Open Access Macedonian Journal of Medical Sciences.
http://dx.doi.org/10.3889/oamjms.2015.087
eISSN: 1857-9655
Review Article
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Heart Failure with Preserved
Ejection Fraction – Concept, Pathophysiology, Diagnosis and Challenges for
Treatment
Lidija Veterovska Miljkovik1*, Vera Spiroska2
1Institute for Gerontology “13. November”, Skopje, Republic of
Macedonia; 2University Clinic of Cardiology, Faculty of Medicine,
Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Heart failure (HF) with preserved left ventricular (LV)
ejection fraction (HFpEF) occurs in 40 to 60% of the patients with HF, with
a prognosis which is similar to HF with reduced ejection fraction (HFrEF).
HFpEF pathophysiology is different from that of HFrEF, and has been
characterized with diastolic dysfunction. Diastolic dysfunction has been
defined with elevated left ventricular stiffness, prolonged iso-volumetric
LV relaxation, slow LV filing and elevated LV end-diastolic pressure.
Arterial hypertension occurs in majority cases with HFpEF worldwide.
Patients are mostly older and obese. Diabetes mellitus and atrial
fibrillation appear proportionally in a high frequency of patients with
HFpEF. The HFpEF diagnosis is based on existence of symptoms and signs of
heart failure, normal or approximately normal ejection and diagnosing of LV
diastolic dysfunction by means of heart catheterization or Doppler
echocardiography and/or elevated concentration of plasma natriuretic
peptide. The present recommendations for HFpEF treatment include blood
pressure control, heart chamber frequency control when atrial fibrillation
exists, in some situations even coronary revascularization and an attempt
for sinus rhythm reestablishment. Up to now, it is considered that no
medication or a group of medications improve the survival of HFpEF patients.
Due to these causes and the bad prognosis of the disorder, rigorous control
is recommended of the previously mentioned precipitating factors for this
disorder. This paper presents a universal review of the most important
parameters which determine this disorder.
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Citation: Veterovska Miljkovik L, Spiroska V.
Heart Failure with Preserved Ejection Fraction – Concept, Pathophysiology,
Diagnosis and Challenges for Treatment. OA Maced J Med Sci. http://dx.doi.org/10.3889/oamjms.2015.087
Key words: hearth failure; diastole; preserved ejection fraction;
echocardiography; old people.
*Correspondence: Lidija Veterovska Miljkovik, MD. Institute for
Gerontology “13. November”, Skopje, Republic of Macedonia. E-mail:
lidijaveterovskamiljkovic@yahoo.com
Received: 01-jun-2015; Revised: 10-Jun-2015; Accepted: 22-Jun-2015; Online
first: 28-Jul-2015
Copyright: © 2015 Lidija Veterovska Miljkovik, Vera Spiroska.
This is an open access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source are
credited.
Competing Interests: The authors have declared that no competing
interests exist.
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