Heart failure with preserved ejection fraction (HFpEF) accounts for at least half the cases of
heart failure, currently diagnosed. There are several cardiac and non-cardiac manifestations of the syndrome. Structure and function abnormalities can include all four cardiac chambers. The left ventricle has abnormal systolic and diastolic functions which can be examined by invasive and non-invasive measurements. In addition, the left atrium enlarges with abnormal left atrial function,
pulmonary hypertension occurs, and the right ventricle can develop
hypertrophy, enlargement, and systolic dysfunction. There are a paucity of data on
calcium handling in HFpEF patients. Growing literature supports the presence of abnormalities in
titin and its phosphorylation, and increased interstitial
fibrosis contributing to increased chamber stiffness. A systemic inflammatory state causing reduced myocardial cyclic
guanosine monophosphate along with defects in the unfolded protein response have been recently reported. Diagnosis relies on signs and symptoms of
heart failure, preserved ejection fraction, and detection of diastolic function abnormalities based on echocardiographic findings and abnormally elevated
natriuretic peptide levels or invasive measurements of wedge pressure at rest or with exercise. There are currently two diagnostic algorithms: H2FPEF, and HFA-PEFF with limited data comparing their performance head to head in the same patient population. Despite the growing understanding of the syndrome's pathophysiology, there have been little success in developing specific treatment for patients with HFpEF.