorithms including comorbidities that require diagnosis and rigorous treatment during the evaluation process. Therapeutic recommendations differ between guidelines. Whilst sodium glucose transporter 2 inhibitors have a solid evidence base, the recommendations differ with regard to the use of inhibitors of the renin-angiotensin-aldosterone axis. Unless indicated for specific comorbidities, the use of beta-blockers should be discouraged in HFpEF. The aim of this article is to provide an overview of the current state of the art in HFpEF diagnosis, clinical evaluation, and treatment.

Address: Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany. [email protected].; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany. [email protected].; Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Giessen, Germany.; Department of Cardiology and Angiology, Universitätsklinikum Magdeburg, Magdeburg, Germany.; Institute of Gender in Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Campus Virchow-Klinikum, Berlin, Germany.; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Campus Virchow-Klinikum, Berlin, Germany.; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Berlin, Germany.; Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.; I. Medical Department, Cardiology, Pneumology, Endocrinology and Intensive Care Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany.; Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany.; Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.; Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.; Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany.; Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.; Kardiologie, Angiologie und Internistische Intensivmedizin, Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany.

DOI: 10.1007/s00392-024-02396-4

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MeSH Terms: Humans, Heart Failure, Stroke Volume, Risk Assessment, Ventricular Function, Left