Heart failure with preserved ejection fraction: diagnosis and current medical treatment
Keywords:
heart failure, ventricular ejection fraction, treatment, mortalityAbstract
Heart failure is one of the main causes of mortality worldwide. Currently, a trend towards stabilization and even a decrease in incidence has been observed. However, heart failure with preserved ejection fraction continues to increase its incidence, which is why this research is carried out with the aim of updating the diagnosis and treatment of this entity, according to the current trend. A bibliographic review of scientific publications from the last five years available in databases and repositories such as PubMed, SciELO, Elsevier, and other virtual libraries was carried out. From it, it was possible to update the diagnostic methodology of this entity, using the clinical manifestations, together with the data obtained in echocardiography, emphasizing its differences with diastolic dysfunction, together with the application of different scores to ratify the diagnosis. Likewise, at present, the use of sodium-glucose co-transporter 2 inhibitors has been proposed as first-line drug, together with aldosterone antagonists, the use of angiotensin inhibitors and neprilysin, in addition to the treatment of comorbidities and accompanying symptoms. It can be concluded that heart failure with preserved ejection fraction has satisfactory diagnostic and therapeutic methods.
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References
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8. Pieske B, Tschope C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J [Internet]. 2019 [citado 05/09/2023];40(40):3297-317. Disponible en: https://academic.oup.com/eurheartj/article/40/40/3297/5557740
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10. Redfield MM, Borlaug BA. Heart failure with preserved ejection fraction: A review. JAMA [Internet]. 2023 [citado 05/09/2023];329(10):827-38. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/2802310
11. Singh S, Pandey A, Neeland IJ. Diagnostic and prognostic considerations for use of natriuretic peptides in obese patients with heart failure. Prog Cardiovasc Dis [Internet]. 2020 [citado 05/09/2023];63(5):649-55. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0033062020301626
12. Selvaraj S, Myhre PL, Vaduganathan M, et al. Application of diagnostic algorithms for heart failure with preserved ejection fraction to the community. J Am Coll Cardiol HF [Internet]. 2020 [citado 05/09/2023];8(8):640-53. Disponible en: https://www.jacc.org/doi/abs/10.1016/j.jchf.2020.03.013
13. Sanders-van Wijk S, Barandiarán Aizpurua A, Brunner-La Rocca HP, et al. The HFA-PEFF and H2 FPEF scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction. Eur J Heart Fail [Internet]. 2021 [citado 05/09/2023];23(5):838-40. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359393/
14. Koepp KE, Reddy YNV, Obokata M, et al. Identification of patients with preclinical heart failure with preserved ejection fraction using the H2FPEF score. Nat Cardiovasc Res. 2022;1(1):59-66. Citado en PubMed; PMID: 35669933.
15. Wang Z, Fang J, Hong H. Evaluation the value of H2FPEF score and HFA-PEFF step E score in the diagnosis of heart failure with preserved ejection fraction. Acta Cardiol [Internet]. 2023 [citado 05/09/2023];78(7):790-5. Disponible en: https://www.tandfonline.com/doi/abs/10.1080/00015385.2023.2221149
16. Shi Y, Zhang H, Qiu Z, et al. Value of the HFA-PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the inflammatory myopathy population. Arthritis Res Ther [Internet]. 2023 [citado 05/09/2023];25(141). Disponible en: https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03131-6
