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Open Access Macedonian Journal of Medical Sciences.

http://dx.doi.org/10.3889/oamjms.2015.087

eISSN: 1857-9655

Review Article

 

 

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


 

Abstract

 

 

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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