Interv Akut Kardiol. 2007;6(2):56-60

Heart failure with preserved ejection fraction

Vojtěch Melenovský, Jiří Kettner

Klinika kardiologie, Institut klinické a experimentální medicíny, Praha

It has been increasingly recognized that half of patients hospitalized for heart failure has relatively preserved systolic function of the left ventricle. Prevalence of this type of heart failure is increasing and long-term prognosis is similarly dismal as in systolic dysfunction. In its typical form, this disease occurs in older patients, more in females, with long history of arterial hypertension and/or diabetes, who have concentric left ventricular hypertrophy or remodeling, dilated left atrium and abnormalities of diastolic ventricular filling. Despite so frequent, pathophysiology of this disease is not completely elucidated. Besides abnormal diastolic ventricular properties and decreased contractile reserve, other extraventricular mechanisms are equally relevant, such are increased stiffness of large arteries, abnormal mechanical function of left atrium and abnormal autonomic cardiovascular control. Clinical presentation of this condition is characterized by rapidly developing pulmonary congestion, increased systemic arterial blood pressure and preserved cardiac output and ejection fraction. Acute therapy consists of maintaining adequate oxygenation, sedation, administration of diuretics and most importantly, vasodilatators. Long term care consists of handling fluid retention with diuretics and meticulous control of hypertension, preferably with drugs with proven capacity to induce regression of left ventricular hypertrophy. It can be expected that current intensive research of this condition will identify critical mechanisms responsible for the pathophysiology, which will ultimately lead to more specific and causal therapies.

Keywords: heart failure, ejection fraction, diastolic dysfunction, arterial hypertension, left ventricular hypertrophy

Published: June 1, 2007  Show citation