17. Pinto YM. Heart Failure with Preserved Ejection Fraction—A Metabolic Disease? N Engl J Med [Internet]. 2023 [citado 05/09/2023];389(12):1145-6. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMe2309294?query=recirc_curatedRelated_article
18. Fácila Rubio L, Lozano-Granero C, Vidal-Pérez R, et al. Nuevas tecnologías para el diagnóstico, tratamiento y seguimiento de las enfermedades cardiovasculares. Rev Esp Cardiol [Internet]. 2024 [citado 10/01/2024];77(1):88-96. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0300893223003238
19. Rasmussen M, Prado A, Hominal MA. Global Variations in Heart Failure Etiology, Management, and Outcomes. JAMA [Internet]. 2023 [citado 05/09/2023];329(19):1650-61. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/2804824
20. Perna E, Coronel ML, Echazarreta D, et al. Registro Argentino de insuficiencia cardíaca con fracción de eyección preservada: ArFey-Preser: Comité de Insuficiencia Cardíaca e Hipertensión Pulmonar de la Federación Argentina de Cardiología. Rev Fed Arg Cardiol [Internet]. 2023 [citado 05/09/2023];52(2):97-103. Disponible en: https://revistafac.org.ar/ojs/index.php/revistafac/article/view/483
21. Ruiz Quintero MA. Tratamiento actual de la insuficiencia cardíaca con fracción de eyección preservada. Diabetes práctica [Internet]. 2023 [citado 05/09/2023];14(Suppl 4):1-46. Disponible en: https://www.diabetespractica.com/files/112/art5.pdf
22. Fernández A, Sociedad Argentina de Cardiología. Consenso de Insuficiencia Cardíaca 2022. Rev Argent Cardiol [Internet]. 2023 [citado 05/09/2023];91(Suppl 2). Disponible en: https://www.sac.org.ar/wp-content/uploads/2023/06/COMPLETO-E.pdf
23. Abraham WT, Psotka MA, Fiuzat M, et al. Standardized definitions for evaluation of heart failure therapies: scientific expert panel from the Heart Failure Collaboratory and Academic Research Consortium. J Am Coll Cardiol HF [Internet]. 2020 [citado 05/09/2023];8(12):961-72. Disponible en: https://www.jacc.org/doi/abs/10.1016/j.jchf.2020.10.002
24. Blum M, Goldstein NE, Jaarsma T, et al. Palliative Care in Heart Failure Guidelines–A Comparison of the 2021 ESC and the 2022 AHA/ACC/HFSA Guidelines on Heart Failure. Eur J Heart Fail [Internet]. 2023 [citado 05/09/2023];25(10):1849-55. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2981
25. Speranza Sánchez M, Avilés Bósquez E, Cadena Barranco E, et al. Tercer Consenso Centroamericano y de El Caribe para el manejo de la Insuficiencia Cardíaca. Rev Costarric Cardiol [Internet]. 2022 [citado 07/09/2023];24(Suppl 2):3-39. Disponible en: http://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S1409-41422022000400003&lng=en
26. Tárraga López PJ, Iruela Martínez C, Tárraga LM, et al. Novedades de la insuficiencia cardíaca y los inhibidores del cotransportador de sodio-glucosa 2. J Health Sci [Internet]. 2023 [citado 05/09/2023];38(2):144-56. Disponible en: medicinabalear.org/pdfs/Vol38n2.pdf#page=144
27. Shah SR, Ali A, Ikram S. Sotagliflozin and decompensated heart failure: results of the SOLOIST-WHF trial. Expert Rev Clin Pharmacol [Internet]. 2021 [citado 05/09/2023];14(5):523-25. Disponible en: https://www.tandfonline.com/doi/full/10.1080/17512433.2021.1908123
28. McMurray JJV, Jackson AM, Lam CSP, et al. Effects of sacubitril-valsartan versus valsartan in women compared with men with heart failure and preserved ejection fraction: insights from PARAGON-HF. Circulation [Internet]. 2020 [citado 05/09/2023];141(5):338-51. Disponible en: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.044491
29. Ferreira JP, Cleland JG, Girerd N, et al. Spironolactone effect on cardiac structure and function of patients with heart failure and preserved ejection fraction: a pooled analysis of three randomized trials. Eur J Heart Fail [Internet]. 2023 [citado 05/09/2023];25(1):108-13. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2726
2. Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the heart failure society of America, heart failure association of the European society of cardiology, Japanese heart failure society and writing committee of the universal definition of heart failure. J Card Fail [Internet]. 2021 [citado 05/09/2023];27(4):387-413. Disponible en: https://www.sciencedirect.com/science/article/pii/S1071916421000506
3. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation [Internet]. 2023 [citado 05/09/2023];147(8):e93-621. Disponible en: https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001123
4. Dirección de Registros Médicos y Estadísticas de Salud. Anuario Estadístico de Salud 2021 [Internet]. La Habana: Ministerio de Salud Pública; 2022 [citado 05/09/2023]. Disponible en: https://files.sld.cu/dne/files/2022/10/Anuario-Estadistico-de-Salud-2021.-Ed-2022.pdf
5. Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure with Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol [Internet]. 2023 [citado 05/09/2023];81(18):1835-78. Disponible en: https://www.jacc.org/doi/abs/10.1016/j.jacc.2023.03.393
6. Abovich A, Matasic DS, Cardoso R, et al. The AHA/ACC/HFSA 2022 Heart Failure Guidelines: Changing the Focus to Heart Failure Prevention. Am J Prev Cardiol [Internet]. 2023 [citado 05/09/2023];15:100527. Disponible en: https://www.sciencedirect.com/science/article/pii/S2666667723000685
7. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. J Card Fail [Internet]. 2022 [citado 05/09/2023];28(5):e1-167. Disponible en: https://avesis.ogu.edu.tr/yayin/b7622f64-d17c-4068-b0f4-8223a4ff313e/2022-aha-acc-hfsa-guideline-for-the-management-of-heart-failure
8. Pieske B, Tschope C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J [Internet]. 2019 [citado 05/09/2023];40(40):3297-317. Disponible en: https://academic.oup.com/eurheartj/article/40/40/3297/5557740
9. Ivey LC, Rodriguez FH, Shi H, et al. Positive Predictive Value of International Classification of Diseases, Ninth Revision, Clinical Modification, and International Classification of Diseases, Tenth Revision, Clinical Modification, Codes for Identification of Congenital Heart Defects. J Am Heart Assoc [Internet]. 2023 [citado 05/09/2023];12(16):e030821. Disponible en: https://www.ahajournals.org/doi/full/10.1161/JAHA.123.030821
10. Redfield MM, Borlaug BA. Heart failure with preserved ejection fraction: A review. JAMA [Internet]. 2023 [citado 05/09/2023];329(10):827-38. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/2802310
11. Singh S, Pandey A, Neeland IJ. Diagnostic and prognostic considerations for use of natriuretic peptides in obese patients with heart failure. Prog Cardiovasc Dis [Internet]. 2020 [citado 05/09/2023];63(5):649-55. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0033062020301626
12. Selvaraj S, Myhre PL, Vaduganathan M, et al. Application of diagnostic algorithms for heart failure with preserved ejection fraction to the community. J Am Coll Cardiol HF [Internet]. 2020 [citado 05/09/2023];8(8):640-53. Disponible en: https://www.jacc.org/doi/abs/10.1016/j.jchf.2020.03.013
13. Sanders-van Wijk S, Barandiarán Aizpurua A, Brunner-La Rocca HP, et al. The HFA-PEFF and H2 FPEF scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction. Eur J Heart Fail [Internet]. 2021 [citado 05/09/2023];23(5):838-40. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359393/
14. Koepp KE, Reddy YNV, Obokata M, et al. Identification of patients with preclinical heart failure with preserved ejection fraction using the H2FPEF score. Nat Cardiovasc Res. 2022;1(1):59-66. Citado en PubMed; PMID: 35669933.
