IMR Press / RCM / Volume 24 / Issue 7 / DOI: 10.31083/j.rcm2407202
Open Access Review
The Concept of "Heart Failure with Preserved Ejection Fraction": Time for a Critical Reappraisal
Show Less
1 Heart Failure Clinic, Istituto Scientifico San Raffaele, 20132 Milano, Italy
*Correspondence: (Gabriele Fragasso)
Rev. Cardiovasc. Med. 2023, 24(7), 202;
Submitted: 5 December 2022 | Revised: 18 May 2023 | Accepted: 26 May 2023 | Published: 14 July 2023
(This article belongs to the Special Issue Heart Failure and Atrial Fibrillation: The XXI Century Diseases)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Heart failure with preserved ejection fraction (HFpEF) is frequently observed in elderly physically deconditioned subjects, mainly women with hypertension, obesity, glucose intolerance/diabetes, atrial fibrillation, anaemia, coronary artery disease, chronic pulmonary disease, and chronic renal insufficiency. In practice, these conditions represent the majority of cardiac diseases we deal with in our daily clinical practice. For this reason, the HFpEF disease does not exist as a single entity and, as such, no specific unifying therapy could be found. New classification attempts still do not consider the multifaceted aspect of the HF syndrome and appear rather as an artefactual attempt to categorize a condition which is indeed not categorizable. The aim of the present article is to critically review the construction of the concept of the HFpEF syndrome and propose the return of a pathophysiological approach in the evaluation and treatment of patients. Considering the huge economic efforts employed up to date to run awfully expensive trials and research in this field, it is time to call action and redirect such resources towards more specific pathophysiological classifications and potential specific therapeutic targets.

heart failure
preserved ejection fraction
myocardial fibrosis
atrial fibrillation
arterial hypertension
coronary artery disease
drug therapy
Fig. 1.
Back to top