Heart failure with preserved ejection fraction (HFpEF) represents approximately half of all heart failure cases. It is characterized by EF >50%, as well as different pro-inflammatory and metabolic co-morbidities. HFpEF entails structural and cellular alterations such as cardiomyocyte hypertrophy, fibrosis, and inflammation. These factors render the left ventricle unable to relax properly. The 5-year survival rate of HFpEF is 35%, which is worse than most cancers. Additionally, most treatments for HFrEF are ineffective for HFpEF.
The other 50% of heart failure cases comprise heart failure with reduced ejection fraction (HFrEF) and heart failure with mid-range or mildly reduced EF (HFmrEF).
HFrEF is characterized by EF ≤ 40% and involves severe cardiomyocyte loss, therefore resulting in the development of systolic dysfunction, or contractility problems of the left ventricle. Heart failure with mid-range or mildly reduced EF (HFmrEF) represents a liminal stage—categorized by an EF between 40% and 49%.
In 25% of cases, HFmrEF progresses to HFpEF, and in 33% of cases, it progresses to HFrEF. HFmrEF is more akin to HFrEF than HFpEF in terms of ischemic etiology. Nevertheless, HFmrEF exhibits a higher chance of underlying coronary artery disease (CAD) and improved overall prognosis.
Hypertension, T2DM, obesity, and renal insufficiency occur before HFpEF. On the other hand, HFrEF occurs after acute or chronic loss of cardiomyocytes due to ischemia, genetic mutation, myocarditis, or valvular disease.
What important clinical differences do you observe in HFrEF vs. HFpEF (vs. HFmrEF)? How does your assessment and plan differ in HFrEF vs. HFpEF (vs. HFmrEF)?
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Samira Bahrainy3yrARNI ( or ace) , MRA , diuretic, SGLT inh, beta blocker for both types -
Anita Kedia3yrI treat patients with HFmrEF similar to patients with HFrEF with beta-blockers, ARNi, spironolactone, diuretics, and SGLT2 inhibitors. I treat patients with HFpEF with diuretics, SGLT2 inhibitors, and blood Show More