15. Wang Z, Fang J, Hong H. Evaluation the value of H2FPEF score and HFA-PEFF step E score in the diagnosis of heart failure with preserved ejection fraction. Acta Cardiol [Internet]. 2023 [citado 05/09/2023];78(7):790-5. Disponible en: https://www.tandfonline.com/doi/abs/10.1080/00015385.2023.2221149
16. Shi Y, Zhang H, Qiu Z, et al. Value of the HFA-PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the inflammatory myopathy population. Arthritis Res Ther [Internet]. 2023 [citado 05/09/2023];25(141). Disponible en: https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03131-6
17. Pinto YM. Heart Failure with Preserved Ejection Fraction—A Metabolic Disease? N Engl J Med [Internet]. 2023 [citado 05/09/2023];389(12):1145-6. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMe2309294?query=recirc_curatedRelated_article
18. Fácila Rubio L, Lozano-Granero C, Vidal-Pérez R, et al. Nuevas tecnologías para el diagnóstico, tratamiento y seguimiento de las enfermedades cardiovasculares. Rev Esp Cardiol [Internet]. 2024 [citado 10/01/2024];77(1):88-96. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0300893223003238
19. Rasmussen M, Prado A, Hominal MA. Global Variations in Heart Failure Etiology, Management, and Outcomes. JAMA [Internet]. 2023 [citado 05/09/2023];329(19):1650-61. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/2804824
20. Perna E, Coronel ML, Echazarreta D, et al. Registro Argentino de insuficiencia cardíaca con fracción de eyección preservada: ArFey-Preser: Comité de Insuficiencia Cardíaca e Hipertensión Pulmonar de la Federación Argentina de Cardiología. Rev Fed Arg Cardiol [Internet]. 2023 [citado 05/09/2023];52(2):97-103. Disponible en: https://revistafac.org.ar/ojs/index.php/revistafac/article/view/483
21. Ruiz Quintero MA. Tratamiento actual de la insuficiencia cardíaca con fracción de eyección preservada. Diabetes práctica [Internet]. 2023 [citado 05/09/2023];14(Suppl 4):1-46. Disponible en: https://www.diabetespractica.com/files/112/art5.pdf
22. Fernández A, Sociedad Argentina de Cardiología. Consenso de Insuficiencia Cardíaca 2022. Rev Argent Cardiol [Internet]. 2023 [citado 05/09/2023];91(Suppl 2). Disponible en: https://www.sac.org.ar/wp-content/uploads/2023/06/COMPLETO-E.pdf
23. Abraham WT, Psotka MA, Fiuzat M, et al. Standardized definitions for evaluation of heart failure therapies: scientific expert panel from the Heart Failure Collaboratory and Academic Research Consortium. J Am Coll Cardiol HF [Internet]. 2020 [citado 05/09/2023];8(12):961-72. Disponible en: https://www.jacc.org/doi/abs/10.1016/j.jchf.2020.10.002
24. Blum M, Goldstein NE, Jaarsma T, et al. Palliative Care in Heart Failure Guidelines–A Comparison of the 2021 ESC and the 2022 AHA/ACC/HFSA Guidelines on Heart Failure. Eur J Heart Fail [Internet]. 2023 [citado 05/09/2023];25(10):1849-55. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2981
25. Speranza Sánchez M, Avilés Bósquez E, Cadena Barranco E, et al. Tercer Consenso Centroamericano y de El Caribe para el manejo de la Insuficiencia Cardíaca. Rev Costarric Cardiol [Internet]. 2022 [citado 07/09/2023];24(Suppl 2):3-39. Disponible en: http://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S1409-41422022000400003&lng=en
26. Tárraga López PJ, Iruela Martínez C, Tárraga LM, et al. Novedades de la insuficiencia cardíaca y los inhibidores del cotransportador de sodio-glucosa 2. J Health Sci [Internet]. 2023 [citado 05/09/2023];38(2):144-56. Disponible en: medicinabalear.org/pdfs/Vol38n2.pdf#page=144
27. Shah SR, Ali A, Ikram S. Sotagliflozin and decompensated heart failure: results of the SOLOIST-WHF trial. Expert Rev Clin Pharmacol [Internet]. 2021 [citado 05/09/2023];14(5):523-25. Disponible en: https://www.tandfonline.com/doi/full/10.1080/17512433.2021.1908123
28. McMurray JJV, Jackson AM, Lam CSP, et al. Effects of sacubitril-valsartan versus valsartan in women compared with men with heart failure and preserved ejection fraction: insights from PARAGON-HF. Circulation [Internet]. 2020 [citado 05/09/2023];141(5):338-51. Disponible en: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.044491
29. Ferreira JP, Cleland JG, Girerd N, et al. Spironolactone effect on cardiac structure and function of patients with heart failure and preserved ejection fraction: a pooled analysis of three randomized trials. Eur J Heart Fail [Internet]. 2023 [citado 05/09/2023];25(1):108-13. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2726
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2024-07-17
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Arredondo-Rubido AE, Arredondo-Bruce AE. Heart failure with preserved ejection fraction: diagnosis and current medical treatment. Rev Méd Electrón [Internet]. 2024 Jul. 17 [cited 2025 Jan. 23];46:e5349. Available from: https://revmedicaelectronica.sld.cu/index.php/rme/article/view/5349
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