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Heart failure with preserved ejection fraction
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Heart failure with preserved ejection fraction
Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; this may be measured by echocardiography or cardiac catheterization. Approximately half of people with heart failure have preserved ejection fraction, while the other half have a reduction in ejection fraction, called heart failure with reduced ejection fraction (HFrEF).
Risk factors for HFpEF include hypertension, hyperlipidemia, diabetes, smoking, and obstructive sleep apnea. Those with HFpEF have a higher prevalence of obesity, type 2 diabetes, hypertension, atrial fibrillation and chronic kidney disease than those with heart failure with reduced ejection fraction. The prevalence of HFpEF is expected to increase as more people develop obesity and other medical co-morbidities and risk factors such as hypertension in the future.
Adjusted for age, sex, and cause of heart failure, the mortality due to HFpEF is less than that of heart failure with reduced ejection fraction. The mortality is 15% at 1 year and 75% 5-10 years after a hospitalization for heart failure.
HFpEF is characterized by abnormal diastolic function: there is an increase in the stiffness of the left ventricle, which causes a decrease in left ventricular relaxation during diastole, with resultant increased pressure and/or impaired filling. There is an increased risk for atrial fibrillation and pulmonary hypertension.
As of 2025, no medical treatment has been proven to reduce mortality in HFpEF, however some medications have been shown to improve mortality in a subset of patients (such as those with HFpEF and obesity). Other medications have been shown to reduce hospitalizations due to HFpEF and improve symptoms.
There is controversy regarding the relationship between diastolic heart failure and HFpEF.
Clinical manifestations of HFpEF are similar to those observed in HFrEF and include shortness of breath including exercise induced dyspnea, paroxysmal nocturnal dyspnea and orthopnea, exercise intolerance, fatigue, elevated jugular venous pressure, and edema.
Patients with HFpEF poorly tolerate stress, particularly hemodynamic alterations of ventricular loading or increased diastolic pressures. Often there is a more dramatic elevation in systolic blood pressure in HFpEF than is typical of HFrEF.
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Heart failure with preserved ejection fraction
Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; this may be measured by echocardiography or cardiac catheterization. Approximately half of people with heart failure have preserved ejection fraction, while the other half have a reduction in ejection fraction, called heart failure with reduced ejection fraction (HFrEF).
Risk factors for HFpEF include hypertension, hyperlipidemia, diabetes, smoking, and obstructive sleep apnea. Those with HFpEF have a higher prevalence of obesity, type 2 diabetes, hypertension, atrial fibrillation and chronic kidney disease than those with heart failure with reduced ejection fraction. The prevalence of HFpEF is expected to increase as more people develop obesity and other medical co-morbidities and risk factors such as hypertension in the future.
Adjusted for age, sex, and cause of heart failure, the mortality due to HFpEF is less than that of heart failure with reduced ejection fraction. The mortality is 15% at 1 year and 75% 5-10 years after a hospitalization for heart failure.
HFpEF is characterized by abnormal diastolic function: there is an increase in the stiffness of the left ventricle, which causes a decrease in left ventricular relaxation during diastole, with resultant increased pressure and/or impaired filling. There is an increased risk for atrial fibrillation and pulmonary hypertension.
As of 2025, no medical treatment has been proven to reduce mortality in HFpEF, however some medications have been shown to improve mortality in a subset of patients (such as those with HFpEF and obesity). Other medications have been shown to reduce hospitalizations due to HFpEF and improve symptoms.
There is controversy regarding the relationship between diastolic heart failure and HFpEF.
Clinical manifestations of HFpEF are similar to those observed in HFrEF and include shortness of breath including exercise induced dyspnea, paroxysmal nocturnal dyspnea and orthopnea, exercise intolerance, fatigue, elevated jugular venous pressure, and edema.
Patients with HFpEF poorly tolerate stress, particularly hemodynamic alterations of ventricular loading or increased diastolic pressures. Often there is a more dramatic elevation in systolic blood pressure in HFpEF than is typical of HFrEF.
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