Heart failure with preserved ejection fraction (HFpEF) is a condition in which the heart fails to pump adequately despite an ejection fraction within the normal range (≥ 50%). This type of heart failure is characterized by secondary changes in myocardial stiffness and diastolic dysfunction, resulting in inadequate ventricular filling and, as a result, low cardiac output and pulmonary venous congestion. HFpEF is most common in older patients and in individuals with hypertension, diabetes, and chronic lung disease. The problem of managing this condition is compounded by a relatively limited understanding of its pathophysiology, which complicates diagnosis and treatment.
History of the disease and interesting historical facts
Heart failure as a clinical category has been described in medical literature since ancient times. The first mentions of symptoms associated with heart failure are found in the works of Hippocrates and Galen. However, the original classification of heart diseases did not take into account the differences between the various forms of heart failure.
The 20th century saw an intense study of heart failure, leading to attempts to classify the condition. Understanding of HFpEF has improved significantly with large population studies such as the Framingham Heart Study, which linked HFpEF to hypertension and other factors.
Epidemiology
HFpEF is a global health problem, especially in the aging society. According to various epidemiological studies, HFpEF occurs in 50-70% patients with heart failure, making it one of the most common forms of this condition.
Statistics show that the incidence of HFpEF increases significantly with age: among patients over 75 years of age, about 70% have diastolic dysfunction. It has also been found that this condition is often associated with a high risk of hospitalization and mortality.
Genetic predisposition to this disease
Genetic factors play a role in the pathogenesis of HFpEF. Research suggests that certain gene variants may increase the likelihood of developing heart failure symptoms. Genes involved include:
- Cardiomyosin-α gene (MYH7)
- β-myosin gene (MYBPC3)
- Sodium-potassium ATPase gene (ATP1A2)
In addition, mutations associated with cardiomyopathies have been identified that may contribute to the development of HFpEF. Research is ongoing, and newer genetic technologies such as exome sequencing may reveal additional mechanisms involved in the development of this condition.
Risk factors for the development of this disease
HFpEF often develops against the background of concomitant diseases and various risk factors. These include:
- Arterial hypertension
- Diabetes mellitus
- Obesity
- Chronic lung diseases
- Age
- Genetic predisposition
- Lack of physical activity
- Smoking
These factors contribute to both direct thickening of the myocardial wall and the development of sclerosing changes in the myocardium and vascular system, which ultimately leads to diastolic dysfunction.
Diagnosis of this disease
Diagnosis of HFpEF includes clinical examination, as well as laboratory and radiological methods.
The main symptoms include:
- Shortness of breath during physical exertion
- Fatigue
- Swelling in the lower extremities
- Weight gain due to fluid retention
Laboratory tests, such as natriuretic peptide (BNP) and NT-proBNP, help confirm the diagnosis. Radiological tests, such as echocardiography, can assess the ejection fraction and detect changes in cardiac structure.
Other diagnostic tests may include cardiac MRI and stress testing. Differential diagnosis includes other forms of heart failure, as well as associated conditions such as lung disease or anemia.
Treatment
Treatment of HFpEF involves a multifaceted approach involving both pharmacological and non-pharmacological therapy.
General treatment is aimed at correcting risk factors and improving the patient's quality of life. Pharmacological treatment includes:
- Antihypertensive drugs
- Diuretics to eliminate edema
- Beta blockers
- Alpha blockers
Surgical treatment may be considered in rare cases given certain morphological changes (eg, valvular defects). The need for rehabilitation and adherence to a physical activity program are also important for patients with HFpEF.
List of medications used to treat this disease
Medications commonly used to treat HFpEF include:
- Lisinopril
- Losartan
- Furosemide
- metoprolol
- Digoxin
Each of these agents is used depending on the clinical situation and the presence of concomitant diseases.
Disease monitoring
Monitoring of HFpEF includes regular visits to the doctor, monitoring of blood pressure and weight, and assessment of the patient's functional status. Complications such as thrombosis or progression of heart failure require special attention. The prognosis for HFpEF can vary, but with adequate treatment and control of risk factors, many patients are able to lead an active lifestyle.
Age-related features of the disease
HFpEF is more common in older people who experience specific age-related cardiovascular changes. In older patients, the disease may be less severe, but the consequences may be more severe, including a higher risk of stroke and cardiovascular complications. In younger people, HFpEF is less common and is usually associated with other cardiovascular diseases.
Questions and Answers
- What is heart failure with preserved ejection fraction? This is a condition in which the heart fails to fill normally but maintains an ejection fraction above 50%.
- What are the main symptoms of HFpEF? Shortness of breath, fatigue, swelling, weight gain due to fluid retention.
- What risk factors contribute to the development of HFpEF? Major risk factors include hypertension, diabetes, obesity and age.
- How is HFpEF diagnosed? Diagnosis includes clinical examination, natriuretic peptide levels and echocardiography.
- How is HFpEF treated? Treatment may include pharmacological and non-pharmaceutical treatments, including risk factor management and physical rehabilitation.
Advice from Dr. Oleg Korzhikov
For patients with heart failure with preserved ejection fraction, it is important to monitor changes in their condition and seek medical attention promptly.
Some key tips include:
- Measure your blood pressure and pulse regularly.
- Monitor your body weight to detect edema early.
- Maintain a physical activity regimen, adapting your activities to your capabilities.
- Eat right and avoid excessive salt intake.
These measures will help improve the quality of life and prevent exacerbation of the condition.
